No Bones About It: Staying a Step Ahead of Osteoporosis
For generations, women (and men) were more or less resigned to the inevitable effects of growing older. Among those effects were the gradual loss of height and an increasing level of frailty, particularly in women, as their bone structure shrunk and grew weaker through the middle and latter stages of old age.
Today, there is an expanding body of knowledge on the subject of aging generally, and what women (and men) can do specifically to postpone or lessen the effects of aging on bone health. Because hormonal changes following menopause accelerate bone loss, thereby magnifying its effects and the risk of injury, the issue is especially important to women.
Over a lifetime, bones go through a constant cycle of cell loss and re-growth. The aging process, however, eventually makes the transaction uneven: bone re-growth cannot keep up with bone loss. Other factors, including the reduced production of estrogen in women following menopause, accelerate bone loss. As additional elements related to lifestyle, family history, nutrition and ethnicity come into play, bone loss, left unchecked, may worsen until osteoporosis develops.
The National Osteoporosis Foundation defines osteoporosis as “low bone mass and structural deterioration leading to bone fragility and increased susceptibility to fractures.” According to the American Academy of Orthopedic Surgeons, by the year 2020, 50 million Americans will have osteoporosis.
Osteoporosis has at least two distinct dangers. First, its presence or progress may go unnoticed until a fracture occurs. According to the American Academy of Family Physicians, for white and Asian women the estimated lifetime risk of suffering a fracture from osteoporosis is as high as 50 percent. Second, the fractures are likely to occur in the spine or hip. Spine fractures can lead to deformity or a total or artial loss of mobility. The outlook for hip fracture patients is even more discouraging. According to a recent study cited by the American Academy of Orthopedic Surgeons, depending on a range of related factors, one in three hip fracture patients die from complications within one year.
Garrett J. Lynch, M.D., an orthopedic surgeon with Anne Arundel Orthopaedic Surgeons, P.A., points to the devastating nature of hip fractures. “Half of hip fracture patients never return to their pre-injury ambulatory status—their ability to walk without assistance—as before the fracture,” he said.
Slowing the march of time
The good news is that it’s almost never too late to do something about bone loss to either slow or lessen its effects. And, considering that the loss of bone cells begins to outpace their re-growth as early as age 30, clearly the earlier in life prevention efforts begin, the better. As with so many other aspects of healthier lifestyles, nutrition and exercise play leading roles in preventing or slowing down bone loss.
Across the board, orthopedic surgeons promote the benefits of exercise, in particular weight bearing or strength training exercises. Weight bearing exercises subject joints and bones to some degree of impact, which stimulates an increase in bone mass. Strength training improves muscle mass to support bone structure as it strengthens bones. Age and general level of fitness, in addition to consulting with a physician, will help in determining how much and what level of exercises are safe and appropriate. Physicians emphasize that even men and women of advanced years will benefit from appropriately prescribed and supervised exercise programs.
AAMC Smoking Cessation
AAMC Nutritional Counseling
For those who smoke, the advice is to stop. “Smoking is the worst thing you can do for bone loss,” said Edward R. McDevitt, M.D., an orthopedic surgeon with Bay Area Orthopaedic & Sports Medicine and chief of surgery at AAMC. “I advise people to keep active, lose weight if necessary and by all means, quit smoking today, not tomorrow.”
Because of their effects on the body’s ability to absorb or retain calcium, both excessive alcohol consumption, defined as more than two drinks per day, as well as the caffeine in more than two cups of coffee a day, also accelerate bone loss.
Sunshine and vitamins
Advice from healthcare professionals also is virtually unanimouswhen it comes to the nutritional aspects of osteoporosis prevention. Calcium intake is vitally important, yet the National Osteoporosis Foundation cites data showing that many women consume less than half the recommended amount. Women aged 51 to 70, for instance should be taking in 1,000 to 1,200 milligrams a day. (See “Food for Thought,” below.)
Vitamin D helps the body absorb calcium, and some calcium supplements contain Vitamin D for just that reason. Mother Nature supplies Vitamin D as well. For many people just 10 to 15 minutes of direct exposure to sunlight two to three times a week is enough to meet the body’s Vitamin D requirement.
Act now, not later
Dr. Brassard pointed to these attention-getting statistics from the American Academy of Orthopedic Surgeons as a wake up call for those at risk. “The incidence of hip fractures doubles with each decade in age,” he said, “and the ratio of occurrence in women is three times that of men. A woman in her early or mid-70s is more than four times as likely to suffer a hip fracture than a woman, say, in her late 50s.”
Dr. Lynch added that the current generation of women entering their fifties won’t get the bone loss preventive benefits from estrogen supplements the generation before them did because of hormone therapy’s recent link to increased risk of breast cancer. “Nutrition and exercise are fine,” he said, “but nothing takes the place of estrogen. The tradeoff is something we have to accept.”
Dr. McDevitt said that physicians can be more proactive and vigilant, too, by taking “a closer look at fractures that occur in a patient’s forties or fifties, those that may indicate bone loss or signal the precursors to osteoporosis.”
All three doctors emphasize the importance of bone density testing as a preemptive measure even for those at moderate risk. The overall message seems clear: bone loss and osteoporosis are issues that are sneaking up on an entire generation. Both men and women, but women especially, should begin to pay attention to risk factors and prevention earlier in life.
Food for Thought: A Calcium-Rich Diet
We know that the bone loss side of the ledger begins to outpace the bone cell re-growth side shortly after the age of thirty. That means even before age 30 calcium intake needs to be a steady 1,000 milligrams a day, and after age 30 should increase to 1,200 mg. At age 65, it should go up to at least 1,500-1,700 mg per day.
Generally, foods with high calcium content are dairy products; fish, especially salmon and sardines; nuts and legumes (beans); cheeses; vegetables, especially green leafy vegetables; fruits; and breads and grains.
A complication arises, however, in that absorbing sufficient volumes of calcium each day solely through food sources is a challenge. This is especially true since alcohol, caffeine, and soda, plus dietary fiber, fat, sodium and protein all work against the absorption of calcium. In fact, according to the National Osteoporosis Foundation many women consume (absorb) less than half the recommended daily amount. Consider that even one the most calcium-rich foods available, a cup of yogurt, has only 425 mg of calcium. Many other foods considered calcium-rich have less than 200 mg per serving.
Fortunately, the answer exists in the form of calcium supplements, of which there are many. The National Osteoporosis Foundation web site, www.nof.org/prevention/calcium_ supplements.htm, lists the varieties of calcium supplements along with the features and benefits of each. Taking a calcium supplement, such as Caltrate with Vitamin D, is an excellent means of boosting bone health.