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Osteoporosis: maintaining bone health

Good health: you can feel it in your bones
(Much of this information is from the National Osteoporosis Foundation)
Mid-life can be a time of joy and accomplishment. Your career may be at its peak. You may be enjoying your children to the fullest. Grandchildren may be keeping you busy.

You may also be planning for your later years. Having good health and the get-up-and-go to do the things you want to do, both now and in the future, are very important. That's why you should take time out from your busy schedule to look after your health -- particularly your bone health.

Your once-in-a-lifetime opportunity to maintain bone health
Bones are not lifeless structure, but are, in fact, living tissue. Bone constantly changes, with bits of old bone being removed and new bone being laid down. Think of bone as a bank account, where you "deposit" and "withdraw" bone tissue.

During childhood and adolescence, much more bone is deposited than withdrawn, so that the skeleton grows in both size and density. The amount of tissue or bone mass in the skeleton reaches its maximum by the mid-30s. At this point, the amount of bone in the skeleton typically begins to decline slowly, as withdrawals exceed deposits of new bone.

Around the time of menopause, the ovaries' production of estrogen declines. This decrease in estrogen production greatly accelerates the loss of bone in most women -- so the mid-life woman loses estrogen's protective benefits. It is this five - 10-year period of rapid postmenopausal bone loss that probably accounts for the strikingly high proportion of women with osteoporosis.

Osteoporosis is an exaggerated loss of bone tissue, a painful and disfiguring disease that develops in older persons -- usually women -- who do not have enough bone density. Osteoporosis makes bones more susceptible to fracture, most often of the wrist, spine, and hip. Spinal fractures cause stooped posture, loss of height and chronic back pain. Hip fracture, the most serious consequence of osteoporosis, threatens one's independence and life.

Fortunately, at mid-life, you can still take advantage of the once-in-a-lifetime opportunity to maintain bone health. To protect bone density, you need a balanced diet rich in calcium and a regular program of exercise -- and you may want to consider hormonal therapy. Consult your physician if you want more information on the use of estrogen or other drug therapies.

Estrogen replacement therapy
Estrogen replacement therapy (ERT) has been used to help prevent osteoporosis in women who no longer produce estrogen because of menopause or surgical removal of the ovaries.

Experts believe that ERT is most effective in reducing bone loss during the five to 10 years following menopause, when bone loss is at its peak. But there may be some benefit to starting ERT later in life.

If a woman has a uterus, estrogen is usually given with another hormone called progestogen -- this may cause light menstrual bleeding to start, but fertility does not return. (This side effect does not occur in women who have had their uterus removed, because they take estrogen only.)

The benefits of ERT include:

  • Prevention of osteoporosis. Women who begin ERT within a few years of the onset of menopause have fewer fractures than women who do not take ERT.
  • ERT provides protection against heart disease.
  • ERT can prevent some of the side effects of menopause, including hot flashes.

The risks of ERT include:

  • An increased chance of developing endometrial cancer. ERT increases this risk from one per 1,000 women to four per 1,000 women. The addition of progestogen, however, lowers the likelihood of this type of cancer. (This risk does not apply to women who have had their uterus removed.)
  • There is evidence to suggest that some women may be put at a slightly increased risk of breast cancer when ERT is used over a 10 - 15-year period, since certain types of breast cancer are related to estrogen.

While ERT can help, it also has risks. It should be undertaken only after a careful discussion with your doctor.

In order for estrogen therapy to provide the maximum benefit, it is important that the intake of calcium remain high, since a high-calcium diet may diminish the amount of estrogen required to produce the desired protective effect against osteoporosis. Continuation of physical activity is essential.

Calcitonin and alendronate
For postmenopausal women who are not candidates for estrogen therapy, calcitonin may be an option. Calcitonin is a hormone that occurs in the body (produced in the thyroid gland) and is involved in calcium regulation. This hormone has been shown to slow bone breakdown. Calcitonin has been used not only for treating persons with established osteoporosis, but also for prevention of bone loss in women who cannot take estrogen. Calcitonin can be administered by injection or nasal spray.

Another new drug approved by the FDA for the treatment of osteoporosis is alendronate, a medication which can actually increase bone mass. Alendronate is taken orally.

If you are interested in learning more about calcitonin and alendronate, talk to your doctor.

A must throughout your lifetime, calcium is not just important for growing children. Because bone tissue is constantly building up and breaking down, calcium is important to people of all ages. To prevent osteoporosis, you need to eat a balanced diet rich in calcium throughout your lifetime.

  • Postmenopausal women on ERT need 1,000 mg. of calcium daily.
  • Postmenopausal women at risk for developing osteoporosis need 1,500 mg. of calcium daily.

To add calcium to your diet, have a dairy product at every meal. Grate cheese over your salad or add a slice of low-fat cheese to your sandwich. Try low-fat yogurt, frozen yogurt or ice milk for desserts or snacks. Enjoy high-calcium foods such as broccoli, tofu, canned salmon with bones, and calcium-fortified orange juice.

Some people have difficulty digesting milk products, a condition known as lactose intolerance. People who are lactose intolerant can satisfy their daily calcium requirements in a number of ways: by incorporating non-dairy, calcium-rich foods into their diet, by taking calcium supplements and by using lactase pills or drops which make the milk products digestible.

Remember that calcium-rich foods need not be fattening. For example, a cup of skim milk gives you somewhat more calcium that a cup of whole milk.

Calcium supplements: are they for you?
It's best to get the calcium you need from your daily diet. If, however, you need a calcium supplement, you'll have to choose carefully from the many products on the market. If you're thinking about using a calcium supplement:

  • Stick to name brands with proven reliability or ask your pharmacist to recommend a supplement that meets USP standards. These standards ensure that the calcium in the supplement is bioavailable, which means that the calcium can be absorbed and used by your body.
  • If you have a family history of kidney stones, consult your doctor about taking calcium.
  • Avoid taking more than 500 or 600 mg. at a time. Smaller doses several times during the day are more easily absorbed by the body.
  • Take the supplement at mealtime. Experts say that supplements are better absorbed at these times.

It is important that the calcium in the supplement be bioavailable. Unfortunately, not all the calcium in supplements is bioavailable. If you do not know whether a particular supplement is USP-approved, one measure of bioavailability is a "home test" to see if the pills dissolve. Put one in a glass of vinegar and stir every few minutes. If the pill is not at least 75 percent dissolved within 30 minutes, it probably won't help you.

Some antacids are made mostly of calcium carbonate, and some women use them as calcium supplements. However, some antacids don't contain any calcium at all. Instead they contain aluminum, which can cause increased calcium loss through the kidneys. Read the label!

Exercise Regular weight-bearing exercise, which causes muscles to work against gravity, can help build bone density.

Walking is an excellent weight-bearing exercise, as are water aerobics, tennis and dancing. Experts believe that other forms of exercise, such as swimming, bicycling and rowing, while not precisely weight-bearing, are probably beneficial as well. The bottom line is that any physical activity is better than nothing! And keeping active allows you to eat more without gaining weight, making it easier to maintain an adequate intake of calcium and other nutrients.

The Baptist East/Milestone Wellness Center offers more than 100 fitness classes each week plus cardiovascular and resistive equipment; a five-lane, 25-yard lap pool; 1/11th mile walking/running track; personal trainers; the Oasis Spa with massage therapy, manicures and pedicures and child-care services. Personal trainers can assist in designing a fitness program aimed at preventing osteoporosis, or aiding those already diagnosed. Use of the facility for osteoporosis-related exercise is limited to members only. Call (502) 896-3900, ext. 302 for a tour and more information.

Adopt an active lifestyle. Walk short distances instead of driving. Do housework and yard work that involves lifting and carrying. If you spend a lot of time at a desk in your office, it's especially important that you exercise. Use the stairs instead of the elevator and whenever possible, walk to appointments.

Remember, before embarking on any exercise program, be sure to consult your physician.

Healthy habits make healthy bones
Certain substances are toxic to bones:

  • Smoking is toxic to bone cells, and extra calcium won't make up for the damage.
  • Alcohol abuse is also detrimental. Not only is it directly toxic to bones, but it also interferes with proper nutrition.

To help protect your bone density, avoid smoking and practice moderation with alcoholic beverages.

Bone density testing
The best treatment for osteoporosis is preventing it in the first place. Since osteoporosis can develop silently for decades until a fracture occurs, early diagnosis is essential for therapy to be effective. Bone densitometry is a safe, accurate and non-invasive test for measuring bone loss and assessing the risk of fracture. It can be critical is preventing fractures later in life. With the results of these measurements, physicians can identify areas in the body with low bone mass and determine the type of therapy to be used to prevent further bone loss.

Baptist Health Louisville offers bone densitometry in the Women's Imaging Services suite. For more information, call the Baptist Health Information Center at (502) 897-8131.