Fighting Osteoporosis

[Originally published in Hospital for Special Surgery's HealthConnection: Your Good Health Newsletter, Volume 13, No.1, Summer 2004.]

The huge bone factory we know as the human skeleton serves many wonderful and incredible functions. There is always something going on these, since bone is living tissue, constantly remodeling itself.

Some cells remove old bone (resorption), while others build new bone (formation). As we get older, bone loss outpaces bone formation. Some people lose bone mass more rapidly than others for reasons that scientists do not yet fully understand.

Osteoporosis results when this decrease in bone mineral density is significant. It is a disease of global proportions, affecting more than 200 million people worldwide - over 20 million women and 5 million men in the United States alone.

Who is at Risk?

Osteoporosis, which literally means "porous bones", has been called the "silent" disease, because the loss of bone tissue progresses gradually (often without pain or other symptoms) before a fracture occurs.

But fractures do occur - a million and a half each year, usually of the spine, hip, or wrist. White and Asian women have twice as many fractures as African-American women. Hispanic women are also at significant risk.

Having risk factors does not mean you will develop the disease or have a fracture, but if you have a number of the following characteristics, you should discuss testing your bone mineral levels with your doctor:

Your Bone Bank

They call it a "pediatric disease with geriatric consequences" because the groundwork for healthy bones, or for eventual osteoporosis, is laid in childhood. The best prevention strategy is to start acquiring peak bone mineral levels early. Vigorous exercise and adequate intake of calcium are most important.

Think of bone as a bank account, where you are making "deposits" and "withdrawals". In childhood, bones become heavier, larger and denser. In adolescence and early adulthood (11-24 years), bone formation occurs rapidly until peak bone mass is reached.

After 35 years of age, "withdrawals" slowly being to exceed "deposits."

Remember - the stronger your "bank account", the longer it takes to draw it down. For women, "withdrawals" become much more frequent after menopause. By age 65, loss rate slows down and both women and men seem to lose bone mass at the same rate.

Healthy Measures

Midlife presents an ongoing opportunity to maintain healthy bones. In later life, those with osteoporosis can take measures to prevent further bone loss and fractures, including optimal daily consumption of calcium and vitamin D, plus frequent weight-bearing exercise. Any weight-bearing activity can help form stronger bones, such as walking, jogging and dancing.

For post-menopausal women, especially those at high risk, several medical treatments are available to stem bone turnover. While recent studies have outlined increased health risks, estrogen has historically been an effective therapy for bone loss.

Calcium and vitamin D are key ingredients for preventing excessive bone loss and maintaining healthy bones. They should be taking throughout life. Vitamin D, essential for the absorption of calcium, can be obtained in most multivitamin preparations, since it is not readily available from dietary sources other than milk or feed products that are fortified with vitamin D. Sunshine is a primary source of vitamin D.

Here are some guidelines* for getting enough calcium through supplements and diet. 1500 mg per day is recommended for women after menopause. It is best to get to the 1500mg through a combination of diet and supplements.

Supplements:

• How much calcium should be taken at one time?
  Take no more than 500 mg of calcium supplements at one time with a meal. This is because calcium is absorbed better with food and only certain amount of calcium can be absorbed at one time. For example, if you are taking 1000 mg of calcium supplement a day, divide the dose and take 500 mg twice.
• Which form of calcium is best?
  Any form will give you the calcium you need. There are price differences, with calcium carbonate containing the most calcium per pill at the lowest price. Some people may have constipation with calcium carbonate, in which case they can try calcium citrate which is absorbed readily.

Diet: Get as much calcium as you can from foods since they contain other important nutrients, some of which promote calcium absorption.

What foods contain calcium?

• Dairy products are especially useful to get calcium:
  1 cup skim milk: 300 mg
  8 oz. plain nonfat yogurt: 400 mg (Nonfat dairy products are slightly richer in calcium than fat-containing products)
  1 oz. cheddar cheese: 200 mg
• Calcium content of other foods such as vegetables, fish, and nuts:
  ½ cup tofu: 250 mg
  1 cup broccoli: 70 mg
  ½ cup beans (navy, etc.): 50-75 mg
  3 oz. sardines with bones: 370 mg
  ½ cup spinach: 80 mg (Please note: Spinach contains a substance called oxalate which binds calcium which can decrease absorption of calcium within spinach, but not the calcium in other sources consumed at the same meal.)
  1 oz. almonds: 60 mg

New York State Osteoporosis Prevention Program (NYSOPEP)

Osteoporosis education is the key to helping individuals achieve healthy, strong bones for a lifetime. In 1997, Governor George Pataki signed the Osteoporosis Education Bill. This bill established the New York State Osteoporosis Prevention and Education Program (NYSOPEP) within the New York State Department of Health. This educational initiative makes it possible for all New Yorkers (the general public and healthcare professionals) to learn about the prevention, diagnosis and treatment of osteoporosis.

NYSOPEP provides education about the causes of osteoporosis, the value of prevention and early detection, and options for treatment. NYSOPEP information is accurate, current, and research-based. Hospital for Special Surgery was selected as a NYSOPEP Regional Center to provide osteoporosis education as a service to the citizens of New York.

For more information, contact:
212-606-1057

or go to:
http://www.nysopep.org/

Footnote:

*From a patient hand-out by Theodore R. Fields, MD, FACP
Associate Professor of Clinical Medicine, Weill Medical College of Cornell University
Hospital for Special Surgery
Associate Attending Physician, Hospital for Special Surgery
Associate Attending Physician, The New York Hospital

posted 4/30/2004