Osteoporosis: A guide to bone health

Osteoporosis, which literally means “porous bone,” is a disease characterized by low bone mass and structural deterioration of bone tissue. Low bone mass leads to fragile bones and an increased susceptibility to fractures. Since you can lose bone mass without realizing or feeling it, it is often referred to as the “silent disease.” Often when an elderly person falls and breaks their hip, there is a possibility that the hipbone actually broke first and caused them to fall down. While osteoporosis is often thought of as an older person's disease, it can strike at any age. The first step in preventing the development of this disease is to determine whether you are at risk or not. Here are some common risk factors:

• Age – As part of the natural aging process, the older you are, the weaker your bones tend to be.
• Gender – women are at greater risk than men.
• Family History – young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass.
• Race - Caucasian and Asian women are more likely to develop osteoporosis, however, African American and Hispanic women are also at significant risk.
• Bone Structure and Body Weight –Small-boned frame or if you are thin, your chances increase.
• Menopause/Menstrual History - Normal or early menopause, brought about naturally or because of surgery. In addition, women who stop menstruating before menopause because of conditions such as anorexia or bulimia, or because of excessive physical exercise, may also lose bone tissue and develop osteoporosis.
• Lifestyle - Cigarette smoking and/or drinking too much alcohol increases your risk. Other lifestyle factors include consuming an inadequate amount of calcium or performing little or no weight-bearing exercise such as walking or weight training.
• Medications/Chronic Diseases - Medications to treat disorders such as rheumatoid arthritis, endocrine disorders (i.e. an under-active thyroid), seizure disorders and gastrointestinal diseases may have side effects that can damage bone and lead to osteoporosis. One class of drugs that has particularly damaging effects on the skeleton is glucocorticoids.

Use of the following drugs can also cause bone loss:

• Excessive thyroid hormones
• Anticonvulsants
• Antacids containing aluminum
• Gonadotropin releasing hormones (GnRH) used for treatment of endometriosis
• Methotrexate for cancer treatment
• Cyclosporine A, an immunosuppressive drug
• Heparin
• Cholestyramine, taken to control blood cholesterol levels.

Many of the above mentioned drugs are life-saving or life-enhancing drugs, and their use may be the only way to achieve a better quality of life. Always be sure to discuss the use of these medications with your physician before you alter or stop your medication doses.

Speaking of medications…PREVENTION is the best medicine! If you feel you are at risk for developing osteoporosis, talk to your doctor about whether or not you should have a bone mineral density test done to test the strength of your bones. This is a painless procedure that can sometimes be done right in the doctor's office.

In the meantime, work on building a strong skeleton. Establishing strong bones, especially before the age of 30, can be the best defense in preventing this disease.

Here are some recommendations to help prevent osteoporosis:

• Include weight-bearing exercise into your day such as walking, dancing, jogging, stair-climbing, racquet sports and hiking. If you have been sedentary most of your adult life, be sure to check with your healthcare provider before beginning any exercise program.
• Avoid smoking or excessive alcohol use. It is never too early or too late to start your prevention program.
• Choose a balanced diet rich in calcium and vitamin D. Calcium-rich foods include low-fat milk, cheese, broccoli and others. Many foods are fortified with calcium and are readily available and affordable such as orange juice, cereals and breakfast bars.
• Another easy and economical way to boost the calcium content of many meals is to add nonfat powdered dry milk to puddings, homemade cookies, breads or muffins, soups, gravy, casseroles and even a glass of milk. A single tablespoon of nonfat powdered dry milk adds 52 mg of calcium, and 2 to 4 tablespoons can be added to most recipes. You may add:
  

  -3 tablespoons to each cup of milk in puddings, cocoa or custard

  -4 tablespoons to each cup of hot cereal before cooking

  -2 tablespoons sifted into each cup of flour in cakes, cookies or breads

• Take a calcium supplement. If you have difficulty getting enough calcium from the foods you eat, a calcium supplement will make up the difference.

Vitamin D is needed for the body to absorb calcium. Vitamin D comes from two sources: through the skin following direct exposure to sunlight and from your diet. The major food sources of vitamin D are vitamin D-fortified dairy products, egg yolks, saltwater fish and liver.

A few things to consider when taking a supplement :

• Calcium, whether from the diet or supplements, is absorbed best by the body when it is taken several times a day in amounts of 500 mg or less, but taking it all at once is better than not taking it at all.
• Calcium carbonate is absorbed best when taken with food.
• Calcium citrate can be taken any time.
• Calcium also interferes with iron absorption, so a calcium supplement should not be taken at the same time as an iron supplement. The exception to this is when the iron supplement is taken with vitamin C or calcium citrate.
• Any medication to be taken on an empty stomach should not be taken with calcium supplements.
• Avoid calcium from unrefined oyster shell, bone meal or dolomite without the USP, as these historically have contained higher lead levels or other toxic metals.

If you have questions about osteoporosis, healthier eating or other health concerns, consult a Registered Dietitian for an individual assessment.