30 Sep FAQ about Osteoporosis
What Is Osteoporosis?
Osteoporosis (which means “porous bones”) is the most common bone disease in Canada and the United States, affecting as much as 50 percent of the population over age 65. As people age, they experience an increase in bone loss in relation to bone formation. This can result in a thinning of the bones, making the bone more susceptible to fracture.
Prevalence of Osteoporosis
According to the National Osteoporosis Foundation, “One in two women and one in eight men over 50 will have an osteoporosis-related fracture in their lifetime. Thirty-three percent of women over 65 will experience a fracture of the spine, and as many as 20 percent of hip fracture patients will die within six months from conditions caused by lack of activity such as blood clots and pneumonia.”
Who Is at Risk for Osteoporosis?
Although osteoporosis is not strictly a women’s disease, it is less common in men. Men generally have larger and stronger bones, and bone loss in men usually begins later in life. Nevertheless, 2 million men now have osteoporosis, and another 12 million men are at risk.
The Following Population Groups Have an Increased Risk for Osteoporosis:
- Women in general
- Postmenopausal women
- Women who have undergone a complete hysterectomy before menopause
- Men or women who have an inactive lifestyle
- Smokers
- Individuals who consume too much sugar
- Heavy users of caffeine or alcohol
- Small-boned individuals
- Anglo-Saxons and Asians
- Men or women who have taken steroids or anticonvulsants for a long period of time
- Individuals who avoid sun exposure, resulting in a vitamin D deficiency
- Men, and even women, with low testosterone levels
- Individuals with a family history of osteoporosis
- Individuals with low body weight
- Individuals deficient in vitamin D and vitamin K, such as people with poor fat absorption (because these are fat-soluble vitamins)
What Are Some of the Symptoms of Osteoporosis?
Osteoporosis is not usually visible and can go undetected for a long time. In fact, by the time osteoporosis does show up on an X-ray, one-third of the bone mass may have already been lost. Symptoms can include bone pain, loss of height, or a hump in the upper back. Fractures, especially of the hip, can cause considerable pain, suffering, and even loss of life.
How Is Osteoporosis Diagnosed?
As noted above, osteoporosis is usually a silent disease until as much as one-third of bone mass has been lost. For this reason, monitoring bone health is essential. Monitoring bone health can be done with instruments that measure bone mineral density, referred to as BMD. As bones begin to thin, bone mineral density decreases. An individual’s BMD can be determined with the use of what is called a DXA scan, which analyzes bones using X-ray technology to determine how many grams of calcium and other minerals are packed into a specific segment of bone. The results are compared to what is considered to be the normal BMD for that individual’s age and gender. It is recommended that a woman have her first DXA scan at age 65 (or at age 60 if the risk for osteoporosis is higher than normal) and thereafter as her health-care practitioner recommends.
Conventional Medical Treatment of Osteoporosis
Estrogen replacement therapy has been one approach for the prevention and treatment of osteoporosis in menopausal and postmenopausal women. Taking estrogen appears to slow the rate of bone loss; however, taking estrogen does not replace bone that has already been lost. The U.S. Food and Drug Administration and the National Academy of Sciences conclude, “Estrogen replacement in postmenopausal osteoporosis is probably effective only when used in conjunction with other therapeutic measures such as diet, calcium, physical therapy, and other good health-promoting measures.”
A category of drugs called bisphosphonates (e.g., Fosamax® and Boniva® ) are also prescribed frequently. Although these drugs can be effective in preventing bone loss, they are sometimes not well tolerated.
What Can Be Done to Prevent Bone Loss?
Prevention is the key to protecting against osteoporosis, and the best time to begin is now. Although women usually don’t start worrying about osteoporosis until middle age or older, significant bone loss has been detected in young women. Healthy bone building is a lifelong process, and it is never too early to start. Young women who maintain an active lifestyle, a healthy diet, and receive an adequate daily amount of bone-building nutrients can substantially reduce the risk of suffering the consequences of osteoporosis later in life.
Diet
A diet high in fruits and vegetables and moderate in protein and the avoidance of carbonated beverages can help maintain a good calcium-to-phosphorus ratio. Consumption of large amounts of alcohol, sugar, and caffeine should be avoided as these substances can increase the loss of calcium via the kidneys (in urine).
Exercise
At least 20-30 minutes daily of some sort of aerobic, weight-bearing exercise is one of the most important aspects of maintaining good bone health. Weight-bearing exercises include walking, jogging, bicycling, and dancing. It also appears that swimming, while not a weight-bearing exercise, helps increase bone density.
Nutritional Supplements
In addition to a comprehensive multiple vitamin-mineral formula, most health-care practitioners recommend that older individuals, especially those at risk for osteoporosis, take some form of additional supplementation, including the B vitamins, vitamins D and K, and the minerals calcium, magnesium, and zinc.
Two Important Nutrients for Good Bone Health — Calcium and Vitamin D
New health claim guidance recently issued by the U.S. Food and Drug Administration states, “Adequate calcium and vitamin D throughout life, along with a well-balanced diet and physical activity, may reduce the risk of osteoporosis in later life.”
Most of the body’s calcium is found in the bones and teeth, although a small amount is found in the blood to help maintain normal electrolyte balance. When calcium levels start to drop in the blood, the body is very efficient at pulling what calcium it needs from the bones. Calcium is also necessary for normal blood clotting, muscle contraction and relaxation, and nerve functioning. Although calcium is an essential mineral, the majority of Americans do not get adequate dietary calcium.
Calcium supplements are not created equal. Because we absorb only a percentage of the minerals we take in, the best strategy is to take a form of calcium that offers the greatest percent absorption. For example, calcium carbonate is a poorly absorbed form of calcium, especially for individuals with low stomach acid (which tends to decrease as we age). On the other hand, calcium bound to natural organic acids (citric acid and malic acid as calcium citrate-malate) is relatively well absorbed. Absorption studies comparing the absorbability of calcium carbonate to calcium citrate-malate show that between 22-29 percent of calcium from carbonate was absorbed as compared to 36-42 percent of calcium from calcium citrate-malate.
In a 2009 study of 4,958 women and 5,003 men, BMD was directly related to blood levels of vitamin D. Vitamin D is necessary for calcium absorption and metabolism. In addition to inhibiting calcium absorption, a deficiency of vitamin D can result in more calcium being pulled out of the bones. Because vitamin D is manufactured in skin exposed to sunlight, spending time in the sun can increase vitamin D levels. The best time of day for vitamin D production is around noon, but vitamin D can be produced anytime between 10 a.m. and 3 p.m. during spring, summer, and fall. Ten minutes in the sun is usually long enough to obtain benefit.
Start a Prevention Program
An individual at risk for osteoporosis should consult with a health-care practitioner who can recommend a healthy diet and an appropriate exercise plan and any needed supplements. Don’t wait till menopause — start a prevention program when you are young, especially if you are in a high-risk group.