Bone Health Starts Early
Eight Important Steps
Offense is the Best Defense
-Unless you’ve broken a bone or know someone who has, you probably don’t pay much attention to your skeleton. But you should. If you don’t, your bones will weaken as you age, causing osteoporosis, the brittle-bone disease that’s a leading cause of fracture. Osteoporosis shouldn’t be taken lightly.
About 10 million Americans—including eight million women—have osteoporosis and another 34 million have osteopenia, meaning their bone mass is low enough to put them at risk for osteoporosis down the road. According to the National Osteoporosis Foundation (NOF), nearly half of all women older than 50 and an estimated one in four men will eventually break a bone—vulnerable spots are the hips, vertebrae, wrists and pelvis—because of the disease. All those broken bones will take a staggering economic toll, costing our nation $25 billion by 2025, reports the NOF reports. The personal toll is equally sobering: 20% of people 50 and older who break a hip will die within a year. It’s no wonder that in 2004 the Surgeon General declared osteoporosis a major public health threat.
Breaking a bone can have life-altering effects. When I broke my right ankle after slipping on a New York City sidewalk, I was stunned that one clumsy move could turn my life upside down. I couldn’t grocery shop, cook, clean, dress myself easily, go to the corner ATM or shower for six weeks. Once my bone healed, I needed five months of physical therapy to regain full function.
Fast forward to my elderly mom. Her bones were so weak that when she fell down six carpeted stairs, she broke both her wrists and her right shoulder, and had to be hospitalized. She was never the same.
Fortunately, medications can slow bone loss and rebuild some bone, but I’m all about prevention. Even if you take medicine, you need to be pro-active about your bones.
Bone Health Starts Early
Building peak bone mass begins in childhood. Up to 90% of adult mass is built by age 18 if you’re female and by age 20 if you’re male. Until age 30, you continue to build bone mass. The more you have at this point, the better. We gradually lose bone mass as we age, so the stronger our bones are when this process begins, the less likely we’ll develop osteoporosis.
Though osteoporosis is gender-blind, being female is a risk factor. The pace of bone loss picks up two to three years before a woman has her last period and continues until three to four years after menopause. According to a recent position statement from the North American Menopause Society (NAMS), published in the journal Menopause, a woman can lose 2% of her bone mass yearly in the five to seven years around menopause and 1% per year after that. That’s a huge loss if you never achieved peak bone mass.
Besides being female or growing older, other risk factors for osteoporosis include not getting enough calcium, being sedentary, being Caucasian or Asian, genes (the disease runs in families), smoking and drinking alcohol. Thinner and smaller women—weighing less than 127 pounds—are also more vulnerable. Certain diseases—including rheumatoid arthritis, anorexia nervosa, Type 1 diabetes and hyperthyroidism—can boost risk. So can medications such as glucocorticoids, heparin, aromatase inhibitors and some anticonvulsants.
TLC for Bones
Most osteoporosis research has been done on women but everyone can benefit from these eight good-for-bone strategies:
#1: Meet Your Calcium Quota. Calcium builds bone and can prevent bone loss. Good sources include milk, yogurt, cheese, sardines and calcium-fortified orange juice. According to the NOF, you should aim for 1000 milligrams of calcium per day up until age 50 and 1200 mg. after that. (One eight-ounce glass of milk has about 300 mg.) If you don’t get enough calcium from food—and lots of us don’t, take calcium carbonate or calcium citrate supplements. Tip: Check the supplement’s label for the amount of elemental calcium it contains—that’s what your body absorbs so that’s the amount you need to meet NOF recommendations. For best absorption, take your elemental calcium in equal doses—no more than 500 mg. at a time— over the course of the day.
#2: Get Plenty of Vitamin D. When paired with calcium, vitamin D can reduce the risk of osteoporosis. It also helps keep muscles strong, minimizing falls. Our bodies make vitamin D when skin is exposed to sunlight. However, most of us don’t get enough sun or regularly—and wisely—apply sunscreen to prevent skin cancer. And it’s hard to get enough vitamin D from food, but D-fortified milk is the best source. Other sources are salmon, sardines, tuna, mackerel, cod and D-fortified foods like orange juice. The Institute of Medicine (IOM), which advises the nation on health matters, recommends getting 200 IUs of D until age 50; 400 IUs until age 70; and 600 IUs after that. But to get 400 IUs, for example, you need to down a quart of milk a day or eat a ton of seafood. Even that may not be enough: Some experts think we need 800 to 1500 IUs per day. What to do: Eat D-containing foods and take a daily multivitamin or supplement containing at least 400 IUs of D on top of whatever you get from sun and food. The IOM is expected to change its D recommendations this fall, so stay tuned.
#3: Do Weight-Bearing Exercise. Activities like strength-training, walking, jogging and aerobics stress bone, increasing bone mass. (Swimming and cycling, while good for muscles and overall health, aren’t weight bearing.) If you have osteoporosis, ask your doctor or physical therapist to recommend “safe” exercises. If your bones are weak, you don’t want to do anything that might make you fall or put undue stress on your spine.
#4: Don’t Smoke. Women who smoke lose bone more quickly than non-smokers, and enter menopause about two years sooner.
#5: Limit Alcohol. Don’t have more than seven drinks per week—one drink is defined as 12 ounces of beer, four ounces of wine and one ounce of liquor. The North American Menopause Society position statement advises against having more than two drinks in a six-hour period as that increases your risk for falling.
#6: Fall-Proof Your Life. Clean up the clutter. Anchor scatter rugs—or get rid of them. Do exercises that will improve your balance—such as Tai Chi or strength training. Wear shoes with soles that grip. (I was wearing slippery, leather-soled heels the day I broke my ankle. After I recovered, I had rubber grips put on all my shoes). Turn on lights at night; don’t walk on stairs in the dark. And install grab bars in the tub or shower.
#7: Be Medication Savvy. Some drugs such as benzodiazepines, antipsychotic agents or antidepressants may boost the likelihood of falling. Know the potential risks of any medicine you take. If falling is a possibility, be extra careful and ask your doctor about adjusting your dosage.
#8: Be Vigilant. Osteoporosis is sneaky. You can’t feel your bones thinning over time. And while breaking a hip or wrist is pretty hard to ignore, a vertebral fracture can be subtle. Sudden back pain is one symptom. But often the only sign will be a loss of height or kyphosis, a rounding of the upper back, referred to as hunchback or dowager’s hump.
Osteoporosis is also frustrating. While we can keep tabs on our blood pressure or cholesterol, we often don’t know the state of our bones until the damage has occurred. Unless you’re a woman over 65 or a man over 70, bone density testing isn’t routinely done. But if you have risk factors for the disease or symptoms or break a bone, you’re a candidate for screening. The most common screening method is a Dual Energy X-Ray Absorptiometry (DXA) scan—a painless X-ray. Ask your doctor if you meet the criteria for a scan and check with your health insurer to see if it’s covered.
As I said earlier, if you have osteoporosis, you’ll be prescribed medicine to slow bone loss and rebuild bone. But since you’ll also be encouraged to adopt bone-friendly strategies, why wait? When it comes to your bones, a good offense is the best defense.
Yours in health,
Catherine Winters
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