7 Tips For Healthy Bones if You're Over 30 A Woman's Guide to Osteoporosis Prevention

If you’re over 30, your skeleton’s already rebelling, tossing out bone faster than you can replace it. Doctors deliberate over when to begin osteoporosis treatments, but your best bet is osteoporosis prevention. Now is the time to get serious about diet and exercise. Here are 7 tips for maintaining healthy bones... Did your Grandma fall and break a hip or do you have a friend who cracked a rib? Blame osteoporosis, a loss of bone that leads to debilitating fractures. The disease is a major health threat for aging females, affecting about 8 million of the 10 million osteoporosis sufferers in the U.S. One in three women over 50 get fractures resulting from osteoporosis. Another 34 million have osteopenia, a precursor to the disease. What Bone Loss Looks Like Bone is not just a solid hunk of calcium; it’s living, growing tissue with a soft core and a hardened framework of calcium phosphate. The inner core, or marrow, produces our blood cells. And bones (along with teeth) act as a storage tank for more than 99% of the body’s calcium. As a living organ, bone is constantly breaking down its older framework and replacing it. Formation outpaces destruction until about age 30. After that, the process slowly reverses, causing a net bone loss. As the loss becomes severe, bones lose density, becoming more porous and fragile. In fact, under a microscope, osteoporotic bone looks like a sponge. The weakened bone, like a dry twig, becomes more vulnerable to fractures, even under normal stresses. That’s one reason Grandma hunches over like she’s perennially searching for a dropped penny. The hump on the back of the elderly – called the dowager’s hump because it occurs mostly in women – results from small bone fractures on the front of the vertebrae, usually upper ones. As the fractured edge of a vertebra compresses, the vertebrae above it shift forward, curving the spine. The forward tilt results in a hump, or kyphosis (which means "bent over"). As more vertebrae crack or collapse, the hump becomes more pronounced and painful, limiting activities as well. A woman may have to crane her neck to look someone in the face and breathing becomes more difficult because the new spinal position makes it harder for the lungs to expand. Other common results of osteoporosis are fractures of the hip and wrists in a fall. Hip fractures – 300,000 per year – are the most serious. About 24% of hip-fracture patients and a third of elderly men with hip fractures die within a year, often because they can’t regain mobility. Women are particularly vulnerable: Their bone loss accelerates in the first few years after menopause as estrogen, which stimulates bone growth, declines. Small, thin-boned women are at greatest risk. Other factors include: Caucasian or Asian ancestry Family history of osteoporosis Anorexia Low calcium and vitamin D intake Long-term use of steroids Cigarette smoking Alcoholism Inactivity When Bone Loss Becomes a Problem As with many trends in medicine, the prevailing wisdom on bone loss is shifting. This has affected recommendations on when bone-loss treatments should begin. Normal bone mass is defined as the average bone mineral density of a white woman 20-29 years old. Based on that, researchers developed a T-score: A zero score was baseline (ideal), anything between zero and negative 1 was normal; negative 2.5 or lower indicated osteoporosis. But scores between negative 1 and negative 2.5 fell into a grey area called osteopenia, which involves low bone density and mass. It became a catch phrase for bone density scores falling outside the "normal" range. In 2004, the National Osteoporosis Foundation (NOF) and the American College of Obstetrics and Gynecology (ACOG) advised women who scored negative 2.0 or lower (or negative 1.5 or lower if they had certain risk factors such as family history, smoking, etc.) to get osteoporosis treatment. That shift increased the number of aged 65-plus women recommended for treatment from 6.5 million to 11 million. For women 50-64 years old, the treatment group expanded from 1.6 million to 4 million. Now women’s health experts question whether those diagnosed with osteopenia need medical treatment. Drugs are expensive and can have significant side effects, such as chest pain, severe joint, bone or muscle pain or heartburn. The new standard raised questions: How much would the extension of treatment reduce serious fractures? At what point along the bone loss continuum – from osteopenia to osteoporosis – should treatment begin? When do the benefits outweigh the cost and risks? Ways to Ensure Healthy Bones Fortunately, you don’t have to wait for doctors to weigh in to protect yourself. Here are seven ways to strengthen your bones: 1. Eat right for strong bones. Bulk up on foods high in calcium and vitamin D. Calcium is the major bone builder, but it needs vitamin D to do its job. Vitamin D helps the body absorb calcium that would otherwise flush out in our urine. Foods high in calcium include dairy products, tofu, sardines, salmon, turnips and leafy greens. Foods high in vitamin D: salmon, tuna and other saltwater fish, fortified milk, egg yolks, liver and fish oils. 2. Get out in the sun. Sunlight stimulates the production of vitamin D in our skin. So get about 5-30 minutes of sun – without sunscreen – at least twice a week. (But don’t overdo it because too much sun raises the risk of skin cancer.) 3. Exercise your body. Just like muscles, bones need exercise to stay healthy. Strength training with weight-bearing exercises (such as walking, jogging and dancing) helps prevent or slow progression of osteoporosis. Strength-training increases the tug of muscles on the bones and weight-bearing exercise also stresses bones, which keep them strong. 4. Consider supplements. If you can't get enough calcium from food or sunshine, take a daily supplement that includes 1,000 milligrams calcium and 400 I.U. (international units) of vitamin D. But don't take it all at once: The body can only absorb 500 milligrams of calcium at a time. 5. Get a bone density test. A bone mineral density test – a DEXA scan, or dual-energy X-ray absorptiometry – will show how your bone mass is holding up. The NOF advises women older than 65, and those with risk factors (like thinness, family history, history of fractures) to get one earlier. Because bone loss accelerates after menopause, doctors also recommend getting a baseline bone scan, especially if you’re not planning to take estrogen. Talk to your doctor about the test. 6. Move to medications. If you have osteopenia or osteoporosis, discuss drug therapy with your doctor. Medications include biphosphonates (alendronate, risedronate and ibandronate), raloxifene, calcitonin, teriparatide and estrogen/hormone therapy. Biphosponates, the most widely used medication for osteoporosis, increase bone mass and reduce the incidence of spine, hip and other fractures. But they have drawbacks: They’re tough to swallow and hard on the GI tract, leading to heartburn and gastric ulcers. Some meds can be given intravenously, but they can cause side effects such as flu-like symptoms, muscle and joint pains and headaches. 7. Protect yourself from falls. Remove slippery area rugs; salt icy pathways; wear snow and ice traction cleats on your shoes (buy them online or at sporting stores); use a cane or walker if you need one. This won't keep you from getting osteoporosis. But given the devastating repercussions of hip fractures, it doesn't hurt to skid-proof your house. For more information, visit our Osteoporosis Health Center.