Reduce Your Risk of Osteoporosis Fractures

Building strong bones is your best defense against osteoporosis injuries. Read for expert advice on exercise, diet and how to “fall-proof” your home… Osteoporosis is characterized by progressive bone loss and increased risk of fracture. It literally means “porous bone.” Because the changes in bone are at the microscopic level, and the disease initially produces no pain or other outward symptoms, osteoporosis often goes unnoticed for years. As a person ages, it causes loss of height and, in some cases, a dowager’s hump, or rounded back. Osteoporosis affects some 28 million Americans. The term bone mineral density, or BMD, is used to describe bone strength. The lower the BMD, the more porous and weaker the bone. Causes and Risk Factors Although the exact cause of osteoporosis is not known, a number of factors do increase risk. There is clear evidence of a genetic predisposition to osteoporosis. For women, excessive loss of bone occurs when certain hormones essential for bone formation and maintenance decrease substantially following menopause. If the body does not receive enough dietary calcium to meet its needs, it takes calcium from the bones to make up the difference. In premenopausal women, the sex hormone estrogen protects bones from being robbed of calcium by other demands of the body and helps produce and maintain collagen, an important component of bone. Once estrogen levels are depleted, it can no longer play this protective role. Another hormone, calcitonin, may facilitate the uptake of calcium from the blood into the bone and, at the same time, inhibit the loss of calcium from the bone. Other known risk factors include being underweight, tobacco use, excessive alcohol use and certain medications. On the basis of criteria set forth by a World Health Organization (WHO) expert panel, 54% of postmenopausal white women in northern parts of the United States have osteopenia, or low bone mass, and an additional 30% have osteoporosis in at least one skeletal site. Osteoporosis occurs in all racial and ethnic groups. For example, 13%-16% of Hispanic women have osteoporosis; as many as 49% of Mexican-American women age 50 years or older have low bone density; about 10% of African-American women age 50 and older have osteoporosis; and an additional 30% have low bone density. Between 80% and 95% of all fractures experienced by African-American women over age 64 are related to osteoporosis. Diagnosing Osteoporosis Osteoporosis is diagnosed on the basis of a medical history and physical examination, skeletal X-rays, bone densitometry and laboratory tests. Bone densitometry is an X-ray technique that compares a patient’s BMD to the BMD that someone of the patient’s gender and ethnicity should have reached at about age 20 to 25, when bone density is at its highest. Doctors use several types of bone densitometry to detect bone loss in different areas of the body. Dual-beam X-ray absorptiometry (DEXA) is one of the most accurate methods, but other techniques can identify osteoporosis. These include single-photon absorptiometry, quantitative computed tomography (CT) and ultrasound. WHO has defined osteoporosis as bone mineral density measuring two and one-half standard deviations or more below the young adult mean. The test is often performed in women at the time of menopause. Bone densitometry is used not only to diagnose osteoporosis but also to monitor the effects of treatment. Prevention Once bone mass is lost, it is difficult or impossible to replace. For this reason, preventing osteoporosis is vital. It’s important to do everything you can to build peak bone mass by age 25 and then ensure that the inevitable loss of bone occurs as slowly as possible. Prevention entails a variety of measures, including the following: Monitor calcium and vitamin D intake. Calcium requirements depend primarily on age. The Institute of Medicine offers the following guidelines for daily calcium intake: Children aged 4-8 – 1,000 milligrams (mg) Children aged 9-18 – 1,300 mg Men and women aged 19-50 (including pregnant and nursing women) – 1,000 mg Pregnant and nursing women under age 19 – 1,300 mg Women over age 50 – 1,200 mg Dairy products, especially those low in fat such as skim milk and low-fat yogurt, are an excellent source of calcium. An eight-ounce glass of skim milk provides 300 mg of calcium and only 90 calories. Women who are lactose-intolerant and vegans – as well as anyone who wants a varied, calcium-rich diet – can turn to dark-green leafy vegetables such as kale, broccoli, and mustard greens; soy milk and other soy products such as tofu; salmon (with edible bones); and calcium-fortified fruit juices and breakfast cereals. Vitamin D is essential for calcium absorption and muscle strength. There is, moreover, increasing evidence that a vitamin D deficiency may increase fracture risk. The skin manufactures vitamin D when exposed to the sun; however, widespread use of sunscreens has reduced the role of natural light in preventing vitamin D deficiency. In addition, older people who are rarely out of doors need a supplemental source of this essential vitamin. Improve overall nutrition. A high protein intake has been shown to be associated with a lower risk of hip fracture in men and women between age 50 and 69, although not in older individuals. Contrary to earlier reports, there is no conclusive evidence that the carbonation in beverages has an adverse effect on bone health. It is possible, however, that the caffeine in some carbonated beverages increases calcium excretion. Drinking large quantities of carbonated beverages rather than milk also deprives the body of a major calcium source. Finally, recent research has indicated that vitamin B12 may be an important link in preventing osteoporosis. Good sources of this vitamin include low-fat dairy products, fish and lean meat, and eggs. The ability to absorb B12 from food decreases with age, so a vitamin supplement may be advisable for older women. Exercise. Women of all ages should engage in regular weight-bearing exercise. Walking is one of the best ways to maintain bone strength. Other weight-bearing exercises include jogging, hiking, tennis, bicycling, dancing, aquatic exercises (although swimming is not considered “weight-bearing”), and weight training. Choose an exercise that combines movement with impact on the limbs. Start exercising slowly, especially if you have been inactive. Because falls are the most common cause of fractures, do some balance activities to reduce your risk. The benefits of tai chi in particular have been documented. Consult your doctor before beginning any exercise program. Eliminate smoking and excessive alcohol. Cutting out smoking, and reducing alcohol intake, will also improve bone health. Both cause bone loss and increase risks of fracture. Fragility Fractures Osteoporosis is often called a silent disease because it has no symptoms in the early stage. In fact, bone fracture is often the first indication of osteoporosis. Fractures caused by osteoporosis are typically called fragility fractures – fractures that occur as a result of a relatively minor injury or blow, such as falling from standing height or less. The most common sites of fragility fractures are the vertebrae, hip, wrist and shoulder. Osteoporosis is a contributing factor in as many as 1.5 million fractures each year. Fractures of the hip are among the most debilitating and costly consequences of osteoporosis. Among those at greatest risk for hip fracture are women over 65. Slender, small-boned women may be more prone to such fractures than are large, heavy-boned women. A family history of fractures in later life is another risk factor. Women who have a low dietary intake of calcium, who smoke, or who drink alcohol excessively are at high risk, as are those with arthritis or poor balance, coordination and eyesight. In women over 75, the most commonly performed surgery is repair of a hip fracture. Although modern orthopedic surgical techniques and care can assist in healing of the bone, most hip-fracture patients require extended periods of rehabilitation. Around one of every four people who have an osteoporotic hip fracture need long-term nursing home care, and virtually all need extended assistance from family members or home care providers. Walking aids may be necessary for several months after injury, and many patients will permanently require canes or walkers to move around their homes or outdoors. Prevention of hip fractures is far less costly, in both financial and human terms, than treatment after the bone is broken. A diet high in calcium and vitamin D, regular exercise, and the correct medications can help prevent weak bones and the possibility of hip fracture. Paying attention to home safety is also important, especially for older women. Most of these injuries occur as a result of a fall, and most falls occur in the home. The American Association for Retired Persons (AARP) recommends the following measures to “fall-proof” your surroundings: Remove clutter; pick up papers or clothes from the ground; move garbage bins under cabinets. Keep living areas well lit. Be aware of your surroundings: Know where your furniture is placed and any stairs or change of entry levels. Clean up any spills immediately. Be sure furniture is stable. Use nonslip mats in the bathtub and on shower floors. Secure area rugs with double-faced tape, tacks or slip-resistant backing. Excerpted from The Savvy Woman Patient: How and Why Sex Differences Affect Your Health (Capital Books) by the Society for Women’s Health Research. For more information, visit Lifescript's Osteoporosis Health Center. What’s Your Supplement IQ? You know that taking calcium supplements can help build strong bones when you don't eat enough dairy foods, but do you really know all that you should about supplements? 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