Were you a wild child – drinking, smoking and eating badly in your younger years? If so, you might be at risk for osteoporosis. Here’s how to prevent additional bone loss in 7 simple steps…
The excesses of youth – smoking, drinking and starving yourself skinny – are now showing up as bone loss and osteoporosis in women.
About 8 million women in the U.S. have osteoporosis, and 30 million more may get the disease, which can cause bones to break with something as harmless as a sneeze, according to the National Osteoporosis Foundation (NOF).
But even if you’ve abused your body in the past, you still have time to save your bones with simple changes, like getting enough vitamin D, eating more fresh fruits and veggies and, yes, adding some weight if you’re too thin.
Read on for the latest studies and doctor-recommended tips.
1. Know where you stand
Not sure where you fall on the bone-strength scale? Head to your doctor’s office for a couple of helpful tests.
One is the software program FRAX (Fracture Risk Assessment Tool). Developed by the World Health Organization, it helps a physician calculate your probable osteoporosis risk over the next 10 years by assessing lifestyle, health, risk factors and genetic history through an online tool. Its predictions have proven to be “reasonably accurate” for women, but less so for men, according to a 2010 study by the Osteoporosis and Bone Biology Program at the Garven Institute of Medical Research in Australia.
A bone-density test is the most accurate, also known as a dual-energy X-ray absorptiometry (DEXA) scan, which you should get when you reach menopause – earlier if you’re at high risk – says Felicia Cosman, M.D., clinical director of NOF, medical director at the Clinical Research Center of Helen Hayes Hospital in West Haverstraw, N.Y., and author of What Your Doctor May Not Tell You About Osteoporosis (Warner).
During the simple noninvasive test, the patient lies on her back on a padded cushion as the screening device beams low-dose X-rays onto hips and spine to measure bone-mineral density.
The patient then gets a “T score” that compares her bone density with women in their 30s, when bone strength peaks. A T score of +1.0 to -1 indicates normal bone-mineral density. Scores of -1 to -2.5 indicate osteopenia, a condition in which bones are less dense than normal. (Many doctors consider this a precursor to osteoporosis.) Less than -2.5 indicates osteoporosis.
DEXA is easy, fast, cheap and painless, Cosman says.
“And the radiation risk is inconsequential,” she adds. At 0.5 millirem (mrem), a measurement used to calculate radiation, it’s less than a typical chest X-ray, which is 20 mrem, according to the Office of Radiation Protection, Washington State Department of Health.
2. Bone up with calcium
Your bones store up to 99% of the calcium your body needs for nearly every function, including blood clotting, muscle and nerve function. And women can lose up to 20% of their bone density during the 5-7 years following menopause because of a decrease in estrogen.
How the hormone strengthens bones isn’t clear. But a 2007 University of Buffalo study found that it may maintain bone density by preventing an enzyme called caspase-3 from triggering the death of osteoblasts, cells that help grow new bone and teeth.
That’s why women over 50 should get about 1,200 milligrams of calcium daily, according to updated guidelines issued by the Institute of Medicine (IOM) in November 2010.
Your best sources for the mineral are low-fat and fat-free dairy products, such as milk, ice cream, cheese and yogurt, but calcium supplements can fill nutritional gaps, says Katherine Brooking, M.S., R.D., a New York-based dietitian.
“Just don’t overdo it," Cosman adds.
Too much calcium – more than 2,500 mg for adults 19-50, or more than 2,000 mg if you’re over 51 – can cause constipation and kidney stones, and it could interfere with the body’s ability to absorb other essential minerals such as iron and zinc, according to the Office of Dietary Supplements of the National Institutes of Health.
3. Get more vitamin D
“Without enough vitamin D, [women] could lose up to 4% of their skeletal mass per year,” says Michael F. Holick, Ph.D., M.D., professor of medicine at Boston University Medical Center, who discovered calcitriol (vitamin D3), the hormonally active form of the vitamin. He’s also the author of The Vitamin D Solution (Penguin).
That’s why increasing vitamin D intake is essential. It helps maintain normal calcium levels in the bones and aids in its absorption.
You can get D from leafy greens and fortified dairy products, but the major source is sunlight, which triggers production of the vitamin in your skin.
But you’ll probably need a vitamin D supplement if you live in a cloudy climate, use sunscreen religiously and/or have dark skin, Holick says.
The IOM just raised its vitamin D recommendation to 600 International Units (IU) a day for women under age 71 and a maximum 800 IUs for women age 71 and older. But many doctors, including Holick, believe that women older than 50 need 2,000-3,000 IUs daily.
4. Eat your veggies
Milk and vitamin D aren’t the only ways to build strong bones. Fruits and vegetables also have high levels of nutrients essential for skeletal health, including magnesium, potassium, vitamin C, vitamin K and several B vitamins, according to a large 2009 study conducted by the USDA Human Nutrition Research Center on Aging at Tufts University in Boston.
Magnesium gets calcium into all cells; vitamins C and K regulate enzymes responsible for strengthening bone; and B vitamins help cells regenerate, according to the NIH Osteoporosis and Related Bone Diseases National Resource Center.
Five servings of fruits and veggies a day is all you need, according to a 2005 landmark study at the Clinical Research and Regional Bone Centers at Helen Hayes Hospital in West Haverstraw, N.Y. Calcium-rich produce includes broccoli (180 mg/cup), cooked spinach (240 mg/cup), arugula (125 mg/cup), orange juice (300 mg/cup), kiwi (50 mg/cup) and dry figs (300 mg/cup).
5. Kick butts
Here’s another reason to quit smoking: It’s a leading cause of bone loss and fractures in women older than 40, according to a three-year study conducted on 4,332 women at Universidade Federal de São Paulo in Brazil and published in 2010.
“Nicotine seems to have toxic effects on bone-forming cells and lowers estrogen levels, which in turn reduces bone density and leads to an earlier menopause,” Cosman says.
Cigarette smoking may increase spontaneous bone loss in women not taking estrogen, according to a two-year study on 270 postmenopausal women conducted at the Center for Clinical and Basic Research in Denmark.
Kicking the habit isn’t easy, so here’s some help: Your No-Fail Guide to Stop Smoking.
6. Drink moderately
If you drank heavily during your adolescent and teenage years – the critical bone-building time – you may have irreversible skeletal damage and a greater risk of future fractures and osteoporosis, according to a 2010 Loyola University Study on rats.
When researchers exposed adolescent rats to the human equivalent of binge drinking (defined as four drinks on one occasion) three days in a row, more than 300 genes responsible for bone formation and bone-mass maintenance were disrupted. And the damage was long lasting, researchers said.
But moderate drinking (about 1-2 glasses of wine a day) actually protects bones, especially if you’re postmenopausal, according to a 2009 study published in The American Journal of Clinical Nutrition.
Moderate drinking may affect estrogen concentrations or suppress bone breakdown to release minerals used in the rest of the body, researchers theorize.
So go ahead and enjoy just one glass of wine with dinner, Cosman says.
7. You really can be too thin
Here’s a good excuse to hang on to those love handles: A little extra padding protects your bones.
A low body weight often goes hand in hand with low bone mass and increased fracture risk, according to a 2006 Rutgers University Study. And those extra pounds may even protect you from fractures if you take a tumble.
Trying to lose weight? A 10% weight loss results in up to 2% bone loss, the Rutgers researchers say.
Weight protects you in several ways, the study shows. First, just carrying around an extra load has a weight-bearing benefit. Also, fat is associated with bone-building hormones, such as estrogen. And when you lose weight, circulating estrogen decreases.
“If you’re naturally thin, you may want to gain a few pounds just to protect your bones,” says registered dietitian Timothy Carlson, Ph.D, editor of The Nutrition Forum, the newsletter of the Nutrition Division of the American Association for Clinical Chemistry Nutrition.
Resources
Want more information on bone loss during menopause? Check out the NOF’s “Bone Healthy Lifestyles: What Women Can Do/Menopause: A Time for Action”.
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