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Osteoporosis: “The most important factor is prevention”

May is Women’s Health Month, a great time to celebrate and promote stronger health and a perfect time to discuss the latest information about preventing and treating health challenges like osteoporosis.

More than 44 million American women experience the debilitating effects of the bone disease, and many women fear aching joints and brittle bones are an inevitable part of aging. It is important to know the risks, and engage opportunities to maintain optimum bone-health.

Dr. Lawrence R. Housman is an orthopaedic surgeon who specializes in musculoskeletal disease at Tucson Orthopaedic Institute. He sat down with us to discuss the best ways to prevent and treat osteoporosis.

osteoporosis, know your risksWhy are women at greater risk for osteoporosis?  

Women start with a lower bone density than men. They also lose bone mass more quickly as they age. Between ages 20-80, women will lose about 1/3 of her bone density compared to men who lose only 1/4 of their bone density in that time frame. Estrogen levels also affect bone density, and women lose bone mass more quickly in the years immediately following menopause than at any other time of their lives.

What can accentuate this risk?

Alcohol in moderation is not a risk factor, however more than four drinks per day results in a twice the risk of hip fracture. Steroids can also increase this risk. Long term use of steroids will double the risk of fracture in women.

It should be noted that proton pump inhibitors (e.g. Nexium/Protonix used for stomach disorders such as acid reflux) decrease the absorption of calcium from the stomach.

While increasing fiber, phylates (beans, wheat bran), oxalates (spinach, beet greens, rhubarb) and phosphorus (colas) can provide other health benefits they can also interfere with calcium metabolism.

What are the most effective means of preventing osteoporosis?

Regular exercise is one of the most effective means of preventing osteoporosis. Thirty minutes per day – walking is excellent, and Tai Chi reportedly decreases falls by 47 percent and hip fracture by 25 percent.

Nutrition is another import part of maintaining healthy bones. Fruits and vegetables are important. Women ages 19-50 should take in 1000 mg of calcium daily and women older than 50 should get 1200 mg per day.

Vitamin D is another vital nutrient the body needs to prevent osteoporosis. An individual can get their vitamin D through measured exposure to sunlight or through supplements. A diet with dairy, protein or calcium fortified foods (e.g. orange juice), fish (salmon/sardines) and yogurt (6 ounces has 300 mg of calcium) will go a long way in getting vitamin d to the bones.

What are the warning signs of the disease – and when is it time to see a doctor?

There are usually no warning signs before a fracture occurs; therefore, the most important factor is prevention.

A primary care provider (PCP) is the best person to monitor bone health. Most physicians recommend a DEXA (bone density test) after the age of 50.

The DEXA scan is the bone density test done most frequently and is predictive of fracture risk. The scan will also show whether you have normal bone density, osteopenia (bone is becoming weaker) or osteoporosis (bone is at high risk for fracture).

If a fracture occurs, then an orthopaedist would enter the picture to advise on treatment concerning the spine or extremity fracture.

If diagnosed with osteopenia or osteoporosis – what’s next?

With treatment patients can live normal, active and happy lives.

There are many types of medications that are now available – which work to reverse and then rebuild the bone loss. With treatment, the risk of a vertebral fracture drops from between 30-70 percent and the risk of a hip fracture drops by up to 40 percent.

Dr. Housman is an orthopaedic surgeon who practices at the Tucson Orthopaedic Institute. He earned a medical degree from the University of Alberta in Edmonton, Canada and completed an orthopaedic surgery residency at the Montreal General Hospital and McGill University. Dr. Housman is fellowship trained in several orthopaedic pursuits and is a past chief of staff at Tucson Medical Center. He has also served as president of the Western Orthopaedic Association and Arizona Orthopaedic Society.


The Pediatric Disease with Geriatric Consequences – Preventing Osteoporosis

As we mentioned earlier, bone density cannot be increased after early adulthood but from childhood through adolescence there is a lot of bone-building that can be done. So you lucky kids and teens, listen up—or parents, pay careful attention to the following:

  • Eat a diet rich in calcium—dairy products, leafy greens, fish with bones (who doesn’t love sardines??), other fish if you don’t like them bones, figs, apricots, legumes, and fortified juices and cereals.
  • Vitamin D helps your body use calcium. So include foods that are high in Vitamin D, and talk to your physician about Vitamin D supplements. Baseline blood levels will determine whether supplementation is recommended. Vitamin D can be synthesized by the body using sunshine, and despite the copious quantity of sunshine in Tucson we find people of all ages who are deficient. Before you rush out into the sun to soak up a few rays know that the known risks of skin cancer are significant particularly at our southern latitude and altitude. Doctors strongly recommend using diet and supplementation to meet Vitamin D needs rather than sun exposure.
  • Make sure to keep your body moving. Do lots of weight-bearing exercises and resistance training. Run if your body likes it. Walk, hike, play soccer or tennis, take a dance class. Putting healthy stress on your skeleton increases bone density, and this is your last chance to build that bone mass, so do it while you can!!
  • Minimize the amount of soda you drink. Some studies suggest excessive consumption of cola and other drinks can prevent your body from absorbing calcium.
  • If you are struggling with body image, or feel pressure to stay thin because you are a dancer or gymnast, seek professional help. Anorexia is a disease of the mind and the body and is a strong risk factor for osteoporosis, among many other ailments. Onset is typically in adolescence and occurs more commonly in girls and women. It is a potentially fatal illness that is hard to treat if ignored. Getting effective treatment is essential. Your health care provider can provide referrals to both inpatient and outpatient options for recovery.

For other posts on Osteoporosis at TMC for Women check here.
For parents, teens and young women looking to prevent osteoporosis the Better Bones Forever site has positive steps you can take today.

Osteoporosis isn’t just for Grandmas – Know your Risk Factors.

osteoporosis isn't just for grandmas, know your riskSo here we are again, with good and bad news about risk factors for osteoporosis. Which do you want first? Bad news? Okay. I like to get that over with too.

The bad news is that many of the risk factors are things that you can’t do a thing about, like, well, being female, for example. Other risk factors are being Caucasian, having a family history of osteoporosis, and having a smaller or thinner frame.

Getting older also increases risk of osteoporosis because bone mass declines after early adulthood. Also, estrogen has a protective effect on bones. So menopause, whether it occurs naturally as a woman gets older, or surgically, through removal of the ovaries because of medical necessity, decreases bone density. Alas, though humans have tried to reverse aging for millennia, the fountain of youth is indeed a myth and like it or not, we get older. But keep in mind that getter older is better than the alternative, as they say.

Other risk factors that aren’t an innate part of every woman’s life, but still aren’t simply lifestyle choices are:

  • Hyperthyroidism
  • Steroid-based medications often used for respiratory illnesses
  • Use of selective serotonin reuptake inhibitors (SSRIs) for depression / anxiety
  • Use of proton pump inhibitors (PPIs) for acid reflux / GERD
  • Antiepileptic medications
  • Intestinal disorder
  • Cancer
  • Rheumatoid arthritis
  • Anorexia

The latter is likely a result of depressed estrogen levels. (Estrogen is stored in fat, so being anorexic and having very little fat means the body has minimal amounts of estrogen.) Incidentally, chronically obese women have a lower incidence of osteoporosis for this exact reason ‑ they have more estrogen stored in their bodies. Also, their day-to-day life involves a greater amount of weight-bearing exercise, because, well, they are indeed bearing more weight. This does NOT mean that one should set out to become obese, as the health risks far outweigh (no pun intended) this particular benefit.

Some other risk factors that one has more control over are:

  • Smoking
  • Excessive alcohol or soda consumption
  • Sedentary lifestyle
  • Long-term use of injectable progestin-only birth control (Depo Provera)*

*If this is your birth control method of choice, discuss with your gynecologist the pros and cons of this particular hormonal contraceptive. You may decide that it’s still a good choice for you, even with the increased change of osteoporosis. There are risks inherent in many forms of contraception, as well as in pregnancy, so these important decisions should be discussed with your provider.

osteoporosis, know your risksHow can you find out if you have osteoporosis? As we said in our previous installment, this is a silent disease. If you are wondering if you should be screened for bone density loss, talk with your health care provider.

Tucson Medical Center offers state-of-the-art bone scanning technology. The facilities are located near TMC’s breast imaging center, so if you are referred for a bone-density screening, you might be able to schedule it to coincide with your next mammogram. The machine, the GE Lunar 1-DXA, known as DEXA, can scan the back, legs, forearms or the entire body. It can accommodate patients up to 400 pounds, a much higher limit than most scanning machines, and can scan children as well. There is minimal radiation exposure in this type of scanning.

To find out more about bone density screening at TMC check out this page which includes how to schedule an appointment.

Have you had a bone density screening yet?

photo credit: chris zerbes via photopin cc

The Magically Shrinking Grandma: Osteoporosis basics

Osteoporosis: The Pediatric Disease with Geriatric Consequences

The following is either good news or bad news, depending on your age (I’m guessing it’s bad news for most of our readers): By the time we’re young adults (twenty-something) our bone mass has peaked. Yikes. But chin up ‑ we have lots of tips for maintaining and supporting the skeleton at all ages.

Osteoporosis literally means “porous bones,” and it is typically asymptomatic. Changes in upper back curvature can indicate bone loss, as can the “Magically Shrinking Grandma” phenomenon, where one’s granny seems ‑ and is ‑ shorter and shorter each time you see her. Later, we’ll discuss guidelines for screening for this “silent disease.”

Recommendations for maintaining our current bone mass are the same for all age groups:

  • Eat a calcium-rich diet ‑ whole foods are preferable, but supplementation is appropriate if necessary. Vitamin D helps the body use calcium, so make sure your levels are adequate. A baseline blood test for Vitamin D is recommended by many providers, and if your levels are low, discuss supplementation.
  • Weight-bearing exercises ‑ walking, jogging, elliptical machines, Zumba, weight-lifting, resistance bands ‑ all will help increase (if you’re younger) or maintain bone density. Of course, all exercises should be done only if approved by your doctor, and you should ensure that you don’t put yourself at risk for injury by over exercising.
  • Swimming and cycling are great for building muscles and improving cardiovascular health, but don’t do much for bone density. Still, these activities will help you protect your skeletal structure. A strong core, achieved through yoga, Pilates, or other means, will also help support your bones.
  • Smoking is, as usual, an unequivocal NO when it comes to preventing osteoporosis, as it contributes to deterioration of bone mass. Fad diets that consist of consuming enormous amounts of protein can be dangerous as excessive protein intake can decrease calcium absorption.

Coming next: Risk factors and screening protocol for osteoporosis, and bone health tips for each stage of life.