Making healthy bones a priority
February 25, 2008
It wasn’t too long ago that bone fractures were considered an inevitable part of aging.
Research strides in the past 15 years, however, have revealed bone diseases such as osteoporosis not only can be diagnosed early and treated to reduce fracture risk but can be prevented altogether in most individuals, according to the 2004 Surgeon General’s Report on Bone Health and Osteoporosis.
Despite a better understanding of major factors contributing to poor bone health – a lack of calcium, vitamin D and exercise – osteoporosis and other bone diseases continue to be a major national health problem.
The report warns that half of all Americans will have osteoporosis or be at risk of developing the disease by 2020 if more people do not take prevention seriously.
A ‘silent disease’
The deterioration of bone mass caused by a lack of calcium signifies osteoporosis, the most common bone disease.
The risk of osteoporosis is highest among post-menopausal women because lower estrogen levels associated with menopause change the body’s metabolism and protein balance in bones. However, osteoporosis also affects men, explained Dr. Richard Rende, a retired orthopedic surgeon and part-time doctor at Steamboat Medical Group.
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Rende has a special interest in osteoporosis because he suffers from a version of the disease characterized by abnormally high concentrations of calcium in the urine.
The condition, known as renal calcium wasting, is emerging as a particular problem among men, but it also can affect women, Rende said.
Other factors can increase a person’s risk of osteoporosis including genetics, inactivity and some medications and chronic conditions, such as lupus, rheumatoid arthritis and some cancers, he said.
Low bone mass makes the bones soft and more susceptible to breaking. Unfortunately, fractures are sometimes the first sign of osteoporosis, also known as the “silent disease.”
About 40 percent of patients hospitalized for hip fractures die within a year or have to live in a nursing home. Others become depressed, isolated and fearful of falling or leaving home, according to the Surgeon General’s report.
The report also notes that spine fractures, which are more difficult to diagnose, can result in chronic pain or disfigurement.
Diagnosis and treatment
There are noninvasive ways of testing bone density and assessing a person’s risk of fracture before it happens. The best procedure uses a DEXA-scan, an X-ray-like machine that measures calcium in parts of the body, Rende said.
Candidates for bone density tests include post-menopausal women, those with chronic diseases or reoccurring kidney stones and patients who have had frequent fractures, he said.
In addition to adapting prevention measures, individuals diagnosed with osteoporosis can be treated with medication.
Boniva is among medications called visphosphonates, which prevent further calcium loss in the bones, Rende said.
Another option particularly beneficial to younger osteoporosis patients is Forteo, a modified hormone that rebuilds up to 15 percent of calcium in bones. The hormone, which patients can inject at home, is not effective once a patient has undergone visphosphonate therapy.
“It’s important to get diagnosed as young as you can so you can take Forteo and rebuild some of the bone rather than accept it as, ‘This is as good as it gets,'” Rende said.
Building and maintaining strong bones with exercise and sufficient calcium and vitamin D should be a lifelong priority, however, older adults also can apply these measures to improve their bone health.
The National Osteoporosis Foundation recommends 1,000 mg of calcium a day for adults ages 49 and younger and 1,200 mg for adults ages 50 and older.
The best sources of calcium include dairy products and some leafy, green vegetables. Options for lactose intolerant individuals include calcium-fortified soy or rice milk or lactose-free dairy products.
Information near the bottom of food labels shows percentage of the daily value of calcium (based on 1,000 mg per day) provided in a serving. A serving of dairy product provides about 30 percent of daily value of calcium, said Pam Wooster, registered dietician at Yampa Valley Medical Center.
“I think it’s a challenge for most of us to get enough calcium, but it’s a focus we need to pay attention to decrease our risk of osteoporosis,” she said.
Wooster recommends making a routine of drinking milk or other calcium-rich food at certain times of the day as well as incorporating low fat dairy products into sauces and fun foods such as smoothies, Wooster said.
Adding a few tablespoons of nonfat powdered milk (each tablespoon contains about 50 mg of calcium) to puddings, homemade cookies, muffins or soups is another suggestion from the National Osteoporosis Foundation.
A well-balanced diet is also important for providing other bone-healthy minerals. Excessive amounts of caffeine, sodium or protein can interfere with calcium intake.
People who do not get enough calcium from food can take supplements, which come in different calcium compounds. Calcium citrate tends to work well for older adults who have less stomach acid to break down calcium carbonate and other compounds, Wooster said.
Calcium is best absorbed in amounts of 600 mg or less. Individuals should check with their doctors about whether supplements might interact with any medications they are taking.
Vitamin D is needed for the body to absorb calcium, and is available from three sources: Sunlight, food and supplements or medications.
Adults ages 49 and younger should get 400 to 800 International Units of vitamin D3 daily and adults ages 50 and older should get 800 to 1,000 IU of vitamin D3, according to the NOF recommendations.
The skin produces adequate amounts of vitamin D with 10 to 15 minutes of sun exposure two to three times a week, Wooster said, though sunscreen and dark skin pigment limit this process.
It’s difficult to get needed amounts of vitamin D from food. Some products such as milk and orange juice are fortified with vitamin D, which also can be found in fatty fish, egg yolks and liver.
Vitamin D is present in some calcium supplements, multivitamins and medications. Too much vitamin D can be harmful, so individuals should check with their doctors if they are unsure about their vitamin D levels.
Physical activity in the form of weight-bearing and resistance exercises stimulate bones to become stronger and thicker. Weight-bearing exercise includes walking, running and dancing – activities in which the feet and legs bear the body’s weight. Weight lifting provides resistance that improves both muscle and bone strength.
Individuals who have had bone fractures should consult their doctors for safe exercise suggestions.
Tamera Manzanares can be reached at firstname.lastname@example.org.