Kathryn Jean Lucas, MD
|BONING UP ON OSTEOPOROSIS|
|By: K. Jean Lucas, M.D.|
What is Osteoporosis?
Osteoporosis, a term literally meaning "porous bone", is the loss of so much of the mineral content of the bone in the body that even the slightest injury or a daily activity may cause a fracture. Bone loss occurs rapidly during the onset of and for approximately 5 years after menopause. Bone is also lost gradually as people get older. A wide variety of medical disorders and medications may also increase bone loss throughout life.
Osteoporosis, a major public health concern, affects more than 20 million people in the United State. Among those who live to be 90 years old, 32% of the women and 17% of the men will have a hip fracture. Osteoporosis is responsible for 1.3 million spine and hip fractures per year. Complications of fractures caused by osteoporosis are the 12th leading cause of death in the U.S.
The Ever-Changing Bones
Despite the idea that the skeleton is a rigid structure that does not change, the bones of the body are constantly remodeling. Part of this process is done to keep the levels of calcium stable in the bloodstream, but also the bones are constantly repairing and strengthening themselves in response to minor damage and outside forces such as exercise. Bone reaches its peak mass at age 35; after that age, bone strength and weight may be gradually lost as we age. The stronger the bones are as they mature, the less an effect aging will have on them.
Until age 35, you build and store calcium in your bones easily. Your intestine absorbs calcium more efficiently as well. With aging, the calcium from your bones is lost at a faster rate than it is added. Especially around menopause, bone mass may drastically decrease because of the loss of estrogen.
|Caucasian, Asian females > Black females (African Americans have 10% more bone mass on average than Caucasians and have 50% less fractures)|
|Early or surgically induced menopause|
|Low calcium intake throughout life (the amount of calcium you take in from teenage years to age 35 is extremely important in determining how strong your bones will be as you age.)|
|Lactose intolerance (may cause avoidance of calcium rich dairy products)|
|Positive family history of osteoporosis|
|Small frame and low weight during bone forming years (these people have lower bone mass to start with)|
|Cigarette smoking (has a direct effect on the bone, causes earlier menopause, and lessens the effectiveness of estrogen replacement)|
|Lack of physical activity or immobilization (prolonged bed rest causes rapid bone loss while weight-bearing exercise reduces bone loss)|
|Excessive alcohol intake (has a direct effect on the bone and predisposes to falls which may result in fractures)|
|Older > younger|
|Women > men (women have four times the risk of osteoporosis than men. They have less bone mass to start with, lose bone rapidly at menopause and live longer)|
|Hyperthyroidism: either by your own body producing too much thyroid hormone or your taking too much thyroid hormone replacement (as indicated by a lower than normal TSH)|
|Taking cortisone, steroids, (cause loss of calcium rapidly from the body as well as impair the absorption of calcium from the diet) or anticonvulsants (affect the absorption of calcium by interfering with the action of vitamin D)|
|Hyperparathyroidism (causes the loss of calcium from the bones leading to an elevation of the calcium level measured in the blood)|
|Eating disorders or any type of prolonged malnutrition (may cause loss of weight, low calcium intake especially in the crucial teenage years, and low estrogen levels leading to periods stopping)|
|Adequate calcium intake through life (1000-1500 mg/day of elemental calcium)|
|Maintain normal body weight and do regular physical exercise|
|Take estrogens starting at the time of menopause or at any time after menopause. Estrogens decrease bone loss no matter at what age they are started.|
|If estrogens contraindicated, other drugs (alendronate, calcitonin) may improve bone density|
|Lower alcohol intake|
|Be aware of risk factors listed above which may affect you in order to make lifestyle modifications|
Getting adequate calcium
calcium is the major component of bones and teeth. If you have had kidney stones, you should check with your doctor before starting calcium supplementation. Calcium kidney stones may be a sign that you are losing too much calcium through your kidneys. Medical evaluation is needed for treatment of this situation.
|Recommended daily intake:|
|Teenage years:||1200-1500mg per day|
|Before menopause:||800-1000 mg per day|
|During or after menopause:||1200-1500 mg per day|
How do I increase my calcium intake?
Food sources: increase calcium without increasing fat content of the food. Examples are as follows:
|Skim milk:||300mg/cup||Mozzarella cheese:||207mg/oz|
|Ricotta cheese:||337mg/ 2 cup||Yogurt, low fat:||415mg/cup of plain|
|Yogurt, low fat:||345mg/ cup of fruit||Calcium enriched orange juice:||250mg/ cup|
|Salmon with bones:||167mg/ 3oz||Vanilla ice milk:||176mg/cup|
|Collard greens:||179mg/ one-half cup||Kale||90mg/ 1/2cup|
|Turnip greens||249mg/cup||Broccoli, cooked||177mg/cup|
|Tofu||145mg/4 oz.||Almonds||132mg/2 oz.|
Tips to increase calcium content in cooking:
Avoid excessive protein
An excessively high protein intake will increase calcium loss through the urine. A daily intake of two 3 ounce portions of lean meat or fish is an adequate protein intake for women. If three or four glasses of milk are consumed daily, protein from other sources should be decreased.
Oxalates and phytates
These substances, which are present in whole grain cereals and dark green leafy vegetables (such as spinach), block calcium absorption. The calcium in these foods is not available to the body because it is bound to oxalates or phytates.
|Recommended:||Oscal, Citracal, Nutravescent calcium|
|Calcium carbonate:||Tums, Oscal|
|Calcium citrate:||Nutravescent Calcium, Citracal|
|To test the ability of your calcium supplement to be absorbed in your stomach, the supplement should be placed in a glass of vinegar for 15 minutes. If the calcium completely dissolves in the vinegar, then it will dissolve in your stomach. Do not drink the vinegar. This is only a test. (this test does not apply to and should not be used in chewable forms)|
|Calcium supplements should be taken with meals, at most 500mg at one time|
|Orange juice will increase absorption of calcium|
|Avoid taking calcium with high fiber meals or bulk laxatives such as Metamucil|
|Drink plenty of fluids if taking a supplement|
|Do not take iron supplements with calcium since they will decrease the absorption of each other|
Take a multivitamin with 400 IU of Vitamin D. (Vitamin D allows calcium to be absorbed by the body.) Vitamin D is made in the skin after exposure to sunlight. Sunscreens will block the formation of vitamin D by the skin. Too much vitamin D is harmful because it accumulates in the body. The usual dose in multi-vitamins is the safe dose of 400 IU per day. People with vitamin D deficiency may require a higher dose or a different form of vitamin D prescribed by their physician. These patients require careful monitoring of their blood calcium.
Signs and Symptoms of Osteoporosis
Osteoporosis is a silent disease until the bone mass is so low that fractures occur. No warning signs may occur at the very early stages. Since prevention is much more effective than treatment, each individual should be aware of her/his risk of getting osteoporosis.
|Loss of height as aging occurs|
|Loss of bone on regular x-rays ( as much as 30% of the bone is already lost by the time it shows up on the film)|
|Humping over of the upper spine (dowagers hump)|
|Fractures with minimal trauma (may occur with routine activities such as bending, lifting, or rising from a chair)|
|Low bone density measured on a bone densitometer|
How to measure bone density
A bone density exam is an excellent test to determine the actual density or thickness of your bones. It requires less than one-tenth the amount of radiation that is required by a chest x-ray. As with any medical procedure, be sure to inform your physician if you are or could be pregnant.
The bone density exam is a simple, painless, noninvasive procedure. You will be asked to lie perfectly still on a table while a mechanical arm with x-ray passes over the area to be tested (for example, arms, spine, or hips). A detailed computer analysis of your results is then performed. The procedure lasts approximately 20-30 minutes.
A bone density report will show the percentage of bone you have compared with peak bone mass (which usually occurs around age 35). This "Z-score" assumes that everyone has 100% bone mass at the peak bone mass years. Individually, one may have had a different total bone mass, either greater or less than the 100%; however, since bone density tests are not done during the peak bone mass years, one cannot be accurately compared to oneself, but only to a population of the age of peak bone mass. Another comparison is to members of your own age group. This comparison is helpful in someone with a higher degree of bone loss than normal to determine if another cause for the osteoporosis exists.
As people age, not only do the bones get weaker, but coordination may decrease, vision and hearing may become impaired, and medication may be given which can cause dizziness, unsteadiness, or sedation.
|Do not bend from the waist down. Bend knees in order to pick up or lift an object. By doing the motion this way, you avoid additional force on your back.|
|Do not do sit ups that involve raising shoulders off the floor|
|Avoid twisting motions of the back. Turn the whole body around in order to see something behind you.|
|Practice good posture: head up, back straight, abdomen in , buttocks under|
|Support back with hand when coughing or sneezing.|
|Avoid excessive pushing or pulling. Use a rocking motion of your feet to move objects ahead or back|
|When sitting for prolonged periods of time, use a rolled up towel or back support behind your lower back|
|When standing for any length of time, put one foot up on a step stool and change position of feet periodically|
|Keep feet apart to help balance when you are bending from the knees|
|When you get out of bed, roll over to one side, use your arm to push up from the bed, sit on the edge of the bed for a few minutes before getting up|
The role of exercise in the treatment of osteoporosis
In general, exercise decreases bone loss and stimulates bone formation. Tennis players have a higher bone mass in their playing arm than in the other one. Pushing exercises using the forearm increase the bone mass of the pushing arm. Weight lifting increases the bone of the arm doing the work. Walking, stair climbing and other weight bearing exercises increase the bone mass of the spine and pelvis. Exercise also builds muscle strength and coordination which helps avoid falls or injury when falling.
|Check with your physicians before starting|
|Start slowly with only a few repetitions|
|Avoid injuries, stop if in pain|
|Use comfortable, well-padded shoes to exercise in|
Examples of exercises
Formal physical training to optimize bone building and strength and decrease injury risk are available.
General weight bearing: walking, stair climbing, low impact aerobics
Lay on your stomach, arms at the sides. Slowly raise your shoulders off the floor. Back stretches and squats also improve the low back strength.
Use 1-3 pound weights. One arm at a time with elbow bent and supported on knee, flex wrist with weight up. Repeat with other arm
Stand next to a wall, use arm next to wall as support, Raise leg opposite to wall up as far as it will go comfortably to the side and then to the back. Repeat with the body facing the opposite direction using the other leg.
Squats: Use a bar (broomstick, yardstick) across back of shoulders, holding it with your hands. Keep head up, back slightly arched, squat slowly until upper thighs are at a 45 degree angle to the floor.
Medications used to treat osteoporosis
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Copyright © 1999-2013 K. Jean Lucas, MD, All Rights Reserved
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