Building strong bones is your best defense against osteoporosis injuries.
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.
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.
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:
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.
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