Boost Bone And Stay Strong

Bone health is increasingly taking a place in the spotlight, and bones merit the attention. Osteoporosis—a condition characterized by low bone mass and deterioration of bone structure—affects an estimated 10 million Americans over the age of 50. Each year roughly 1.5 million Americans will experience an osteoporosis-related bone fracture.2 These fractures commonly involve the wrist, hip, or spine but can affect any part of the body.

Though the statistics are sobering, there are things we can do to reduce our risk of osteoporosis and fracture. “One of the older misconceptions that we hope is definitely disappearing is that there’s nothing you can do about it,” says Joan McGowan, PhD, director of the Division of Musculoskeletal Diseases at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). “It is true that some bone loss is a natural part of aging, but it doesn’t have to get to the point of fragility and very frequent fractures.”

What Determines Bone Mass?

Much of our peak bone mass is acquired by the end of adolescence, with some additional increase up to age 30 or so. Depending on our circumstances, bone mass may then stabilize for a while before decreasing sharply during the first few years after menopause.3

Genetics plays an important role in determining our peak bone mass, but several other factors also contribute. Physical activity during childhood and adolescence results in a greater peak bone mass as does a healthy diet with adequate calcium and vitamin D.4Continued physical activity and healthy eating remain important throughout adult life and can help maintain the bone mass that we acquired earlier in life. Weight-bearing exercises—such as walking, dancing, rowing, or weight lifting—provide the greatest bone benefits.

Another important factor in girls and women is estrogen. “Bone loss can occur whenever estrogen is out of the picture,” says Dr. McGowan. Menopause is clearly a time when estrogen levels fall, but disruption of menstrual cycles and low estrogen levels can also occur earlier in life as a result of eating disorders or intense physical activity. “Cessation of menses for whatever reason in younger women is a huge cause of early bone loss.”

Certain health conditions or medications used to treat these conditions can also affect bone density. Long-term use of glucocorticoids for asthma, for example, can reduce bone density. Some cancer treatments, such as aromatase inhibitors for breast cancer or androgen-deprivation therapy for prostate cancer, can also adversely affect bone. For more information about how certain conditions and medications affect bone, talk with your doctor.

Detecting and Treating Osteoporosis

To detect osteoporosis, the U.S. Preventive Services Task Force recommends routine screening of women age 65 and older.5 Women who are at increased risk of osteoporosis may need to begin screening at a younger age.

The most commonly used bone-density test is the dual-energy X-ray absorptiometry (DXA) test, which measures bone mineral density and compares it with an established standard.

If the test indicates that you have osteoporosis, the condition can be treated. Drugs that may be used to treat osteoporosis include bisphosphonates (such as Fosamax® [alendronate], Actonel® [risedronate], Boniva® [ibandronate], and Reclast® [zoledronic acid]), calcitonin, estrogen, Evista® (raloxifene), Forteo® (teriparatide), and Prolia™ (denosumab). Treatment of osteoporosis reduces the risk of fracture.

If the test determines that you have lower-than-normal bone mass (but not osteoporosis), your doctor may talk with you about how to reduce further bone loss. Not everyone with low bone mass develops osteoporosis, but low bone mass does increase the risk of osteoporosis.

Don’t Ignore Fractures

Depending on your age, a fracture may serve as an important warning about low bone mass. A fracture in a woman over the age of 50—or multiple fractures in a younger woman—may warrant a workup for osteoporosis. “Often fractures are dismissed by the person and the physician because you’ve ‘earned’ your fracture,” says Dr. McGowan. “So if you’re ice skating with your granddaughter and you fall and get a wrist fracture, you may dismiss it without recognizing that the granddaughter you were skating with fell 16 times and didn’t fracture.”

Men Need Strong Bones, Too

Asked about important messages for men about osteoporosis, Dr. McGowan responds, “They’re not immune.” Women tend to develop osteoporosis at an earlier age than men, but men are also at risk. “There’s been so much progress in helping men survive longer—taking care of their heart attacks, their strokes, their prostate cancer. We all hope we’re going to keep them longer, and they’re going to need to have strong skeletons. They should be diligent about diet, calcium, vitamin D, and activity and should probably get a bone-density test at least by age 70 if there are no other risk factors.”

Room for Improvement

In the process of writing this, I took a moment to rummage through one of the drawers in my office. There, beneath a phonebook, was a mostly full bottle of calcium and vitamin D supplements. The expiration date was October 2007. I, like many, could be doing more to maintain the health of my bones.

What’s Your Risk?

Check Up On Your Bones is an interactive, online tool developed by the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. The goal is “to help you identify the most common red flags that put your bones at risk and to give you a strategy—specific to you—to make your bones stronger and healthier.”

www.niams.nih.gov/Health_Info/Bone/Optool/index.asp

Living with Osteoporosis

Juli Roos, production manager at Women magazine, has firsthand experience with osteoporosis. She was recently diagnosed with the condition at the age of 48, after what she thought was going to be a routine bone-density test. “My mother has osteoporosis, and I was approaching age 50,” explains Juli, “so I thought, Oh, what the heck. Why don’t I go in and get a bone-density scan.” She expected the test to provide baseline information that would help her track her bone density as she aged. She did not expect the test to reveal that she already had osteoporosis. “I was 100 percent shocked,” says Juli. “Never did I think that I would have it or have it to the degree that I do.” She’d previously broken a leg skiing but had had no other fractures.

Her  response? “I started doing a lot of research, talking to a lot of people, sending my results to friends and family in the medical profession. Given where I work, I have access to some very good research.  I basically just did some homework.” Already postmenopausal, Juli is considering her treatment options. Her doctor suggested treatment with a bisphosphonate drug, but Juli is also considering estrogen or Forteo®(teriparatide). She’s shifted her exercise routine to include more weight-bearing exercises such as running and weight lifting and is paying more attention to her calcium and vitamin D intake.
Looking back, Juli wonders if her history of irregular periods contributed to her osteoporosis or if it’s simply a matter of genetics. Regardless, she’s doing what she can to avoid further bone loss, and she encourages other women—including her teenage daughter—to care for their bones.

references

1. By 2020, One in Two Americans over Age 50 Will Be at Risk for Fractures from Osteoporosis or Low Bone Mass [news release]. US Department of Health and Human Services. Available at: http://archive.hhs.gov/news/press/2004pres/20041014.html. Accessed June 18, 2010.

2. US Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General, 2004.

3. Osteoporosis: Peak Bone Mass in Women. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Available at: http://www.niams.nih.gov/health_info/bone/osteoporosis/bone_mass.asp. Accessed June 18, 2010.
4. Calcium and Vitamin D: Important at Every Age. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Available at: http://www.niams.nih.gov/health_info/bone/bone_health/nutrition/default.asp. Accessed June 18, 2010.5. Screening for Osteoporosis in Postmenopausal Women. Agency for Healthcare Research and Quality Web site. Available at: http://www.ahrq.gov/clinic/uspstf/uspsoste.htm. Accessed June 18, 2010.