The National Institutes of Health estimates that about half of all women over 50 will have an osteoporosis-related fracture at some time in their lives. Act now to reduce your risk.
We tend to think the bones we have in our 20s are the same as the ones we have in our 50s. They’re not. Bones are constantly being remodeled throughout our lifetime to maintain their strength. So how does it work?
Special cells called osteoclasts break down old bone tissue and remove it. Then bone-building cells, known as osteoblasts, replace that tissue with healthy new bone. When you’re young, the bone-building cells work faster than the bone-destroying cells, and your bones grow larger and denser. This continues until about age 30, when women reach their peak bone mass. From then on, bones gradually lose their strength. Your risk of osteoporosis will depend on your peak bone density and your rate of bone loss.
Helpful HormonesBut it’s not just age that determines bone health. Bone remodeling is regulated by several hormones, particularly estrogen. During perimenopause, women lose 2 percent of bone density each year due to decreasing estrogen levels. This loss continues until a few years after menopause, at which point, bone loss will slow to 1 percent a year.
While the rapid loss of bone around menopause puts women at greater risk of osteoporosis and makes menopause a good time to get serious about preserving bone, it doesn’t mean you have to rush into treatment, says Bruce Ettinger, MD, an osteoporosis specialist at the University of California, San Francisco. Osteoporosis, or the fractures it causes, aren’t an immediate risk for women during the menopause transition, he says.
“Relax about osteoporosis—that’s the message I would give to healthy women at the time of menopause,” says Ettinger. “Women at the age of 50 or 55 who are generally healthy have a very low risk of having a fracture in the next five to 10 years.”
Instead, now is a time of prevention. That means finding out if you’re at high risk for osteoporosis and discussing a bone-healthy lifestyle with your healthcare provider.
Maintaining Strong BonesThe most important strategy for preventing osteoporosis is making sure you get enough calcium, says Michael McClung, MD, director of the Oregon Osteoporosis Center in Portland. Calcium deficiency speeds the rate of bone loss, he notes, and studies find calcium supplementation can slow the rate of bone loss in women with low dietary intake of the mineral.
Ideally, premenopausal women should aim for 1,000 milligrams a day of elemental calcium, while perimenopausal and postmenopausal women should try to get 1,200 milligrams a day. Try to get your daily calcium from your diet rather than supplements, says McClung, because your body can better absorb the mineral from food sources. It’s easy enough: three servings a day of dairy products like milk and cheese, or calcium-fortified foods like some orange juices, will do it.
If you can’t get enough calcium from food (maybe you’re lactose intolerant), consider a supplement. You may need only about 600 milligrams extra a day, says Felicia Cosman, MD, an osteoporosis specialist and director of the Clinical Research Center at Helen Hayes Hospital in West Haverstraw, N.Y.
And don’t forget vitamin D, the so-called sunshine vitamin. Without it, your body can’t absorb calcium. If you drink milk fortified with vitamin D or spend at least 15 minutes a day in the sun with your arms, hands and face exposed and not covered in sunscreen, you may be getting what you need. Vitamin D deficiency is especially prevalent in older women in the North where the winter is dark.
If you’re over 50, aim for at least 400 IU a day of vitamin D; if you’re 70 or older, increase that to at least 600 IU. A cup of milk contains about 100 IU. Because your body has a harder time manufacturing vitamin D, even as your need for it increases, you may need to supplement, says McClung. Most calcium supplements and multivitamins contain enough vitamin D to meet your needs.
Work It, Baby! In addition to proper nutrition, exercise is critical when it comes to strong bones, says Cosman. Bone is like muscle, she explains, responding to the stress of exercise by growing stronger. Studies find that inactivity increases the rate of bone loss, and that exercising can slow that loss
.
Not just any exercise will do, however. Building bone requires exercise that forces your skeleton to carry your body’s weight. Brisk walking, jogging and aerobics will do the trick; swimming and biking won’t. Strength training is also important, Cosman says, because it builds bone and lowers your fracture risk by helping you keep your balance and reduce your chance of falling. But if you stop exercising, she warns, you’ll lose both the muscle you built up and the bone. Before you begin any exercise program, check with your healthcare provider to discuss the type that’s best for you.
Other measures to prevent osteoporosis include: quitting smoking, which studies find doubles the risk of osteoporosis; keeping alcohol consumption to a moderate level; and limiting your consumption of salt, caffeine and protein, all of which may deplete calcium.
Breaking the Silence:
Getting ScreenedThere’s a reason osteoporosis is called the “silent disease,” says Charles Kahn, MD, a rheumatologist at Memorial Regional Hospital in Hollywood, Fla. “Most patients don’t get any pain. They never know they have it.” Until, that is, they fracture a wrist or hip. Other osteoporosis signals include chronic back pain or a loss of more than 1.5 inches in height -- both signs of vertebral fractures.
Thus, regular screenings are vital beginning at age 65 or earlier if you are at high risk of the disease (See “Understanding Your Risk” on page 32). The most common and most accurate form of bone mineral density testing is dual energy x-ray absorptiometry (DXA).
DXA produces a T-score, a measure of how your bone density differs from that of a healthy young person of the same gender. The normal range is above -1. If your T-score is below -2.5, you’re diagnosed with osteoporosis.
The problem with T-scores is they don’t tell the whole story, says McClung. They can vary from individual to individual, and age also plays a part. “The bone density value itself tells us almost nothing about the fracture risk,” says McClung.
“You may want to ask your provider to put your T-score into context by providing a sense of your overall risk of fracture, before starting any drug therapy,” suggests Cosman.
The World Health Organization (WHO) has recently announced a new system to replace T-scores that will analyze risk in the context of a woman’s general health, explains Ettinger. “This is going to make it easier to make decisions about when it’s right to treat,” he says. The National Osteoporosis in the United States will provide an analysis of when treatments should and should not be used.
Treating Osteoporosis If you have osteoporosis, there are lots of medical options. All require long-term use to prevent bone loss returning.
“Regardless of what medication you’re taking, you need to make sure you’re getting adequate calcium and vitamin D to maximize their effectiveness,”
Kahn warns. |
