Better Bone Health

by Molly M. Ginty

For Dorothy Gardenier, all it took was one false step. "One Sunday after church, I got up to stand and suddenly felt myself falling," says Gardenier, 79, of Madison, Wisconsin. "After I was rushed to the hospital, I learned I had broken my hip."

Gardenier took the fall in more ways than one. X–rays revealed she had a severe case of osteoporosis — bone thinning that her doctor had never discussed with her, and that likely caused her hip to break.

"If only I’d know I was at risk — or least been offered a bone density test — I could have done something to prevent this," she says. "Now I’m constantly in pain and terrified I’ll fall again."

Like Gardenier, an estimated 8 million American women have osteoporosis. More than 20 million women have a precursory condition called osteopenia — bone mass low enough to put them at high risk for osteoporosis and the bone fractures it can cause.

During May, which is National Osteoporosis Awareness and Prevention Month, health advocates are working to warn women about this incurable disease, which is four times more likely to affect women than men because we live longer, have smaller bones, and lose bone mass faster.

"This is a silent disease in that it’s usually not something you can feel coming on," says Dr. Felicia Cosman, clinical director of the Washington–based National Osteoporosis Foundation. "That’s why every woman should follow prevention measures like stopping smoking, which can lead to bone erosion." All our lives, our bones are continually breaking down and reforming — a cycle called remodeling that usually takes two to three months. After you reach peak bone mass (between ages 25 and 35), bones break down faster than they rebuild. After menopause, you can lose up to 50 percent of your bone mass within ten years, in large part due to the drop in your body’s level of the female hormone estrogen.

Some 55 percent of Americans over age 50 are at risk for osteoporosis. The threat is higher if you have a family history of the disease, if you’re white or Southeast Asian, if you’re thin or smallframed, if you’ve missed menstrual periods (amenorrhea), or if you’ve taken certain medications long–term (some antacids, anti–seizure drugs, birth control pills, blood thinners, chemotherapy drugs, and steroids).

The good news is that you can slash your risk by eating well and getting the exercise you need.

STEP ONE: Drink healthy. Enjoy soy milk, which contains plant estrogens. Each day, have no more than three 8–ounce caffeinated drinks and no more than 6 ounces of wine or 12 ounces of beer. "You may also want to steer away from frequent consumption of cola," says Dr. Katherine Tucker, a professor of nutrition at Boston’s Tufts University. Last year, Tucker led a study on bone health and carbonated soft–drink consumption, which increased more than threefold between 1960 and 1990. "Our research showed that the more carbonated cola drinks women had, the lower their bone mineral density was," she says.

STEP TWO: Eat right. Make sure your daily diet includes 1,200 mg (milligrams) of calcium and 400 IUs (International Units) of vitamin D if you’re pre–menopausal, and 1,500 mg of calcium and 800 IUs of vitamin D if you’re postmenopausal. Load up on fruit, leafy green vegetables, and B–fortified cereal, which reduce levels of homocysteine, an amino acid associated with bone loss.

STEP THREE: Give your bones the workout they deserve. Three times a week, get half an hour of weight–bearing exercise such as walking or jogging — plus half an hour of strength training. When you’re at rest, sit tall, as good posture minimizes stress to your spine.

As you approach menopause, step up efforts to fight osteoporosis. Have a bone density screening test (preferably dual energy X–ray absorptiometry, or DEXA) if you’ve used steroids longterm, experience early menopause, or have type 1 diabetes, or liver or kidney disease. Women over 50 who have other risk factors should also be screened, as should all women over 65.

Watch for the warning signs of osteoporosis: back pain, stooping, and loss of height. And if you do develop the disease, know that special back extension exercises can help keep it in check. Also make sure you faithfully take the medications your doctor prescribes. Hormone therapy (synthetic estrogen that replaces the body’s estrogen) is the only way to stop rapid bone loss. But since a 2002 study found that hormone therapy can increase the risk of breast cancer, stroke, and heart attack, doctors recommend first trying other osteoporosis drugs, including:

◗ bisphosphonates, which can increase bone density in the hips and spine;

◗ calcitonin, a thyroid hormone that boosts spinal density;

◗ teriparatide, a parathyroid hormone that increases the rate of bone formation;

◗ tamoxifen, a synthetic hormone used to treat breast cancer; and

◗ raloxifene, which mimics the effects of estrogen.

If you develop osteoporosis early, do everything in your power to prevent it from progressing to the advanced stage, when even simple movements such as bending over or lifting a box are enough to cause fractures. "Since my fall, I always clutch my walker, the stairwell, or my husband’s arm," says Gardenier. "I need to watch my every move, and that’s no way to move through life."

Molly M. Ginty lives in New York. Her work has appeared in Ms., Marie Claire, Redbook, and Women’s eNews.

For more information:
National Osteoporosis Foundation www.nof.org

Article published in Lutheran Woman Today, May 2007