Information about Osteoporosis
Osteoporosis, literally 'porous bones', is a gradual lessening
of bone density, resulting in bones that are thinner, more porous
and less able to support the body. From the time we are infants,
our bones are undergoing constant remodeling. Up to about age
35, this remodeling generally results in greater bone mass.
After that time, however, bone is gradually lost over the years
as a result of aging, and it can be accelerated by such factors
as smoking, inadequate exercise and menopause or slowed by exercise
and adequate calcium. In its early stages there are no symptoms,
but further in its progression, even routine activities can result
in pain and fractures.
The Four Stages of Osteoporosis
The course of osteoporosis can be divided into four stages:
- Stage 1 - Begins at about age 35 before osteoporosis
- Stage 2 - Occurs between ages 35 and 55 when osteoporosis
becomes detectable with special tests
- Stage 3 - Can begin as early as age 45 and is characterized
by bone fractures
- Stage 4 - May begin as early as age 55 with fractures
accompanied by chronic pain and deformity.
The best way to treat osteoporosis is to prevent it. Since an
astounding 80 percent of women over 65 years of age have osteoporosis,
this issue is certainly worth our attention. We'll outline a good
prevention plan, but if you are already in Stages 2 through 4,
there will be some suggested treatment plans for you. The important
thing to remember is that no matter where you are along the continuum
of bone loss, there are things you can do!
Osteoporosis Causes and Risk Factors
An understanding of risk factors for osteoporosis is a good place
to begin, since if you have many of them you will know that you
must be especially careful to start early and aggressively into
your prevention program. Risk factors include:
- Female sex
- White race
- Postmenopausal, especially early menopause
- Family history of osteoporosis
- Underweight for your height
- Lack of regular exercise
- Cigarette smoking
- Inadequate calcium and/or vitamin D intake
- Heavy alcohol, caffeine or high-phosphate soft drink use.
Osteoporosis Prevention (Stage 1)
Stage 1 - Prevention
Remove your modifiable risk factors...
- Begin a regular exercise program about getting a bone density
- After menopause, discuss the hormone replacement option with
- Stop smoking.
- Avoid heavy alcohol, caffeine and high phosphate soft drink
- Seek medical treatment for conditions which increase the chance
of osteoporosis:rheumatoid arthritis, high thyroid, emphysema,
diabetes, some types of stomach surgery.
- Get adequate calcium (1000 mg. daily, pre-menopause; 1500
mg. daily, postmenopause).
Osteoporosis Treatment (Stages 2-4)
Stage 2 - Osteoporosis Detectable
- If you are at higher risk, ask your physician.
- Remove your risk factors (see Stage 1).
- Be sure to get adequate vitamin D and 1500 mg of calcium daily
(Note: sunshine is a good source of Vitamin D).
Stage 3 - Fractures
- See your physician for treatment of the fracture. Be on the
alert for chronic back pain or severe pain after a fall.
- Begin a regular exercise program when it is medically safe
to do so.
- Remove your risk factors (see Stage 1).
- Be sure to get adequate vitamin D and 1500 mg of calcium daily.
- Ask your physician about prescription medications to treat
Stage 4 - Fractures With Pain and Deformity
- Follow Steps 1 - 5, outlined under Stage 3.
- Discuss pain management options with your physician.
- Keep a positive mental attitude.
Safe Living Note
If you are in Stage 3 or 4, consider some basic safety guidelines:
- Go slowly since falls often occur when you hurry.
- Think before you move; carelessness can result in falls.
- Make your environment safe--keep walking areas cleared of
objects, make sure rugs are secure, install grab bars in showers
(also non-skid mat) and near toilets, place items frequently
used on accessible shelves.
- Consider the indoor/outdoor home as well as work environment.
Osteoporosis and Nutrition
Your eating habits, as you have seen from risk factor management,
feature prominently in prevention and management of osteoporosis.
It is important to limit consumption of alcohol, caffeine and
soft drinks containing high levels of phosphate. If any of these
is a problem for you, try the following:
- Alcohol: Limit your alcoholic beverages to beer and
wine; have distilled liquor only on special occasions, etc.
- Caffeine: Drink fewer than two cups of 'real' coffee
and caffeinated soft drinks each day; brew half caf/half decaf
coffee; switch to decaf coffee; try herbal teas.
- High-phosphate soft drinks: Read labels to avoid soft
drinks containing phosphates; switch to flavored no-cal sparkling
waters; drink more water.
Fat, Protein, and Calcium
Another important consideration in the Western diet is too much
fat and protein. Foods high in fat and protein tend to inhibit
the absorption of calcium. Also, excess protein tends to have
an acidifying effect in the body resulting in calcium being removed
from the bones to buffer that acid.
Your prescription for healthy bones includes a diet moderate
in protein (1 cup beans or 5 oz. lean meat, chicken or fish daily),
low in fat, and high in vegetables, fruits, whole grains and calcium-rich
foods. Some especially calcium-rich foods include:
Calcium delivered through food is best absorbed. Calcium supplements
should be just that: a complement to your calcium-rich diet.
- milk, yogurt and cheese (use skim to manage fat content)
- cooked collard greens, kale and broccoli; sardines or salmon
canned with bones
- blackstrap molasses or sesame seed meal (tahini)
- corn tortillas
- and calcium-fortified orange juice.
Osteoporosis and the Calcium in your Diet
The average American woman falls short of the 1,200 mg RDA for
calcium, taking in only about 400 to 500 mg. Both the National
Osteoporosis Foundation and the National Institutes of Health
recommend that postmenopausal women take 1,500 mg daily to compensate
for calcium loss. If your diet is already rich in calcium, you
may wish to take 1,000 mg per day. These dosages are safe for
the majority of women; however, check with your physician if you
have a personal or family history of kidney disease.
Not all calcium supplements are equally well absorbed. An acidified
form of calcium called calcium citrate is best, followed
by the less expensive calcium carbonate. Calcium lactate
and calcium gluconate are quite poorly absorbed.
Take calcium pills with meals and in divided doses to further
The human body is made to move. It responds readily and favorably
to physical demands placed upon it. Your bones are no exception.
When a resistance load is placed upon a bone, it responds by holding
on to its mineral content, perhaps even building more bone. The
reverse is true for inactivity. In fact, even in young, healthy
people, prolonged bed rest or weightlessness in astronauts results
in rapid bone density loss.
Bone Loading Exercises
Specific types of exercises encourage the process known as 'bone
loading'. These should be considered for the sites most at risk:
the upper arm at the shoulder, the lower arm at the wrist, the
hip and the spine. Weight-bearing activities such as walking/jogging,
mini-trampolining, stair stepping, aerobic classes, cross-country
skiing and the like work on the spine and hip areas. For the arms,
strength training is needed. This can be accomplished with weights,
resistance bands, yoga, gardening and other activities which put
a load on the arm and related muscles.
Exercises for the Inactive Osteoporitic
If you've been inactive, prepare to start gradually and get your
physician's approval if you're over 50. A good health-related
goal would be to accumulate about 30 minutes of activity most
days of the week. This can be divided between weight-bearing aerobic
activity, strength training and gentle stretching. Don't be discouraged
if you need to start with short aerobic sessions of 5 to 10 minutes.
With consistency, you'll be able to go longer and farther. If
you are unsure about how to strength train, consider hiring a
personal trainer or consulting a book or video to learn proper
technique and safety.
Exercises for Stage 3 and 4 Osteoporitics
If you are at Stage 3 or 4 of osteoporosis, you can still benefit
from exercise--just be careful about getting started. First, obtain
your physician's approval if you have been treated for fractures.
You may wish to request working with a chiropractor or physical
therapist for specific, appropriate strength exercises. Weight-bearing
activity should not be high-impact activities like running or
jogging. Walking, low-impact aerobic classes or videos, or cross-country
ski machines may all be appropriate. Remember to start your exercises
slowly and gradually after you have received physician approval.
If you have pain or discomfort, stop, then resume at a slower
pace. If pain persists, consult your physician. Also, if you are
taking pain medication for your condition, remember to take it
before your exercise session.
A Positive Mental Attitude
Your positive mental attitude will go a long way in making you
a successful exerciser at any age or stage!
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