Women's Issues
Osteoporosis Information
by Carolyn Ross, MD

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 is detectable
• 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.

Osteoporosis Treatment

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:

1. Female sex
2. White race
3. Postmenopausal, especially early menopause
4. Family history of osteoporosis
5. Underweight for your height
6. Lack of regular exercise
7. Cigarette smoking
8. Inadequate calcium and/or vitamin D intake
9. Heavy alcohol, caffeine or high-phosphate soft drink use.
   

Osteoporosis Prevention (Stage 1)

Stage 1 - Prevention

Remove your modifiable risk factors...

1. Begin a regular exercise program about getting a bone density test.
2. After menopause, discuss the hormone replacement option with your physician.
3. Stop smoking.
4. Avoid heavy alcohol, caffeine and high phosphate soft drink use.
5. Seek medical treatment for conditions which increase the chance of osteoporosis:rheumatoid arthritis, high thyroid, emphysema, diabetes, some types of stomach surgery.
6. Get adequate calcium (1000 mg. daily, pre-menopause; 1500 mg. daily, postmenopause).

Osteoporosis Treatment (Stages 2-4)

Stage 2 - Osteoporosis Detectable

1. If you are at higher risk, ask your physician.
2. Remove your risk factors (see Stage 1).
3. 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

1. See your physician for treatment of the fracture. Be on the alert for chronic back pain or severe pain after a fall.
2. Begin a regular exercise program when it is medically safe to do so.
3. Remove your risk factors (see Stage 1).
4. Be sure to get adequate vitamin D and 1500 mg of calcium daily.
5. Ask your physician about prescription medications to treat the osteoporosis.

Stage 4 - Fractures With Pain and Deformity

1. Follow Steps 1 - 5, outlined under Stage 3.
2. Discuss pain management options with your physician.
3. 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.

Osteoporosis Diet

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:

• 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)
• tofu
• 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 enhance absorption.

Osteoporosis Exercises

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!