Osteoporosis begins with tiny fractures in the bones of your spine. Instead of healing, the bones compress and flatten. As the disease progresses, the upper spine is pushed outward and the shoulders round. The rib cage travels downward and settles on top of the hip bones. Organs crowd together, and the abdomen begins to protrude. Your skeleton can become so fragile that just bumping into something or even a cough can damage a bone.
Called "the silent disease," the effects of osteoporosis include not only cosmetic factors but also chronic back and neck pain, difficulty walking and breathing, abdominal problems, and risk of future bone fractures. One in two women and one in five men over age 50 are at risk of bone fracture. A woman's risk of hip fracture, the most debilitating side effect, is actually equal to her combined risk of breast, uterine, and ovarian cancer.
"I see this every day, and I'm horrified to see how people's lives are affected," says Dr. Felicia Cosman, clinical director of the National Osteoporosis Foundation and an osteoporosis specialist at Helen Hayes Hospital in West Haverstraw, New York. "It's a very serious disease."
In fact, osteoporosis can kill. Each year, one-and-a-half million fractures occur in the United States as a result of this disease, and an average of 24 percent of hip fracture patients age 50 and over die in the year following their break.
These factors can increase your odds of developing osteoporosis:
- Being female. Eighty percent of patients with osteoporosis are women.
- Going through menopause. In particular the loss of estrogen can be devastating to the skeleton. Left untreated, some women lose 20 percent of their bone density in the first five years after menopause.
- Being age 65 or older. After this age both men and women absorb less calcium from the diet.
- Having a family history of the disease.
- Having a small or thin frame.
- Not getting enough calcium.
- Not getting enough exercise.
- Smoking. One study reports that postmenopausal women who smoke put themselves at a particular risk because they don't reap as much of estrogen's bone strengthening benefits. Smokers also tend to enter menopause earlier.
- Heavy drinking. Alcoholism is also a major cause of osteoporosis, particularly in men. "It's a poison to bone-forming cells called osteoblasts," says Dr. Sydney Lou Bonnick, director of the Institute for Women's Health at Texas Woman's University. If you drink, Bonnick recommends doing so only in moderation, and not every day.
Osteoporosis forms its roots in childhood. Bones develop during childhood when they grow in both size and density. Ninety percent of your bone mass is built by the time you turn 17. After age 18, bones no longer grow in size but continue to increase in density until peak bone mass is reached in our 20s. From age 30, men and women can lose one percent or more of their bone mass each year.
The mineral calcium is needed for good bone health and other functions, such as blood clotting and regulating the heartbeat. When the body doesn't get enough, it robs calcium from the bones. This weakens bones, particularly those in the spine, hip, and wrist, making them vulnerable to injury.
Unfortunately most of us, including half of all children under 5, don't get nearly enough calcium. Calcium intake plummets in adolescence, just as the requirements are increasing. Only about 15 percent of girls and 35 percent of boys ages 12 to 19 get the calcium they need.
Besides not eating right, many teenagers, girls in particular, become obsessed with their weight and cut back on calories. "Young people are concerned that milk is fattening, but it's not true, especially if they're drinking no-fat or low-fat milk," says Dr. Jonelle Rowe, a pediatrician and health scientist for the National Institutes of Child Health and Human Development's Milk Matters campaign.
Adding to the problem is the proliferation of soft drinks. Kids are swapping bone-building calcium for sugar and caffeine. "Soda should be a special thing once a week or at a birthday party," says osteoporosis specialist Felicia Cosman. It has no nutritional value, she says.
Milk and milk products are the best sources of calcium. A cup of skim, low-fat, or whole milk will supply you with 300 mg of calcium. "Milk has the whole package of nutrients important for bones," says Connie Weaver, Ph.D., who heads the Department of Foods and Nutrition at Purdue University.
Although dark green leafy vegetables contain calcium, they don't pack the calcium punch of milk. It takes over four servings of broccoli to equal the calcium benefits of one glass of milk. But don't pass on the fruits and vegetables. You need a balanced diet for all-around good health.
Calcium supplements also can help. A Mayo Clinic study reports that inexpensive supplements have no significant side effects. Supplements should not, however, completely replace dietary calcium. And buy from a reliable source; some calcium supplements can include harmful amounts of minerals like lead.
Calcium Needs at Every Age
The amount of calcium you should be getting varies throughout life. Clip this guide from the National Academy of Sciences as a daily reminder of calcium requirements for yourself and family members. What you do throughout life really does make a difference when it comes to lifelong bone health.
- Birth to 6 months: 210 mg/day
- 7 months to 1 year: 270 mg/day
- 1 to 3 years: 500 mg/day
- 4 to 8 years: 800 mg/day
- 9 to 13 years: 1,300 mg/day
- 14 to 18 years: 1,300 mg/day
- Pregnant and lactating women, 18 years or younger: 1,300 mg/day
- Men and women, 19 to 50 years: 1,000 mg/day
- Pregnant and lactating women, 19 to 50 years: 1,000 mg/day
- Men and women, age 50 and up: 1,200 mg/day
Now that you've gotten the diet part under control, put on your workout shoes. Exercise, including strength training, is an important component of good bone health. Try to work out at least 30 minutes four times a week.
The best exercise for the bones is what's known as weight-bearing exercise. This means any exercise that gives the bones a pounding, such as brisk walking, tennis, and jogging. Anyone at risk for fractures should stick with exercises recommended by a doctor.
Running ranked the highest for bone building out of all the exercises tested, according to a report released by the American Academy of Orthopedic Surgeons. You don't have to run a marathon or even a mile to reap benefits. Just 60 seconds of running during a brisk walk, reports the study, is enough to shift your bones into strengthening mode.
Get Your Bones Tested
The bone mineral density test is the most reliable way to assess bone strength and predict future problems. The X-ray test takes just minutes and is pain free. You don't even have to remove your clothes, and the amount of radiation exposure is minuscule. Medicare began paying for the tests a few years ago, and many insurance companies also cover them.
The most common of the bone-density tests is the DXA (dual-energy X-ray absorptiometry test). A key test, it's used to measure bone mass density at the spine or hip, where fractures are most serious. Tests that measure the extremities may not detect osteoporosis. It's important that both hip and spine be measured since results from these two sites can vary widely. For people who are otherwise healthy, the National Osteoporosis Foundation (NOF) recommends bone density testing for:
- All women 65 and over.
- Postmenopausal women under age 65 who have one or more risk factors besides menopause or who have had a fracture.
- Women on hormone replacement therapy for long periods of time.
While some doctors recommend having bone-density tests before age 30, the NOF's Dr. Cosman is against doing them in healthy women this young. "There is no medication approved for osteoporosis or low bone mass in a young person, so what's the point?" she asks. Instead she recommends that everyone be aware of what they need to do to keep their skeletons strong.
Dr. Bonnick from Texas Woman's University likes her patients to have their first bone density test in their late 40s. "If a patient is entering that period of life with low bone density, I am going to offer prescription intervention very quickly when she starts experiencing the signs of menopause."
Be concerned if you are told to wait until you've gone a year without periods before beginning estrogen replacement therapy. Bone loss can begin even two years before the last menstrual period, says Dr. Bonnick. "While the doctor is waiting for proof that she's not going to have any more periods, a woman may have lost 15 to 20 percent of her bone density." Testing is also recommended for women of any age who have gone through surgical menopause.
So far, a FDA-approved bone builder is not available. There are several medications that have been approved for postmenopausal women for the prevention and/or treatment of this disease. Your doctor can help you determine which is best for you.
- Alendronate. Sold as Fosamax, this is the most potent osteoporosis medicine around. It increases bone mass and reduces fracture risk.
- Hormone replacement therapy. Reduces bone loss, increases bone density in hip and spine, and reduces the risk of hip and spinal fractures in women who are postmenopausal.
- Raloxifene. Sold as Evista, this pill helps prevent osteoporosis by building bone and stopping the thinning of bone.
- Calcitonin. Sold as Miacalcin, this is a synthetic version of a hormone made by the thyroid gland. Calcitonin is sold in nasal spray or injection form.