Osteopenia and osteoporosis means “porous bones” causes bones to weaken and become brittle. Bones become so brittle that a fall from standing can cause a fracture, or bending over or even coughing can cause stress fractures. Osteoporosis related fractures most commonly occur in the hip, wrist and spine. Bone is living tissue which is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone.
Typically there are no symptoms in early stages of bone loss. Once your bones have been weakened by osteoporosis signs could include back pain, caused by the fracture or collapse of vertebrae, height loss over time, stooped posture, and low impact fractures called fragility fractures.
Your bones are in a constant state of renewal. When you are young, your body makes new bone faster than it breaks down old bone and your bone mass increases. Most people reach their peak bone mass between age 25 and 30 years. As we age bone mass is lost faster than it is created. How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age. You may want to speak with your provider about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if your parents had a hip fracture.
Gender plays a large role where women are much more likely to develop osteoporosis than are men. The older you get the greater your risk of osteoporosis. You are at greater risk of osteoporosis if you are white or of Asian descent. Family history is of concern if your parent or sibling has osteoporosis puts you at greater risk. Body frame size in men and women if they have small frames tend to have a higher risk because they may have less bone mass to begin with.
Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Lowered sex hormone levels tend to weaken bone, the reduction of estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis.
Men experience a gradual reduction in testosterone levels as they age. Treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss. The thyroid if it produces too much thyroid hormone which happens when your thyroid is overactive can cause bone loss. Osteoporosis has also been associated with overactive parathyroid and adrenal glands.
Diets with low calcium intake throughout life plays a role in the development of osteoporosis. Eating disorders which severely restrict food intake and being underweight weakens bone in both men and women. Gastrointestinal surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium.
Long term use of oral or injected corticosteroid medications, such as prednisone and cortisone, interferes with the bone rebuilding process. Other medications which interfere with bone rebuilding include seizure, gastric reflux, cancer and transplant rejection medications. The risk of osteoporosis is higher in people who have certain medical problems, including celiac disease, inflammatory bowel disease, kidney or liver disease, cancer, lupus, multiple myeloma and rheumatoid arthritis.
Lifestyle choices such as tobacco use increase your risk of osteoporosis. Excessive alcohol consumption greater than two alcoholic drinks per day increases your risk of osteoporosis. People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Any weight bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking running, jumping, dancing and weightlifting are helpful.
Bone fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often are caused by a fall and can results in disability and even risk of death within the first year after the injury. In some cases, spinal fractures can occur even if you haven’t fallen. The bones that make up your spine can weaken to the point that they may crumple, which can result in back pain, lost height and hunched forward posture.
Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life. Protein is one of the building blocks of bone. While most people get plenty of protein in their diets, some do not. Vegetarians and vegans can get enough protein in the diet if they intentionally seek suitable sources, such as soy, nuts, legumes and dairy and eggs if allowed. Older adults may also eat less protein for reasons such as difficulty chewing animal protein. Protein supplementation is an option. Being underweight increases the chance of bone loss and fractures. Excess weight is now known to increase the risk of fractures in your arm and wrist. Maintaining an appropriate body weight is good for bones just as it is for health in general.
Men and women between the ages of 18 to 50 need 1000 mg of calcium a day. This daily amount increases to 1200 mg when women turn 50 and men turn 70. Good sources of calcium are dairy products, dark green leafy vegetables, canned salmon, sardines complete with bones, soy products, such as tofu, and calcium fortified cereals and orange juice. If you find it difficult to get enough calcium from your diet, consider taking calcium supplements.
Vitamin D improves your body’s ability to absorb calcium and improves bone health in other ways. People can get adequate amounts of vitamin D from sunlight, but this may not be a good source if you live at high latitude, or if you are house bound, you regularly use sunscreen or avoid the sun entirely due to the risk of skin cancer. For people without other sources of vitamin D and especially with limited sun exposure, a supplement may be needed. Most multivitamin products contain between 600 and 800 IUs of vitamin D. Up to 4000 IU of vitamin D a day is safe for most people.
Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you’ll gain the most benefits if you start exercising regularly when you’re young and continue to exercise throughout your life. Combine strength training exercises with weight bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight bearing exercises such as walking, jogging, running, stair climbing, skipping rope, skiing and impact producing sports affect mainly the bones in your legs, hips and lower spine. Balance exercises such as tai chi and yoga can reduce your risk of falling especially as you get older. Swimming, cycling and exercising on machines such as elliptical trainers can provide a good cardiovascular workout, but they are not as helpful for improving bone health.
If you are at high risk for osteopenia or osteoporosis the time is now to set up an appointment with your medical provider for evaluation and if necessary treatment. Prevention begins early in your adolescent years but it is never too late to start working on good bone health.
Questions and or comments regarding this week’s health column please contact Anne Weinberger, Adult Nurse Practitioner, Osteoporosis Clinic, a service of Marcus Daly Memorial Hospital located in the Bitterroot Orthopedics and Sports Medicine clinic, 1200 Westwood Drive, Hamilton, MT 59840. Follow us on Facebook and visit MDMH.org.