What You Need to Know to Prevent Fractures
About 29 million Americans, 80 percent of them women, suffer from osteoporosis or low bone mass, which literally means "porous bones." Most of these people, unfortunately, remain undiagnosed and untreated. The good news? Over the past ten years, medical research has given us prevention strategies, improved diagnostic techniques and new treatments to help us deal with this often debilitating condition.
The deterioration of bone structure and bone mass associated with osteoporosis leads to compromised bone strength and susceptibility to fracture (NIH Consensus Conference on Osteoporosis, March 2000). Simply stated, osteoporosis refers to the thinning of bone which increases a person's risk for fracture or broken bones. It is called the "silent disease" because the person experiences no symptoms associated with the bone lossâ€”until a fracture occurs. The most common types of osteoporotic fractures are of the vertebrae, hips and wrist.
A fracture can occur with little or no trauma, leaving a person with debilitating, severe pain. Repeated fractures lead to more pain, loss of height, postural changes that can limit activity, including bending and reaching. It also causes spinal deformity (Dowager's hump), restrictive lung disease and digestive problems, including constipation, abdominal pain, distention, and reduced appetite. There can be psychological symptoms as well, most notably depression and loss of self-esteem as one grapples with pain, physical limitation and cosmetic changes. Because osteoporosis can affect a person in many ways, it is important to correctly manage the disease, even before symptoms are experienced.
Every year, there are 1.5 million new fractures in people who have soft bone secondary to osteoporosis. Of these, 700,000 people annually sustain spine fractures, 300,000 hip fractures, 250,000 wrist fractures and 250,000 fractures of other bones, all as a result of osteoporosis. With 700,000 spine fractures a year, this translates to one compression fracture every 45 seconds. After a patient sustains their first compression fracture, the risk of an additional fracture goes up more than five fold (Annals of Internal Medicine).
Over half of women aged 70-79 years will have developed osteoporosis. By age 80, it increases to three out of four women. Men also develop osteoporosis, but it is usually related to medications or some other health issue.
Are You At Risk?
Understanding the risks for developing osteoporosis is helpful in prevention and treatment of the disease. Those at most risk are postmenopausal females (including those who had surgery-induced menopause by hysterectomy) of Caucasian or Asian descent; other factors include being thin or having a small frame, a family history of osteoporosis, a low-calcium diet, smoking, alcohol use and an inactive lifestyle. Some medical conditions such as hyperparathyroidism or anorexia nervosa can also lead to bone density loss. Long-term use of certain medications, specifically oral steroids (not inhaled steroids), anti-convulsants, chemotherapy, heparin and aluminum-containing antacids are also associated with bone loss.
Women reach peak bone mass around age 30. After 30, bone loss slowly begins. However, with the loss of estrogen due to menopause, bone loss accelerates to about 2-3% a year for the first five years. Then it slows again to about 1% loss a year. As you can see, over time, bone loss can be significant. As an older adult, it's not surprising that osteoporosis can become a problem particularly when one has one or more risk factors.
Prevention of osteoporosis begins during childhood to early adulthood when bone density is still increasing. A healthy diet with appropriate amounts of calcium is essential while young. Depending on your age, it is recommended that you ingest appropriate amounts of calcium daily (along with vitamin D) – Adults, aged 19-50 years, 1000 mg; 51-64 years, 1200 mg; 65+ years, 1500 mg. Also note that one can not absorb more than 500 mg of calcium supplement at one time. So, if a supplement is necessary because diet is not sufficient, it should be taken in split doses, not all at once.
Calcium supplementation is important in anyone at risk of developing osteoporosis and in those who already have the disease. Several types of calcium supplements are available at your drugstore. Calcium carbonate is most readily available and least expensive. However, adults over age 70 or adults taking medications that reduce stomach acid production should use calcium citrate, which does not need much stomach acid for absorption. Calcium citrate is also most easily absorbed by the body with or without food, while Calcium carbonate is absorbed best when taken with food. Check with your doctor on the best type of calcium and dosage for you.
Other important preventative steps include weight bearing exercise, smoking cessation, and a periodic check-up including bone density testing. Walking as little as 20 minutes a day has been shown to increase bone density. Other weight bearing exercises include jogging, dancing, hiking, and stair climbing. Swimming and bicycling are not considered weight bearing exercises. A weight-lifting exercise program can be helpful but always consult your doctor before beginning any exercise program.
Smoking has been shown to increase a person's risk for osteoporosis. Smoking cessation is vital not only for bone health, but also for the health of the heart and lung, brain, kidneys, skin, sinuses, mouth, teeth and blood vessels. Not smoking is one of the best health decisions a person can make.
An important tool in the prevention and diagnosis of osteoporosis is a dual energy x-ray absorptiometry (DEXA) scan. This scan is very accurate and used to determine bone mass density. It detects osteoporosis and even early loss bone mass. It is important to note that regular x-rays will not show bone mass loss until there has been 30-50% lossâ€”another reason to stress the importance of the DEXA scan. The US Preventative Services Task Force recommends all women, 65 years and over, have a DEXA scan to evaluate bone density. Women who have had early or surgically induced (hysterectomy) menopause should be tested as well. After the initial scan, a repeat DEXA scan is recommended (and covered by Medicare) every 2 years.
Once a diagnosis of osteoporosis is made, there are effective prescription medications available to help increase or maintain bone density. Medications that slow down bone loss are Fosamax, Actonel or Miacalcin. Fosamax or Actonel are taken once weekly and can decrease the risk of hip and spine fracture. Miacalcin, although not quite as effective, can be tried if Fosamax or Actonel are not tolerated or if you are have certain gastrointestinal disorders. A new medication that actually builds new bone is called Forteo. Forteo is self-administered through a daily injection underneath the skin of the abdomen or thigh for one year. It is the most effective drug available to fight against osteoporosis, although it is not used as a first choice because of cost.
What If A Fracture Occurs?
If a spinal fracture(s) occurs as a result of osteoporosis, pain management is the first step. However, there are minimally invasive surgery options available as well with additional benefits. Although the fracture may heal in time, it heals in its compressed state. This can result in the humping over posture (Dowager's hump) as well as long term pain until healing is complete. For a compression fracture(s) of the spine, a simple procedure called Kyphoplasty can be performed to stabilize the fracture and immediately relieve the pain associated with the fracture. It also will restore the height of the vertebra itself, returning you to full activity within a day or two. It is best to have the procedure performed within 6 weeks of the fracture before too much healing has taken place. (Read more about Kyphoplasty in our previous Vertebral Views newsletter, Spring 2005 or at our website, sonoranspine.com.)
You Can Help!
Of course, prevention is the best medicine. The decade of the 2000s has been officially designated by our government as the "Bone and Joint Decade", drawing attention to the underappreciated disease, osteoporosis. As the U.S. population ages, more people will be affected by osteoporosis and the resulting bone fractures. A healthy diet and regular exercise are key to healthy bones and a healthy body. Taking time to exercise, eat well and obtain regular bone density scans will help you live the active lifestyle you desire and deserve.
Food Sources of Calcium
|Plain yogurt, non-fat (13 g protein/8oz), 8-oz container||452||127|
|Romano cheese, 1.5 oz||452||165|
|Pasteurized process Swiss cheese, 2 oz||438||190|
|Plain yogurt, low-fat (12 g protein/8 oz), 8-oz container||415||143|
|Fruit yogurt, low-fat (10 g protein/8 oz), 8-oz container||345||232|
|Swiss cheese, 1.5 oz||336||162|
|Ricotta cheese, part-skim, ½ cup||335||170|
|Pasteurized processed American cheese food, 2 oz||323||188|
|Provolone cheese, 1.5 oz||321||150|
|Mozzarella cheese, part-skim, 1.5 oz||311||129|
|Cheddar cheese, 1.5 oz||307||171|
|Fat-free (skim) milk, 1 cup||306||83|
|Muenster cheese, 1.5 oz||305||156|
|1% low-fat milk, 1 cup||290||102|
|Low-fat chocolate milk (1%), 1 cup||288||158|
|2% reduced fat milk, 1 cup||285||122|
|Reduced fat chocolate milk (2%), 1 cup||285||180|
|Buttermilk, low-fat, 1 cup||284||98|
|Chocolate milk, 1 cup||280||208|
|Whole milk, 1 cup||276||146|
|Yogurt, plan, whole milk (8 g protein/8 oz), 8-oz container||275||138|
Food sources of calcium ranked by milligrams (mg) and calories per standard amount.
Source: Dietary Guidelines for Americans 2005, Center for Nutrition Policy and Promotion(CNPP), U.S. Department of Agriculture (USDA)
Over-the-Counter Calcium Supplements
CALCIUM SUPPLEMENTS are recommended for persons who do not meet their daily calcium requirements from diet alone. The two major choices are outlined below. Calcium is best absorbed if consumed throughout the day. Be sure to read and follow label directions, and to choose a national brand to ensure quality. Avoid bone meal or dolomite, as they may contain toxic ingredients. Dose should not exceed 500 mg at one dosing.
|Calcium Carbonate||Calcium Citrate|
|(Provides 40% elemental calcium)||(Provides 21% elemental calcium)|
|Relative Cost: $||Relative Cost $$$|
|Brand Names: Alka-Mints, Caltrate, OsCal, Titralac, Tums, Viactiv||Brand Names:Citracal Liquitabs, Citracal, Citracal-D|
|Take with food.
||Take with or without food.