Be Good to Your Bones

By June LaValleur, M.D.

Osteoporosis is a pediatric disease with geriatric consequences. As teenagers, we women need enough calcium in our diet to build strong bones for our years as older women. We build bone from the time we are born until we are about 32 years old. After that, the bones stay stable for a few years and then slowly begin to lose density. At menopause, the rate of loss accelerates.

With osteoporosis, the hip, spine, and wrist bones especially become fragile. Along with pain, disability, and possible loss of height, the consequences of osteoporosis can even be deadly. Because of complications, women who break a hip after the age of 70 have a 24 percent chance of death in the first year. Another 25 percent will require long-term nursing. Treating osteoporosis costs the country about $17 billion a year.

In the United States about 55 percent of women age 50 and older 30 million women are at risk for osteoporosis. (Men also are diagnosed with the "brittle-bone" disease, but at one-quarter the rate of women.) Especially vulnerable are: people with a family history of osteoporosis, whites and Asians, those who are thin or small-boned, and those with low calcium in their diets or little physical activity. Causes of bone loss that women have some control over include heavy drinking, some prescription medications, steroid use, and smoking, which typically makes women go through menopause two years sooner than they would have.

Although few girls from 9 to 18 are thinking about osteoporosis, those years are crucial for building bone. Teens and pre-teens should get about 1,300 milligrams (mg.) of calcium daily, combined with vitamin D so that the calcium is properly absorbed by the bones. (For those 19 to 50 years old, 1,000 mg. is recommended; 1,200 mg., after 50 years.) An 8-ounce glass of milk serves up 300 mg. of calcium, as does the same amount of calcium-fortified orange juice or calcium-fortified tofu.

In addition, women need to do a fair amount of walking, 30 minutes, three times a week, in order to build and maintain healthy hips and spines. Jogging, dancing, or tennis would also help. Exercising the wrists and arms will maintain strength and build those bones as well. Even in their 40s, women who follow a calcium-rich diet and exercise may reduce their rate of bone loss.

Preventing osteoporosis is the first and most important thing. The second thing is to get diagnosed. Bone mineral density testing is the best method we currently have to predict risk for fracture. If your bone density is good, it doesn't mean you won't have a fracture but you have far less risk. The National Osteoporosis Foundation recommends these bone-density tests for all women over 65 and those younger who have, besides menopause, an additional risk factor. Women should check with their physician to see if their health plans will cover the test.

If you're diagnosed, get it treated. Women and their doctors now have options. Hormone replacement therapy with Prempro reduced fractures, as was shown by recent Women's Health Initiative research, but that part of the study was stopped because that hormone combination also caused a small increase in breast cancer, heart attacks, strokes, and blood clots. Drugs such as Evista, Actonel, Fosamax can be used for both prevention and treatment. Calcitonin can also be used for treatment. Parathyroid hormone is a new treatment to be used only in certain cases.

Osteoporosis is not normal. A 94-year-old referred to me had been told by her doctor that a little back pain was to be expected at her age. She had multiple fractures and had lost four inches in height. That's not normal or acceptable. No one should suffer like that.

June LaValleur, M.D., is an Associate Professor at the University of Minnesota Medical School Department of Obstetrics, Gynecology and Women's Health. This column is an educational service and advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalkandyou.com/ or look in your television listings for the weekly show "Health Talk & You."

Updated Feb. 9, 2004