How strong is your ‘bone bank’?
Susan Locke, MD, discusses how to slow the onset of osteoporosis as your body ages . . .
Osteoporosis is a condition where the bones become weak and brittle due to loss of bone density, making them more vulnerable to fracture. Bones are continually “remodeling” — new bone is being made and old bone is broken down or “resorbed.” New bone requires calcium, vitamin D, phosphorus and other minerals. Peak bone mass is achieved around age 30. After that, you lose slightly more bone than you gain. The higher the peak mass achieved, the more “savings” you have in your “bone bank.”
According to the National Osteoporosis Foundation, 44 million people in the U.S. over the age of 50 have osteoporosis. Eighty percent of them are women. White women are at higher risk for osteoporosis than women of color. Other than race, risk factors for osteoporosis include:
• Lifetime low intake of calcium and vitamin D
• Family history of osteoporosis
• Personal history of fractures after age 40
• Thin or small frame
• Estrogen deficiency after menopause
• History of amenorrhea
• History of an eating disorder
• Excessive alcohol
• Sedentary lifestyle
• Advanced age
• Certain medical conditions (hyperthyroidism, Crohn’s disease, hyperparathyroidism, Cushing’s Disease or rheumatoid arthritis)
• Malabsorption conditions • Chronic use of certain medications including steroids and aromatase inhibitors.
Prevention and treatment
To answer questions about osteoporosis, I talked to Holly Thacker, MD, director of the Cleveland Clinic Center for Specialized Women’s Health, about modifying one’s risk and treatment options. Not all risk factors are modifiable, but she gave some recommendations to promote bone health.
• “Build up your savings.” It’s nearly impossible to get enough calcium and vitamin D by diet alone. The recommended daily dose of calcium is 1200-1500 mg/day in divided doses. The dose of vitamin D should be at least 1,000 IU/day, with more if there is little or no sun exposure.
• Perform weight-bearing exercises at least three times per week.
• Do not smoke. Do not drink alcohol excessively.
Thacker says that within two years of menopause, women should have their bone density tested — earlier for patients with a family history of osteoporosis, low vitamin D level, longtime steroid medication use, history of unexplained bone fractures, skipped menses, or for those who have taken treatments that lower their hormone levels.
The most common way to diagnose osteoporosis is by a specific type of X-ray called dual energy X-ray absorptiometry (DXA). This X-ray takes a measurement bone density in your hip, spine and wrist. It’s a painless procedure, requiring no preparation. Usually two scores are generated. The T-score compares your density to the ideal number (that of a 30 year old) and then looks at the number of standard deviations from the ideal. The Z-score compares your bone density to that of someone of your own age and ethnic group.
After the initial bone density test, repeat testing should be done in two or three years in order to track the bone loss rate. Thacker emphasizes that, whenever possible, the test should be done on the same machine.
For men, she recommends that bone density screening be done at 65 years old unless other risk factors are present. Men should discuss with their physician whether screening is indicated for them before the age of 65.
Always consult your physician to discuss your individual risk factors for osteoporosis. If you would like information about the treatment of osteoporosis, please contact us (see What is Healthnetwork below) and we will provide you with additional information.
Susan Locke, MD, is Healthnetwork Foundation’s medical director.
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