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Simply put, osteoporosis is the development of weak bones that are so brittle that they fracture with the slightest injury. A slight fall, lifting a heavy bag of groceries - even hard coughs or hugs - all present a risk. Osteoporosis is not rare. It now affects an estimated 28 million Americans, including half the women in the United States over the age of 45, and 90 percent of women past the age of 75.

Each year, over 1.5 million fractures occurring in the United States are due to osteoporosis. Most of these are wrist, spine, and hip. The toll in pain and suffering in the elderly is great. Many "golden years" are lost due to disability from osteoporosis and the medical costs nationally are over $14 billion each year. Hip fractures especially take a toll since they are often the last straw. About one-fourth of elderly patients with hip fractures never regain an independent life-style and are confined to a nursing home until they die. Spinal "crush" fractures lead to loss of height, a rounded hunched forward appearance, and incapacitating back pain.

What Causes Osteoporosis?

Think of your bones like a "bank account." From birth to about age 30, the extra calcium in your diet is deposited in your "xbone bank" making your bones denser and stronger and resistent to injury. But after age 30 or so, it is difficult to add to your account. The account is almost closed. Instead, you begin to make withdrawals. To maintain your blood level of calcium, your body begins to take calcium out of your bones. The trick to avoiding osteoporosis is to build up such a big balance in youth, that your bone bank lasts you a lifetime. However, if you enter middle age with a "low balance" in your account, your bones will run out of calcium long before you die. There are no warning symptoms until the weakened bones begin to break. That is osteoporosis.

How Serious Is Osteoporosis?

Very. Many scientists feel that osteoporosis will be the epidemic of the future as millions of "baby boomers" pass from middle age to Medicare age. For centuries, children drank milk as their main beverage. All during their formative years, calcium was being deposited into their bones. The baby boomers are the first generation that was raised on Diet Coke and Dr. Pepper which, of course, contain no calcium for the "bone bank." Thus, the bank may be empty when it is time to make withdrawals.

Who Is At Risk?

Any adult can develop osteoporosis, but certain factors can increase your personal risk of developing this disorder. There are many - including:

• Female sex
• Caucasian or Asian heritage
• Small, thin frame
• Lack of regular weight-bearing exercise
• Poor calcium intake in diet
• Family history of osteoporosis
• Early menopause or removal of ovaries
• Low testosterone levels in men
• Tobacco use or heavy alcohol use
• Overactive thyroid
• Thyroid hormone pills
• Long-term prednisone use
• Diabetes
• Prior ulcer surgery
• Crohn's disease
• Eating disorders like anorexia

It's just because bigger is better. Osteoporosis causes symptoms when bone mass drops and bones become more fragile and susceptible to fracture. Men are born with "thicker" bones which tend to grow denser because they are generally more physically active than women. Since most women have thinner bones than men to begin with, they are more likely to develop fractures as osteoporosis progresses. Women account for 80% of those affected.

Also, the sex hormones estrogen (women) and testosterone (men) play a big role. During youth, these hormones protect your bones. After menopause, the production of estrogen in a woman's body declines. The deficiency of this bone-protecting hormone speeds up bone loss particularly in the first five years following natural menopause or surgical removal of the ovaries. A man's sex hormones stay relatively stable until about the age of 70, offering him protection much later in life.

How Can You Prevent Osteoporosis?

The American College of Rheumatology has recently published guidelines for preventing osteoporosis. While there is no guarantee that any measure can totally prevent this disorder, evidence suggests that you can minimize your risk of osteoporosis in these ways.

• 1. Getting enough calcium in your diet is essential to maintaining bone strength and can play a vital role in preventing osteoporosis-related fractures. Since calcium cannot be manufactured internally, the body relies on diet to provide it with foods rich in calcium. New guidelines issued in 1997 by the National Academy of Sciences recommend that adults get between 1000 and 1300 mg. of calcium each day. Currently, 90% of females 11 years of age and older fall short of that goal. One way to increase the amount of calcium in your diet is to eat calcium-rich foods like low-fat milk, yogurt, cheese, broccoli, and others. Four glasses of low fat milk every day would meet that goal. Other good sources are the new calcium-fortified orange juices and rice. Calcium is most important before age 30, but still important throughout life.

   

• 2. Another recommendation for high risk patients is to take calcium supplements with vitamin D . Vitamin D aids calcium absorption. We recommend Citracal caplets + D which can be purchased without a prescription in the vitamin section of your local pharmacy. Take two tablets twice daily with food. This will provide an extra 1260 mg. of calcium and 800 mg. of vitamin D each day. More vitamin D can be harmful.

   

• 3. Modify your life-style. Avoid all tobacco and excessive alcohol consumption, both of which may worsen bone loss.

   

• 4. Exercise can also be helpful in building and maintaining strong bones. Exercise that forces you to work against gravity - so called weight-bearing exercises such as walking or jogging - are most beneficial. Other helpful exercises include racquet sports, hiking, aerobic dance, and stair climbing. The benefits of exercise last only as long as you maintain the program. Perform a weight-bearing exercise for 30 minutes per day. Exercises such as sit-ups and others that excessively flex the spine should be avoided to reduce the risk of spinal fracture. Always check with your doctor before beginning an exercise program.

   

• 5. Estrogen replacement is an effective treatment to prevent bone loss in postmenopausal women. It is also effective in the prevention of fractures in women with established low bone mass or osteoporosis - reducing fractures over 50%. Women who are past menopause should receive estrogen hormone replacement therapy unless there is a contraindication. Women who have had pelvic surgery with removal of both ovaries should also be treated. Premenopausal women who have rare or absent menstrual periods should be on oral contraceptive hormone pills.

   

• 6. Have your bone density checked if you are in a high risk group for osteoporosis. This simple painless x-ray is called a bone mineral densitometry and must be ordered by your doctor. There are several ways to measure bone mass density; all are painless, noninvasive and safe. The tests measure bone density in your spine, hip and/or wrist, the most common sites of fractures due to osteoporosis. Newer tests using ultrasound will soon be available. The information from a bone density test enables your doctor to identify where you stand within ranges of normal and to determine whether you are at risk for fracture. In general, the lower your bone density, the higher your risk for fracture. A bone density more than 2.5 standard deviations below the mean is diagnositic for osteoporosis. Osteoporosis has no clear beginning. Until bone densitometry became available, its first visible sign was a debilitating fracture of the hip, wrist, or vertebral bodies causing pain or deformity. Now we can better estimate who is at risk.

   

• 7. The silent process of bone loss with age may no longer be inevitable. Two new drugs show great promise in prevention of osteoporosis. Miacalcin (calcitonin) is given as a nasal spray once a day and reduces bone loss. Fosamax (alendronate) is another new drug that has been shown to actually strengthen weak bones. It is given as a tablet, but may cause ulcers of the esophagus in some patients. Be sure you know how to take it correctly before starting treatment. Much research is being done and other new drugs are on the way.

Surveys show that most women confuse osteoporosis with osteoarthritis and other forms of arthritis. They wait for swollen joints, stiffness, and pain before they are concerned about osteoporosis. But, these two conditions are not the same. Arthritis is a painful inflammation of the joints between the bones. Osteoporosis is a painless weakening of the bones themselves and there are no symptoms until a fracture occurs.

What If You Already Have Osteoporosis?

Don't panic. It is never too late to add extra calcium and some vitamin D to your diet. Every little bit helps. The good news is that drugs like estrogen and Fosamax may actually help reverse early osteoporosis.

Be Careful Out There

If you have thinning bones, take extra precautions against falls and other accidents. Avoid poor fitting slippers and shoes, slippery walking surfaces, steep stairs, loose wires, poor lighting, and unstable furniture. Avoid the use of throw rugs. Use a night light. Consider bathroom support bars in shower or tub. When you were young you had to "baby-proof" your home to make it safer for your children. As you age, you must make it safer for yourself.

The Future....

Even though the symptoms of osteoporosis usually appear late in life, prevention should begin early in life. In fact, you might think of osteoporosis as a disease of teenage years. That is when most of the damage is done. Spread the word to your children and grandchildren. Make sure that their bone bank accounts are full of calcium before they reach adulthood. Don't let the next generation be affected.

Good Sources of Dietary Calcium

1 cup 1 cup 1 cup 1/2 cup 1 cup 1 cup 1 oz. 10 1 oz. 1 cup 1/2 cup

plain yogurt nonfat milk calcium fortified OJ calcium fortified rice 1% chocolate milk leaf spinach swiss cheese dried figs cheddar cheese broccoli, chopped frozen yogurt

450 mg 300 300 290 285 277 270 269 205 177 105

What is Your Risk?

• 1. Do you have a small, thin frame or are you Caucasian or Asian?
• 2. Has a female member of your immediate family broken a bone as an adult?
• 3. Are you a postmenopausal woman?
• 4. Have you had an early or surgically induced menopause?
• 5. Have you been taking thyroid medication or prolonged treatment with prednisone or other cortisone-like drugs for asthma, arthritis, colitis, or other diseases?
• 6. Is your diet low in dairy products and other sources of calcium?
• 7. Are you physically inactive?
• 8. Do you smoke cigarettes or drink alcohol in excess?
• 9. Do you have an intestinal or eating disorder?