Exercise and a diet rich in protein, calcium and vitamin D strengthen bones.

By John Perry

Most people don’t even know they have osteoporosis until they break a bone. This silent thief leaves few warning signs as once-strong bones slowly become thin, brittle, and more likely to fracture. Those signs include height loss, curvature of the spine, and sudden, excruciating back pain.

While no fracture is good, hip and spine fractures are associated with an increased risk of death, said Dr. Walter Sassard, a board certified orthopedic surgeon.

“Hip fractures can produce blood clots that can lead to strokes and heart attacks,” said Sassard, a specialist in the Independent Provider Network.

For a person 75 or older, 21.6 percent will die within a year following a hip fracture. (Source: Journal of Bone and Joint Surgery.)

Osteoporosis affects more than 28 million in the United States, causing more than 1.5 million fractures and health care costs exceeding $12 billion a year. (Source: American Physical Therapy Association.)

More common in women
Menopause quickens the process of bone loss, Sassard said. By age 80, many women have lost about 30 percent of their peak bone mass.

One-third of women 65 or older will have at least one vertebrae fracture attributed to osteoporosis. The hunchback appearance of elderly women, sometimes called “dowager’s hump,” is attributed to osteoporosis of the vertebrae.

Osteoporosis is the 12th leading cause of death among women in the United States. (Source: National Institute of Health.)

Literally, osteoporosis means “porous bones.” Medically, it is having a 25-percent or more loss in normal bone density. A loss of 10 percent to 25 percent is a condition called osteopenia.

Human bone density is related to the hormones estrogen and progesterone. Bone tissue is being continuously regenerated up to around age 35, when regeneration begins to slow. As women go through menopause, their ovaries quit producing estrogen and progesterone causing increased bone loss.

In women, 2 percent to 8 percent of long bone mass – bones in arms, legs, and part of the hip – and up to 20 percent of vertebral bone mass is lost within five years of menopause. Bone loss doubles every seven to eight years after age 50. (Source: HealthMonitor, July 2007.)

After menopause, women should see their doctor to assess risk factors, Sassard said.

Risk factors include a family history of osteoporosis, and a lifestyle that includes smoking, drinking alcohol excessively, and low calcium and vitamin D intake.

A bone mineral density test measures fracture risk. Lower BMD scores indicate more severe osteoporosis and a higher risk of fracture. Testing is recommended for post-menopausal women with at least one additional risk factor for osteoporosis, and for all women older than 65.

The BMD test is a covered benefit if a participating health plan doctor deems it medically necessary, said BlueCross BlueShield of Texas customer advocate Ivan Flake.

But not for women only
Although men typically have larger, stronger bones than women, they also are at risk for brittle bones.

Bone demineralization accelerates with the aging process for both men and women, Sassard said. “One in eight men will suffer an osteoporosis-related fracture during their lifetime.”

Two million men are affected by osteoporosis and another 3.6 million are at risk due to low bone mass. Moreover, one-third of all hip fractures occur in men. (Source: American Physical Therapy Association.)

Risk factors in men result from prescription steroids taken for such conditions as asthma, and chronic pulmonary disease as well as the same lifestyle risk factors for women.

Adults with irritable bowel syndrome are often at risk for developing osteoporosis because the medications needed for the condition interfere with calcium absorption.

“There is no known cure for osteoporosis,” Sassard said. “Once a patient has it, the main goal is management to slow its progression.”

Lifestyle modifications to prevent further bone loss include eating a balance diet.

“To maintain stronger, healthier bones, eat adequate amounts of protein and calcium with vitamin D,” said Sassard, who serves on the Therapeutic and Nutrition Committee for St. Luke’s Hospital.

Protein + calcium + vitamin D + exercise = stronger bones
Protein builds muscle and helps the body recover from injury, Sassard said. Recommended foods include turkey, chicken, and fish, of course, but also beans, peanut butter, and eggs.

Sassard recommends 1,000 to 1,500 milligrams of calcium daily taken with a vitamin D supplement to aid in absorption for patients 50 and older.

Bones are made up of more than 50 percent calcium. Calcium is the single most important nutrient for attaining bone mass. (Source: American Academy of Orthopedic Surgeons.)

Certain kinds of exercise increase bone density, Sassard said. “Weight-bearing activities like resistance training, strengthens bones.

“Not Schwarzenegger’s weights. Doing curls and bench presses using 5-to-8-pound hand weights for 15 to 30 minutes, two to three times a week can be beneficial,” Sassard said. “Walking six times a week for 30 minutes keeps bones and the cardiovascular system healthier.”

Walking on an inclined treadmill or using a stair-climbing machine is also recommended.

“My favorite exercise is swimming. It does wonders for the lower back,” Sassard said.

“Although a lot of my patients don’t like to hear it, golf is definitely not advisable for someone with bone weakness in the spine. There is too much twisting,” he said. “I also counsel older patients to avoid biking and bowling. It’s too easy to hunch over and there’s a risk of falling.”

Drug therapy
Drug therapy is recommended for all post-menopausal women who have osteopenia or a fracture, Sassard said.

Available medications include:

Bisphosphonates

• Fosamax slows osteoporosis in men and women. Available as a pill in daily and weekly doses. A Tier III nonpreferred brand.
  
• Boniva reduces and sometimes prevents postmenopausal osteoporosis. Available as pill in monthly doses or injections every three months. A Tier III nonpreferred brand.
  
• Actonel prevents osteoporosis in postmenopausal women; slows and sometimes prevents bone thinning in men. Available as a pill in daily or weekly doses. A Tier III nonpreferred brand.

Raloxufene

• Evista prevents postmenopausal osteoporosis. Builds bone density. Lowers risk of spinal fractures. Available as a pill in daily doses. A Tier II preferred brand.

Calcitonin

• Miacalcin slows bone thinning five years after menopause. Available as a nasal spray. A Tier II preferred brand.
  
• Fortical slows bone thinning five years after menopause. Available in nasal spray. Generic equivalent available.

Estrogen therapy

Climara slows postmenopausal bone thinning. Reduces fracture risk. Available in patches. May increase risk of breast and uterine cancer and cardiovascular problems. Generic equivalent available.

Sharon Blum, 60, was diagnosed with osteoporosis 10 years ago. She took Fosamax for eight years then switched to Boniva two years ago.

“I started drug therapy as soon as I was diagnosed,” said Blum of Human Resources. “I haven’t had a fracture yet so I guess it’s working.”

For more information on osteoporosis, visit the American Physical Therapy Association at www.apta.org or Everyday Health at www.everydayhealth.com.

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