Osteoporosis in Women

While many of the American women reaching their fiftieth birthdays in the next decade may feel well informed about high profile diseases such as breast cancer, a disease that has been called "the silent thief" may be sneaking up on them. Unlike breast cancer, osteoporosis, the bone-thinning condition affecting 28 million Americans and 29,000 Nevadans — 80 percent of them women — can be prevented.

Osteoporosis is becoming more of a recognized public health threat precisely because women are living longer than ever. Strong bones can make the difference between spending the decades of life after 50 as an active, independent woman or a woman crippled by kyphosis (spinal curvature) or a debilitating broken hip that can hasten dependence and even death.

The good news is that osteoporosis is preventable and treatable. The key is early diagnosis before bone loss becomes severe. An estimated 77 percent of Americans with low bone mass are undiagnosed and receiving no treatment. They are likely to experience one of the 1.5 million fractures of the hip, spine or other bones occurring yearly in the U.S.

Bones Aren't Like Sticks and Stones

Why is treatment so important? Contrary to assumption, bones aren't lifeless structures. As other body tissues, bones change continuously. Bones experience constant renewal through a process called remodeling in which old bone is removed and replaced by new bone. The cycle happens in both exterior and interior bone.

Remodeling is different for youth than for older adults. After teens stop growing and until about age 30, bone is grown at a more rapid pace than it is removed, so bones grow in size and density. At 30, peak bone mass is reached and may be retained until menopause in women — or may start to decline at a rate of up to about one percent per year.

Everyone experiences some bone loss with age, but osteoporosis and its fractures are not a normal part of aging. Detection and treatment make aging with strong bones possible for all women.

The Ugly Side of the Super-model Look

The seeds of osteoporosis can be sown during youth if not enough bone is formed during growth years. In a society that idealizes ultra-thinness and a fast-paced, competitive lifestyle, young women may be particularly vulnerable to the following risk factors that contribute to accelerated bone loss:

• Anorexia
• Bulimia
• Long-term overtraining for sports
• Abnormal absence of menstrual periods (amenorrhea)
• Cigarette smoking
• Excessive alcohol use
• Use of certain drugs including steroids
• Poor diet, especially one low in calcium

Additional risk factors can affect almost anyone:

• Being female
• Small, thin build
• Early menopause in women
• Advanced age
• Family history of osteoporosis
• Use of anticonvulsants, excessive thyroid hormones, certain cancer treatments
• Low testosterone levels in men
• Sedentary lifestyle

What's a Woman to Do?

The National Osteoporosis Foundation places the U.S. cost of osteoporotic fractures at $10 to $18 billion annually. With increased understanding of the consequences of osteoporosis, many doctors have begun to follow the National Institutes for Health recommendations for calcium intake:

• Infants birth to 1 year: 400-600 mg
• Children 1 - 5 years: 800 mg
• Children 6 - 10 years: 800-1,200 mg
• Youth 11 - 24 years and pregnant and nursing women: 1,200-1,500 mg
• Men 25 - 65 years: 1,000 mg
• Women 25 - 49 years and 50 - 64 years taking estrogen: 1,000 mg
• Women 51 - 65 years not taking estrogen and everyone older than 65 years: 1,500 mg

Calcium sources are numerous. "As a rule of thumb, one serving of a calcium source such as a one cup of milk, one cup of yogurt, and one and a half ounces of cheese provides about 300 to 400 milligrams of calcium," said Dennis Brown, MD, who with John Deweerd, MD, is co-medical director of Northern Nevada Medical Center's Vista Osteoporosis Center. "Also, a generally good diet can be counted on to provide about 300 milligrams of calcium from other sources," he added.

Nonetheless, according to one survey, the average American's daily consumption of calcium from food is less than 800 milligrams.**

"The basics of prevention for everyone, regardless of age and menopausal status, are to get regular weight-bearing exercise, appropriate calcium and vitamin D," said Dr. Brown, Not all calcium is equal Absorption of calcium supplements isn't as complete as in food, so nothing truly replicates calcium from food sources. But realistically, many people who are eating less than the desirable diet need to take calcium supplements to provide enough calcium to help ensure against early bone loss.

Vitamin D supplementation is recommended at 1,200 IU for pre-menopausal and 1,500 post-menopausal women. Follow these guidelines to maximize supplement use:

• Take calcium with food.
• Calcium carbonate is absorbed more efficiently than calcium citrate, calcium gluconate, calcium lactate or calcium phosphate.
• Be aware that supplements vary in the amount of calcium per tablet: Caltrate 600 has 600 milligrams, Tums 500 has 500 mg, and Citracal has 200 mg., so two or more tablets must be taken to reach proper dosage.
• Don't overdose: calcium in excess of 1,500 mg daily can cause gastrointestinal problems and interfere with absorption of other minerals and drugs including fluoride, iron, zinc and certain beta-blockers.
• Vitamin D is better accessed when in a multi-vitamin than when taken as an individual supplement.

Should I Get the Test?

Bone density testing is the only way to diagnose osteoporosis before a fracture occurs. The test is quick, painless and uses a very safe type of low-dose X-ray that doesn't even require shielding. It's the only way reliably to predict future chances of fracture.

Doctors who serve as primary care physicians for women — family practitioners, internists and gynecologists — are beginning to recommend bone density testing for women who are deciding whether to begin long-term estrogen replacement therapy. Other risk factors and long-term use of certain medications for diseases such as asthma, arthritis, lupus or Crohn's disease also may prompt testing.

As information about osteoporosis and bone density testing becomes more visible, baby-boomer women who suspect they may be at risk because of years of overdieting and poor nutrition also are initiating the discussion of osteoporosis with their doctors.

Treatment: Several Ways to Go

"Preventative treatment through proper diet and exercise is the ideal for pre-menopausal women," said Dr. Deweerd. "After menopause, estrogen is the primary treatment." Estrogen is available in a variety of formulations of pills and patches.

For women who can't take estrogen, several drugs including pills and nasal spray have been shown to be effective in halting the progress of osteoporosis. Regardless of the drug chosen, it's vitally important that women stay with their medication.

"Studies have shown that about 60 percent of all women taking estrogen end up quitting the medication," said Dr. Brown. Although estrogen has been shown to prevent osteoporosis and heart disease, and even possibly Alzheimer's disease, studies also have shown that the medication increases the risk of breast cancer.

"Women should weigh their family and personal health histories and talk to their doctors," said Dr. Brown. It's important for women to take responsibility for their own health. The more you know, the better you'll be able to live a long and independent life.

Northern Nevada's Vista Diagnostic Center offers bone density screening services. For more information on bone density screening, please call 775-356-1212.