Steps to Prevent Osteoporosis and Osteopenia

Start promoting bone health at an early age, experts say.

January 31, 2011, 1:21 PM

Feb. 4, 2011— -- Long gone are the days when women with the tell-tale humpback were the only ones identified with osteoporosis.

Even women who can stand straight and tall may suffer from the disease that causes weak and brittle bones. While some people often think of the condition as an old woman's disease, it is important for men and women of all ages to maintain good bone health in order to avoid bone loss, experts say.

About 10 million Americans have osteoporosis and 34 million more suffer from low bone density, researchers estimate.

Osteoporosis, Greek for porous bones, is a condition that causes bones to become weak and brittle, making sufferers more likely to sustain fractures, mostly to the spine, hip and wrist. The condition causes more than 1.5 million fractures each year in the United States, and about 20 percent of those people die from complications, according to the National Osteoporosis Foundation.

But aside from those people who have osteoporosis, many more suffer from osteopenia, a condition where bone mineral density is lower than normal, putting people at high risk for osteoporosis.

"Both [osteoporosis and osteopenia] conditions are silent, in that losing bone does not cause symptoms until or unless there is a fracture," said Dr. Murray Favus, professor of medicine at the University of Chicago School of Medicine.

"So, awareness of the individual's risk factors and bone density is critical in preventing fractures."

Once bones have been weakened by osteoporosis, patients will often have a stooped posture, lose height and fracture wrists, hips or vertebrae.

Risk factors for the condition include a low calcium intake, smoking, eating disorders, excessive alcohol use, long-term steroid use, and other medications, including, aromatase inhibitors to treat breast cancer, some anti-seizure medications, and aluminum-containing antacids.

A family history of the condition, a smaller frame, and white and Asian descent increase the risk of osteoporosis and women are almost twice as likely to suffer from fractures related to the condition than men.

'Men Can Have It, Too'

But men are not in the clear.

"Men can have it, too," said Dr. Ranit Mishori, assistant professor in the department of family medicine at Georgetown University School of Medicine in Washington, D.C. "In fact, millions do, but they are often not identified. Men with osteoporosis actually have worse outcomes when and if they fall."

It's important to receive adequate amounts of calcium and vitamin D, and not just as an adult. Humans stop growing new bone around the age of 30, so the more bone you can build up in your early years and maintain in your 30s and 40s will help to reduce risk or even prevent the condition at a later age.

"Adequate calcium intake starting in childhood can prevent osteoporosis later in life," Mishori said. "So get that calcium into your kids, daughters in particular."

Women, especially, should consume at least three servings per day of calcium-rich products such as cheese, yogurt, tofu and sardines. Girls and teens should get about 1,300 mg of calcium per day, women 19 to 50, about 1,000 mg per day, and 1,200 mg for women older than 50.

Vitamin D is also crucial; it promotes calcium absorption in the body and can be found naturally in sunlight. Experts say 15 minutes of sunshine on the skin at least twice a week should give your body the adequate amount of needed vitamin D.

For those who live in cold climates for a good portion of the year, the vitamin can be found in fortified milk, fish, eggs and supplements. People up to 70 years of age should aim for 600 IU per day, and anyone older should up their intake to 800 IU per day. About 3½ ounces of salmon will get you 360 IU, and a cup of vitamin D-fortified milk clocks in at 98 IU.

And, along with receiving adequate calcium and vitamin D, Mishori said it's important to maintain an active lifestyle throughout life.

"Exercise, exercise, exercise to enhance bone strength, particularly weight bearing, but also jumping in place, [and] running if you can," Mishori said. "Tai chi has been shown to be very beneficial in maintaining balance and gait to prevent falls, which could be disastrous if you have weak bones."

Don't Smoke: 'Quit Now'

And, in case people need yet another, kick the smoking habit, Mishori said.

"Smoking is a risk factor for osteoporosis," she said. "Quit now. Don't start."

Smoking decreases estrogen, a hormone that helps to slow bone loss, production in the body. Heavy drinking has a similar outcome: Too much alcohol can slow and prevent calcium absorption in the body.

The National Osteoporosis Foundation recommends that doctors administer a bone-density test to female patients older than 65 and male patients older than 70.

Postmenopausal women with at least one risk factor, people older than 50 with a history of a broken bone, and those taking medications such as prednisone and anti-seizure should receive a bone-density test.

"Once osteoporosis is identified with a DEXA [bone] scan, you do not need to have [the scan] every year," Mishori said. "This is a total waste of money.

"While there are no robust guidelines, the recommendation is that it be done two to three years after the initiation of treatment."

The goal in treating osteoporosis is to prevent bone fractures by reducing bone loss. While the lifestyle changes mentioned above do help with treatment, medications such as Fosamax, Actonel, Evista and Boniva promote bone strength in people who suffer from the condition.

And, despite all the chatter on bone health, Dr. Steve Cummings, professor of medicine and epidemiology at the University of California at San Francisco, said some doctors are moving away from the terms "osteoporosis" and its predecessor, "osteopenia."

"Many experts are moving away from using the words, 'osteoporosis' and 'osteopenia' because we believe that the most important thing is a person's risk of fracture," Cummings said. "Some without osteoporosis have a high risk and some, mainly relatively young women, with osteoporosis or osteopenia have a relatively low risk of fracture."

And, to go along with that, Favus said: "More fractures occur among the population with osteopenia because there are more people in the category; however, the fracture rate is higher in those in the osteoporosis range."

Pursue a Treatment Plan

If you are at risk of weakened bones and osteoporosis, Favus said, be sure to talk with your doctor about the best way to prevent adverse outcomes of the condition.

"For those with weak bones, [or] increased fracture risk with susceptibility to fracture with little or no trauma," Favus said, "a treatment plan to strengthen bone and prevent further bone loss should be undertaken and followed with good adherence."

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