Osteoporosis

Ten million Americans have Osteoporosis and the Surgeon General reports another 34 million are at risk.  Current projections suggest that by 2020, 1 in 2 Americans over 50 will be affected by this debilitating condition.  Osteoporosis develops when bones break down faster than they are rebuilt resulting in more fragile, brittle bones. Although the long-term effects of osteoporosis may be most obvious in the elderly, the disease has roots that often begin in childhood.  The good news is that osteoporosis is not inevitable; we can and should make an effort to improve our bone health.  Eating right and exercising are two great steps to begin with.  Where have I heard this before?

To understand why lifestyle choices are important and what else you can do let’s start with a look at the basic physiology of bone formation.  Cells called osteoblastscontinually build new bone from proteins like collagen and minerals like calcium.  Other cells called osteoclasts continually break down old bone to leave cavities where stronger, new bone can be deposited.  This process of remodeling generally continues in balance until about age 30 when bone density reaches its peak.  Osteoporosis is a condition of weakened bone caused by an imbalance in bone building and bone repair that can occur at almost any age. Several factors can increase your odds of developing osteoporosis including: female gender or age greater than 65, an estrogen deficiency, physical inactivity, low calcium intake, smoking, a small frame or very low body weight, or a family history of osteoporosis.  The drop in estrogen that comes with menopause causes women to lose bone faster than men and puts them at a greater risk.  After 65, though, men and women lose bone mass at about the same rate.  In addition, thyroid problems, long-term use of corticosteroid medication, and some other drugs, like aluminum containing antacids, are also associated with higher risk.

Healthful habits can maximize peak bone mass and prevent or slow the progression of subsequent bone loss.  Number one on the list and an easy step towards keeping bones strong is of course getting plenty of calcium.  Calcium needs vary by age:  Both boys and girls in the peak of bone-building years of adolescence need 1200 to 1500 mg a day.  After age 25, the requirement is for 1000 mg daily and after 65, or for women after menopause, the daily intake should be 1200-1500 mg.  High calcium foods include calcium-fortified orange juice and soy milk, almonds, leafy green vegetables and broccoli, and dairy products including milk, cheese and yogurt.  Calcium supplements are an important addition to a balanced diet since most of us don’t meet these needs through food sources alone.  Studies have also demonstrated benefits that result when calcium is ingested through a combination of dietary sources and nutritional supplements.

Vitamin D helps the body absorb calcium and is another essential component for healthy bones.  Unfortunately, only a few foods such as egg yolks, fatty fish, fortified dairy and soy milk, contain this fat-soluble vitamin so supplementation necessary.  From birth to age 50, the recommended daily intake of Vitamin D is 600 IU, but recent studies are suggesting that more may be better.  The current recommendation for those over 70 is 800 IU daily.  Other nutrients that are important for maintaining strong bones include magnesium, vitamins B6 and B12, folic acid, vitamin K, and Boron.

With regard to exercise, weight-bearing activity like walking done regularly helps maintain bone mass.  More rigorous exercise, like walking with hand weights, and weight training are even better since bones will respond by building more bone.  Resistance training also strengthens muscle groups and when combined with stretching improves balance, coordination, and flexibility reducing your risk of falling.  This is important since osteoporosis is a disease characterized by increased susceptibility to fractures.

Finally, and most emphatically, don’t smoke.  Smoking exerts a toxic effect on osteoblast function, leads to earlier menopause, and results in reduced levels of estrogen.  Therefore, smokers usually have low bone mass.  At the risk of overstating the obvious, smoking is poison.  One way or another it will rob you, it’s just a matter of time.  If you smoke, please quit – the life you save may be your own.

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