BAD TO THE BONE: Medical advances, exercise, diet help brittle-bone patients
Jan Ponder has attended a senior citizens exercise class three times a week for the past 18 months. Ms. Ponder lifts light weights, walks and stretches with the other participants in an effort to combat osteoporosis.
The results are showing in her bones.
“I think it is helping,” says Ms. Ponder, 67, of Alexandria, who also takes the prescription drug Fosamax as well as a calcium supplement to slow bone loss. “I was diagnosed with osteoporosis three years ago, but I don’t feel fragile. I have never broken any bones.”
Ms. Ponder is doing all the right things to keep the condition from getting worse, experts say.
Osteoporosis is a thinning of the bones that affects 28 million Americans, 80 percent of whom are women, says Dr. Robert Heaney, professor of medicine at Creighton University’s Osteoporosis Research Center in Omaha, Neb.
Osteoporosis makes a person susceptible to fractures. How long it takes to get to the point of a fracture depends on a variety of factors, including genetics, build and diet. The most significant bone loss occurs after menopause, so the older a person is, the greater is her chance of breaking a bone.
The National Osteoporosis Foundation estimates about 1.5 million fractures annually can be blamed in part on osteoporosis. Fractures, particularly of the hip and spine, can be costly and debilitating, leading to hospitalizations and long-term care.
It doesn’t have to be that way.
“You can control and prevent some of the things that contribute to osteoporosis,” Dr. Heaney says. “There are no guarantees, of course, but to optimize chances, you should exercise, maintain hormonal adequacy and have proper nutrition. All the things your grandmother probably told you to do can reduce the risk of a fracture later in life by 50 percent.”
Certain people are more likely to develop osteoporosis than others, Dr. Heaney says. Risk factors include advanced age, being thin or having a small frame, a family history of the affliction, anorexia or bulimia, a diet low in calcium, smoking, an inactive lifestyle, excessive use of alcohol and amenorrhea (absence of menstrual periods). Caucasians tend to have a higher risk of the condition than other groups, but it is not clear exactly why.
Men and children also can suffer osteoporosis. In men, the condition sometimes is treated with replacement of the male hormone testosterone. Children can develop osteoporosis from taking corticosteroids such as Predisone to treat asthma or after suffering from severe anorexia. They can be treated with FDA-approved osteoporosis drugs.
Generally, a person’s bone mass peaks between ages 25 and 30, a factor that makes the teen-age years critical for building strong bones. After age 35, women begin to lose bone mass, sometimes at the rate of 1 percent a year.
Because estrogen is needed to maintain bone mass, bone loss jumps to 4 percent a year in the five to 10 years following menopause. Some women lose up to 25 percent of their bone mass during the first five years after menopause, says Dr. Paul Rochmis, chief of rheumatology at Inova Fairfax Hospital in Merrifield.
“It is like compounding interest on an investment,” he says. “But it is different for everyone, depending on what your peak bone mass was and how fast you lose it.
EXERCISE AND MINERALS
The best treatment for osteoporosis is prevention, and one of the most important factors is establishing good bone density through weight-bearing exercise and reasonable vitamin D and calcium intake. Vitamin D, found in milk as well as sunlight, helps a person absorb calcium.
A recent study conducted by researchers in Finland concluded that people who were athletic in their youth maintained strong bones in later years, even after they cut back on competition.
The study measured the playing arms of 13 high-level tennis players who had been competitive since age 11. At the time of the first measurement, the players were 26, and it was found the bones of the playing arm had 13 to 25 percent more mineral content than the bones of the non-playing arm.
Four years later, when the players had been out of competition for an average of two years and had cut their playing time in half, there was no change in the bone’s mineral content, despite the lack of activity.
The National Osteoporosis Foundation recommends weight-bearing exercise – exercise that forces the body to work against gravity – such as walking, hiking, jogging, stair-climbing, tennis, dancing and weight lifting for 30 minutes to an hour four times a week.
Another important part of preventing osteoporosis is adequate calcium intake, something in which most Americans, particularly teen-agers, are deficient, says Dr. Duane Alexander, director of Child Health and Human Development at the National Institutes of Health.
“Only one in eight teen-age girls and three in 10 teen-age boys are getting what they need,” Dr. Alexander says. “The average intake is about half of what is recommended. The last thing going through a teen-ager’s mind is the thought that they will break a hip when they are 80.”
The American Medical Association recommends 1,200 milligrams of calcium daily for children ages 9 to 18. Adults ages 19 to 50 need 1,000 milligrams daily. People older than 50 need 1,200 milligrams of calcium daily, as do pregnant and lactating women.
While essential vitamins, particularly vitamin D, are found in calcium-loaded dairy products, it is acceptable to boost calcium by taking it in supplemental form, Dr. Heaney says.
Vitamin D aids the body’s absorption of calcium, and experts recommend 400 to 800 international units of the vitamin for adequate absorption. That can come from about 15 minutes in the sun, from supplements or from vitamin D-loaded food such as egg yolks, fish and liver.
DETERMINING YOUR RISK
Unfortunately, osteoporosis can be a silent disease. Many people do not realize they have it until they suffer a fracture, a loss of height or “dowager’s hump,” the rounded spine that some older women develop.
A screening tool for women who have several risk factors or who are post-menopausal is a bone-density test. A low-dose X-ray of the spine or a sonogramlike test of the heel can compare a person’s bone density to that of others in the same age group.
The most commonly used bone-density test is dual-energy X-ray absorptiometry (DEXA), in which a small amount of X-ray measures bone density at a crucial area, such as the hip or lumbar spine. It takes as little as five minutes and can detect bone loss in its early stages, while an ordinary X-ray machine cannot pick up differences until the loss exceeds 25 to 40 percent.
“I am in favor of everyone having a bone scan,” Dr. Heaney says. “It gives good information on fracture risk compared with others your age.” TAKING ACTION
If a bone scan determines you are osteoporotic, there are several approaches to take, he says.
“It behooves you to take measures,” Dr. Heaney says. “If you have already broken something, you should take a much more aggressive approach.”
Weight-bearing exercise through the post-menopausal years helps, he says.
“It is vital for the elderly to exercise,” Dr. Heaney says. “You have to use [bones] or lose them. But you need to be careful if you already have osteoporosis and have had a fracture. You do not want to break something else.”
For post-menopausal women, hormone replacement therapy can be helpful for osteoporosis as well as for a reduction in heart disease, doctors say. However, hormone-replacement therapy may increase the risk of breast and uterine cancer, so the benefits should be evaluated carefully.
An effective drug with some of the properties of estrogen replacement is raloxifene, sold under the brand name Evista. This drug appears to prevent bone loss at the hip and spine, but is not quite as effective as hormone replacement.
Another FDA-approved drug is calcitonin, which is a naturally occurring hormone involved with calcium regulation and bone metabolism. Calcitonin has been shown to slow bone loss and may relieve the pain associated with bone fractures for post-menopausal women, according to the American Medical Association.
A very popular drug is alendronate (brand name Fosamax), a biophosonate drug that can increase bone density by 6 percent over a three-year period.
“The normal rate of bone loss is one-half to 1 percent a year,” Dr. Heaney says. Fosamax “seems to stop loss and leads to slow bone gain,” he adds. “It tends to work for almost everyone, but can irritate the esophagus.”
Studies are under way to see if a combination of Fosamax and estrogen would be the most effective treatment, Dr. Rochmis says. A new drug, risedronate (brand name Actonel) is likely to be approved by the FDA soon, he says. Four clinical trials showed women who took the well-tolerated drug had 50 percent fewer fractures than women who didn’t.
Each year, osteoporosis leads to 1.5 million bone fractures, including more than 700,000 vertebral fractures, 300,000 hip fractures, 200,000 wrist fractures and 300,000 fractures of other bones.
Source: National Osteoporosis Foundation, 1997
GOT MILK?
Here are some foods high in calcium. Getting the recommended daily allowance of the mineral can help fight osteoporosis.
Milk, eight oz. = 300 mg
Yogurt, 1 cup = 487 mg
Cottage cheese, 4 oz. = 77 mg
Cheddar cheese, 1 oz = 200 mg
Ice cream, 1/2 cup = 92 mg
Cheese pizza, one slice = 117 mg
Tofu, 1/5 block extra firm = 94 mg
Salmon, canned with bones = 203 mg
Broccoli, 1/2 cup = 36 mg
Spinach, 1/2 cup = 122 mg
Red beans, 1/2 cup = 40 mg
Tums E-X, 2 tablets = 600 mg
Source: U.S. Department of Agriculture
ARE YOU GETTING ENOUGH?
Daily calcium recommendations from the National Academy of Sciences
1-3 years = 500 mg
4-8 years = 800 mg
9-13 years = 1,300 mg
14-18 years = 1,300 mg
19-50 years = 1,000 mg
51 and older = 1,200 mg
MORE INFO:
Books -
* “The Osteoporosis Cure: Reversing the Crippling Effects With New Treatments,” by Dr. Harris McIlwain, Avon Books, 1998. This comprehensive book details what to expect at a DEXA scan, how to load up on calcium, how to perform weight-bearing exercises and what medications can help.
* “150 Most Asked Questions About Osteoporosis,” by Ruth S. Jacobowitz, William Morrow & Co., 1996. In question-and-answer format, this book addresses basic issues of osteoporosis.
* “Better Bones, Better Body: A Comprehensive Self-Help Program for Preventing, Halting and Overcoming Osteoporosis,” by Susan E. Brown, Keats Publishing, 1996. This guide explains how to stop osteoporosis through diet and exercise.
* “Bone Loading: Exercises for Osteoporosis,” by Ariel Simkin, Trafalger Square, 1997. This exercise guide takes into account people who might already suffer from osteoporosis.
Associations -
* National Osteoporosis Foundation, 1232 22nd St. NW, Washington, D.C., 20037. Phone: 202/223-2226. Web site: www.nof.org. This organization has many fact sheets and publications on osteoporosis, risk factors, bone-density tests and fall prevention.
* The National Institutes of Health’s Osteoporosis and Related Bone Diseases National Resource Center, 9000 Rockville Pike, Bethesda, Md. 20892. Phone: 800/624-2663. Web site: www.osteo.org. This is a good source for basic information as well as research updates.
On line -
* The American Dietetic Association’s site (www.eatright.org) offers lots of advice on eating a calcium-rich diet.
* Creighton University’s Osteoporosis Research Center (http://osteoporosis.creighton.edu) has information on bone loss and osteoporosis prevention.
Tags: alendronate, Fosamax, Osteoporosis