Occupational Health Strategies, Inc.
Kent W. Peterson, M.D., FACOEM
901 Preston Avenue, Suite 400
Charlottesville, Virginia 22903-4491
TEL: (434) 977-3784
FAX: (434) 977-8570
Email: OHS@HealthySelf.org


Last updated: February 17, 2009

ITíS TIME TO CONSIDER YOUR BONES


By Sumner Brown


Many of us have seen parents or grandparents shrink in height, develop a hump on their backs, break bones easily, etc. These are all signs of osteoporosis, an often debilitating skeletal disease that affects over ten million Americans and has increased over the last 10 years for no apparent reason. This is a serious problem that we need to look at now, while the problem may be developing but not yet seen.

Osteoporosis is more of a problem for women than men, though men are getting more fractures. For example, 20 percent of hip fractures happen in men. Women have the bigger problem not only because they have less bone to begin with, but because of hormones. A major cause of bone loss in women is low estrogen levels Ė one of the reasons hormone therapy was being prescribed so often. Luckily, there are other solutions, which I will discuss later in this article. Besides being female, other risk factors for osteoporosis include age, family history, having low bone mass to begin with, being White or Asian, smoking, inactivity, prolonged low calcium intake and having a poor diet in general, too much alcohol, excessive caffeine intake, having a very small frame and/or being very thin (under 127 pounds). Another risk factor is not getting enough sun Ė an important source of Vitamin D. Vitamin D is very important for the bones. There are also risks to the bones for those taking prolonged corticosteroids, large does of thyroid hormones or certain anticonvulsants.

Many people donít find out they have osteoporosis until they break a bone. But if you are over 50 and have any of the risk factors listed above, you might want to get a bone density test. After age 65, all women should be tested. You will probably need to be proactive about this, because itís been shown that doctors do a very poor job about screening for and treating osteoporosis. The most reliable bone density test is known as DEXA, which stands for dual energy X-ray absorptiometry. It is most accurate when done for the spine and hip (the gold standard), but that is the more expensive option. (At least $250) It costs less to have a similar test done for your finger, wrist and heel, but itís not as accurate. There is a very low-cost option as well ($25 - $35), which involves an ultrasound test of your heel. These tests are not invasive or painful in any way.

I know itís hard to worry about osteoporosis now when you seem perfectly healthy. But what you do now can make such a significant difference in the quality of your life as you age. Itís very worthwhile to take every measure possible to try to prevent osteoporosis. And there are a number of things we can do to decrease our risk.


1. Do Weight-Bearing Exercises: You actually want to produce some strain on your bones. This is one of the important benefits of doing some kind of strength-training. Aerobically - walking, jogging, tennis, dancing and the like are good. Swimming and bicycling put very little strain on the bones and though excellent for other reasons, are not very good for preventing osteoporosis.

2. Donít smoke or overuse alcohol. Both of these substances are known to weaken bone.

4. Improve your diet. This includes avoiding caffeine, which causes more calcium to be lost through your urine; get enough vitamin D (from sunlight and supplements mostly); you probably need to get sufficient protein and vitamin K (found in leafy greens and some calcium supplements) Ė there are still ongoing studies, but these probably are helpful to bones. Last, but not least, get plenty of calcium. Though there is some conflicting information here, researchers come down on the side of calcium Ė feeling that itís critical for bone health Ė especially for post-menopausal women. Itís hard to know how much calcium we need, but the best research has determined that we need 1000 mg/day until age 50 and then 1200 mg/day. The best way to get calcium is probably from low-fat dairy products. Other foods high in calcium include tofu, canned salmon and sardines with bones, broccoli, kale, collard and mustard greens, pinto beans and calcium-fortified foods such as orange juice and cereal. It also seems that foods high in potassium and magnesium are useful for keeping calcium levels high in the bones. Fruits and vegetables in particular are helpful for this purpose. See the chart below for more information on calcium. Thereís another incentive for taking calcium as well. It may actually help you lose weight. Studies are preliminary, but the news looks promising that keeping your calcium intake high make help you lose weight faster.

5. You may also need to take a supplement. Itís best to get one that has 5 or 600 milligrams of calcium per tablet plus some vitamin D. One thing thatís important to remember is that the body can only absorb about 500 milligrams of calcium at one time, so itís best to spread out your calcium intake. One thing that makes that easier for me is to use some calcium-fortified products and also to carry Viactiv calcium chews in my purse. Taking one of these gives me a nice sweet taste after lunch and that prompts me to remember it!

If you find you already have osteoporosis or have very low bone density or a strong family history and several risk factors, you may consider medication. Estrogen replacement therapy has proven to be very effective in preventing osteoporosis, but there are also many risks as youíve probably read about. Other medications such as Evista, Fosamax, etidronate and risedronate have been shown to be effective in increasing bone mineral density in the hip and spine. Calcitronin may also work by inhibiting calcium resorption from bone. A brand new medication called Forteo can actually stimulate the body to form more bone. It has to be given as a daily injection however and has side effects, so it is now being used only in the more severe cases. All the medications have side effects for some people, so work with your physician to come up with the one thatís right for you.

The bottom line is this: Take care of your bones so they can take care of you!


The Calcium Top 20

Calcium
Yogurt, plain, nonfat, 1 cup 450mg
Sardines, with bones, 3 oz 370mg
Calcium-fortified O.J., 1 cup 300-350mg
Yogurt, fruit-flavored, 1 cup 300mg
Milk, 1 cup 300mg
Swiss Cheese, 1 oz 270mg
Salmon, with bones, 3 oz 225mg
Collard greens, 1 cup 225mg
Cheddar cheese, 1 oz 205mg
Turnip greens, cooked, 1 cup   200mg
White beans, canned, 1 cup 190mg
Ice cream or ice milk, 1 cup 175mg
Oatmeal, fortified, 1 packet 165mg
Cottage cheese, 1 cup 150mg
Soybeans, cooked, Ĺ cup 130mg
Tofu, 2 oz 115mg
Kale, cooked, 1 cup 95mg
Almonds, 1 oz 70mg
Broccoli, cooked, 1 cup 70mg
Bread, 1 slice 20-40mg

Chart Reprinted from University of California, Berkeley Wellness Letter, July, 2003.

Other sources: University of California, Berkeley Wellness Letter, August, 2003; Harvard Womenís Health Watch, March, 2001; Harvard Womenís Health Watch, October, 2000; Harvard Womenís Health Watch, March, 2003; University of California, Berkeley Wellness Letter, July, 2002; Harvard Womenís Health Watch, August, 2000; Tufts University Health and Nutrition Letter, October, 2003; Nutrition Action Health Letter, January/February, 2002; The Harvard Guide to Womenís Health by Karen J. Carlson, MD, Stephanie A. Eisenstat, MD, Terra Ziporyn, PhD., Harvard University Press, 1996.