Osteoporosis: What you need to know to protect your bones

There was a time when osteoporosis was viewed as a normal consequence of aging – not much was in our control and this “silent” disease would go undetected until a painful bone fracture or break occurred.

Decades of research have taught us much about this disease.  And while osteoporosis prevention should begin in childhood, there are steps you can take – at any age – to ensure your bones last a lifetime.

What is osteoporosis?

Osteoporosis, which literally means “porous bones,” results in loss of bone mass and strength increasing the risk for fractures. When you’re young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. Women attain 85% of their peak bone mass by the time they are 18; for men, by the time they’re 20.  You reach your peak bone mass around age 30. After that, the process of making new bone and breaking down old bone continues, but you lose slightly more than you gain.

While we do not know the exact cause of osteoporosis, we do understand how the disease works. Osteoporosis interrupts the normal rebuilding cycle described above, creating an imbalance. While bone continues to break down, osteoporosis thwarts new bone from forming.

The strength of your bones is also a factor and is dependent on their size and density. Bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer minerals than normal, they’re less strong and eventually lose their internal supporting structure.

What are the risk factors for osteoporosis?

About 10 million Americans are affected by osteoporosis – 80% are women – and another 34 million are at risk.

There are many risk factors which, when present, increase your chance of developing osteoporosis.  People more at risk to develop osteoporosis are: women over 50 and postmenopausal women because of a loss of estrogen (which protects against bone loss); Caucasian and Asian women; those with a family history; petite and thinner women; those with inadequate calcium and vitamin D intake; those who smoke or drink; those who take certain medications like steroids, anti-convulsants, aromatase inhibitors and Depo Provera; and individuals with rheumatoid arthritis (RA) and malabsorption syndromes like Crohn’s disease.

We cannot forget that men are also at risk for this disease, and many of the same factors that put women at risk also affect men – your family history, use of steroids, not exercising, smoking, drinking too much alcohol, or having other medical problems such as chronic kidney, lung or gastrointestinal disease, or RA.  Additionally, men who have low testosterone levels or prostate cancer also have an increased risk to develop osteoporosis. 

How can you prevent osteoporosis?

Your diet and lifestyle are two important risk factors you can control to prevent osteoporosis.

• Diet—If you consume dairy, drink your milk! Low-fat and skim milk, nonfat yogurt, and reduced fat cheeses are healthy sources of the calcium you need to maintain strong, healthy bones. Fortified milk products also have the vitamin D needed for proper calcium absorption.  Other good sources of calcium are dark green, leafy vegetables, sardines, salmon, tofu, almonds and foods fortified with calcium.
• Supplements—It is most likely that you will need to take a calcium supplement to give you the full amount of daily recommended calcium. It is not recommended that you obtain all of your calcium from dairy products as this can increase your intake of fat.  Keep in mind that your body can only absorb a limited amount of calcium at a time. Therefore, take supplements in two or three doses during the day, preferably with meals. Make sure the supplement contains vitamin D, which facilitates the absorption of calcium.
• Exercise and Lifestyle—Establish a regular exercise program, avoid excessive alcohol intake and quit smoking. Exercises that make your muscles work against gravity (such as walking, jogging, aerobics and weight lifting) are best for strengthening bones.

How do you know if you have osteoporosis?

Osteoporosis is diagnosed by measuring your bone mineral density (BMD). BMD tests use very small amounts of radiation (using a dual energy x-ray absorptiometry or DXA machine) to determine the bone density of the spine, hip, and wrist.

How is osteoporosis treated?

There is no cure for osteoporosis, but there are treatment options. The goal of osteoporosis treatment is to slow down bone loss, prevent bone fractures with medicines that strengthen bone, and minimize the risk of falls that might cause fractures.

There are medications for established osteoporosis, which include agents that prevent bone loss, such as bisophosphonates, raloxifene (Evista) and calcitonin; and agents that help in bone formation like Teriparatide (Forteo).  You should discuss medication options thoroughly with your doctor, as the appropriate course of treatment for you depends on your gender, age (and for women – whether you have reached menopause or not), how severe your osteoporosis is, and other health conditions or personal preferences that should be taken into account.

If you are at risk or have been diagnosed with osteoporosis, know that there is support out there for you.  Ask your doctor about any support groups in your area. Or, contact the National Osteoporosis Foundation (NOF) at 800-231-4222 for a list of local support groups. If there isn’t a group in your area, the NOF support group coordinator can give you information on starting a support group or the organization also has an online support community at http://www.inspire.com/.

Chloeanne Georgia is an internal medicine physician at Harvard Vanguard Medical Associates in Boston. She completed her internal medicine residency at the Warren Alpert Medical School of Brown University in 2008. She earned her medical degree at the University of Virginia and her undergraduate degree in Chemistry at Duke University. Her professional interests include Women's Health and Preventive Medicine. Dr Georgia blogs at www.artdoesnotapologize.blogspot.com and www.chloegeorgiamd.tumblr.com.