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Bone Health: Are You At Risk For Osteoporosis

As Baby Boomers reach middle age and our population grows older, concerns about bone health are becoming a serious issue. The National Osteoporosis Foundation reports that “osteoporosis is a major public health threat for an estimated 44 million Americans.” For this reason, calcium-fortified foods are popping up in almost every grocery aisle, ads for bone-building drugs can be found in many magazines, and the amount of research on bone health is increasing. In addition, researchers recently began to ask whether or not we really need as much calcium as is recommended, and whether exercise is being underemphasized as an important step in the prevention of osteoporosis.

Amid varied opinions about how much calcium we need, whether or not to take supplements, how much exercise is necessary and when to begin bone density testing, common sense prevails. Irene O’Shaughnessy, MD, Associate Professor of Medicine (Endocrinology) at the Medical College of Wisconsin, reports that the recommendations for the prevention of osteoporosis really haven’t changed much in recent years; nutrition and exercise are still at the top of the list and it’s vital that we understand the risk factors involved.

Family History is Best Indicator

Obviously, the older we get, the higher the risk for poor bone health. “But,” says Dr. O’Shaughnessy, “the strongest indicator for osteoporosis is family history. You are much more likely to have osteoporosis if you have a family member with osteoporosis. And your risk for a bone fracture goes up if you have a first-degree relative who has had a fracture.”

Dr. O’Shaughnessy continues, “Women are at greater risk than men for osteoporosis, because they start out with thinner bones, and they lose bone mass more rapidly.” Also at risk are women who have begun menopause before the age of 45, either naturally or by surgical removal of the ovaries with no estrogen therapy after the surgery. Women who have gone for more than a year without a menstrual period (amenorrhea) and are not on estrogen are also at a higher risk for osteoporosis, as are those with a history of hyperthyroidism. Bone structure and body weight can also indicate a higher risk; the smaller your body frame, the higher your risk.

In addition, says Dr. O’Shaughnessy, people taking steroids for asthma, transplant surgery, rheumatoid conditions, and inflammatory bowel diseases such as ulcerative colitis or Crohn's disease are also at higher risk for osteoporosis. Certain drugs for seizures and cancer treatment can raise the risk as well. Lifestyle choices also figure into your risk for osteoporosis; smoking cigarettes, consuming excessive amounts of alcohol and not getting enough exercise are all factors that increase your risk of developing osteoporosis.

What about Calcium?

Getting enough calcium could be the most important part of keeping your bones strong and healthy. Most people know that milk and other dairy products like cheese and yogurt are good sources of calcium, but calcium can also be found in other foods like broccoli, kale, and almonds. Dr. O’Shaughnessy recommends taking both a calcium and a Vitamin D supplement. “Everyone should take calcium,” she says, “and Vitamin D, which is usually found in a multivitamin, helps your body absorb the calcium.”

Dr. O’Shaughnessy also warns against drinking soda and caffeinated beverages. “Soda has been shown to draw small amounts of calcium out of the bones, and caffeine has been linked to osteoporosis, but more importantly, you’re drinking something in place of milk or orange juice, two very good sources of calcium.” Dr. O’Shaughnessy recommends the following amounts of calcium:

Children under the age of 12: 800 to 1000 mg per day
Ages 12-24: 1000 mg per day
Age 25 to menopause: 1000 mg per day
Post-menopause: 1000 mg per day if taking estrogen, 1500 mg per day if not

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And Exercise?

Dr. O’Shaughnessy also points out the importance of exercise in preventing osteoporosis. “Exercise – primarily weight-bearing exercise like walking and jogging – is very important,” she says. “Any exercise is a good thing, and shouldn’t be discouraged, but weight-bearing exercise is the most helpful for bone health.”

Bone Density Testing

“All post-menopausal women should be screened for osteoporosis,” states Dr. O’Shaughnessy. The National Osteoporosis Foundation (NOF) specifically recommends bone density testing for people in the following categories:

1. All post-menopausal women under age 65 who have one or more additional risk factors for osteoporosis

2. All women age 65 and older, regardless of additional risk factors

3. Post-menopausal women who have a fracture (to confirm the diagnosis and determine the severity of the disease)

4. Women who are considering therapy for osteoporosis, if testing would facilitate the decision

5. Women who have been on estrogen replacement therapy for prolonged periods

A bone density test is not difficult or painful. Tests are performed at the Medical College’s Radiology Department, and use a very small amount of radiation. “There are usually two areas tested,” reports Dr. O’Shaughnessy, “The lumbar spine area of the lower back, and the hips.” Testing usually takes less than half an hour. Sometimes a blood test is necessary as well. Keep in mind that the Bone Mass Measurement Act of 1998 requires Medicare to cover bone density testing in some cases.

Prevention Basics: Diet and Exercise

Dr. O’Shaughnessy says that the bottom line is to avoid developing osteoporosis in the first place, and she offers some advice on prevention: Eat a well-balanced diet that contains lots of calcium, take calcium and Vitamin D supplements and get plenty of weight-bearing exercise. Most importantly, “Be aware of the risk factors. Know if you are at risk, and whether you need to be tested. Osteoporosis is not something that will be obvious until you’ve got a fracture.” If you’re not sure whether you need to be tested, ask your physician. Dr. O’Shaughnessy emphasizes, “It’s important to diagnose it ahead of time. Our primary goal is to prevent a fracture. The good news is that one can do something about osteoporosis.”

P.J. Early
HealthLink Contributing Writer

This article includes information from:
Centers for Disease Control and Prevention (CDC)
National Osteoporosis Foundation (NOF)