Women’s Health: Osteoporosis

Osteoporosis is a major health problem that affects about one fourth of women over the age of 60. Persons with osteoporosis suffer from a loss in bone mass and bone strength. Their bones become weak and brittle which makes them more prone to fracture. Any bone can be affected by osteoporosis, but the hips, wrists and spine are the most common sites. Peak bone mass is reached between the ages of 25 and 35 years. After 35, bone mass is stable until, in women, it starts to drop with menopause. This drop occurs more slowly in males. About one in two women over the age of 65 will develop fractures due to osteoporosis.

The actual causes of osteoporosis are unknown. Certain risk factors, however, increase the likelihood of developing osteoporosis:

• Being female – women are four times more likely to develop osteoporosis than men. The reasons are:
  
  • Their bones are generally thinner and lighter.
    
  • They live longer than men.
    
  • They have rapid bone loss at menopause due to a sharp decline of estrogen. The risk increases for women who have:
• Natural menopause before age 40; a hysterectomy which includes removal of both ovaries with no hormone replacement therapy (HRT); a lack of/or irregular menstrual flow.
  
• Having a thin, small framed body.
  
• Race – Caucasians and Asians are at a higher risk than African Americans.
  
• Having red or blond hair or freckles may also increase the risk.
  
• Lack of physical activity especially activities such as walking, running, tennis and other weight-bearing exercises.
  
• Lack of calcium and vitamin D – adequate intake of these nutrients throughout life helps to insure that calcium deficiency does not contribute to a weakening of bone mass.
  
• Heredity – the risk increases if there is a history of osteoporosis and/or bone fractures in your family.
  
• Cigarette smoking.
  
• Alcohol – regularly consuming alcoholic beverages, even as little as two to three ounces per day, may damage bones. Heavy drinkers often have poor nutrition and may be more prone to fractures from their predisposition to falls.
  
• Taking certain medicines such as corticosteroids (anti-inflammatory drugs used to treat a variety of conditions such as asthma, arthritis, lupus, etc.) and aluminum containing antacids like Rolaids or Di-Gel.
  
• Some anti-seizure drugs and inappropriate overuse of thyroid hormones may also increase the risk.
  
• Other disorders such as hyperthyroidism, hyperparathyroidism, certain forms of bone cancer, anorexia nervosa, scoliosis and gastrointestinal disease can also increase the risk.

Signs and Symptoms

Osteoporosis is a silent disease because it can progress without any noticeable signs or symptoms. The first sign is usually when a bone fracture occurs. Symptoms include:

• Osteoporosis, continued
  
• A gradual loss of height.
  
• A rounding of the shoulders.
  
• Gum inflammation and loosening of the teeth.
  
• Acute lower backache.
  
• Swelling of a wrist after a minor fall or injury.

Treatment and Care

Osteoporosis can only be prevented. (See self-care/prevention procedures on page 47). Reversing the disease is rarely possible.

Medical tests, such as the dual-energy X-ray absorptiometry (DEXA) and densitometry, can measure bone mass in various sites of the body. They are safe and painless. These tests can help doctors decide if and what kind of treatment is needed.

Treatment for osteoporosis includes:

• Medical management. Check with your doctor, especially if you are at a high risk of getting the disorder. He or she may prescribe hormone replacement therapy (HRT) and/or calcium. These can prevent fractures from osteoporosis if taken during or soon after the start of menopause and then on a continual basis. HRT does not rebuild bone, but it does prevent further bone loss.
• There are risks with HRT though, so you need to check with your doctor to see how they apply to you.
  
• Surgery, such as hip replacement, if necessary.
  
• Dietary and lifestyle measures. (See self-care/prevention procedures on page 47).

Questions to Ask

Do you have any of these problems? A broken bone, wrist or hip or swelling of a joint after a minor fall or slight injury.
Do you have curving of the spine that brings with it loss of height and/or a rounding of the shoulders or hump on your back.
Are you going through or have you gone through menopause and have any of these. A family history of bone fractures and/or osteo-porosis? A history of: Taking cortisone-like drugs; high doses of thyroid hormones; an over-active thyroid; excessive use of alcohol; smoking; or a lack of exercise.
Do you want to know your chances for having or getting osteoporosis or the status of your bone density?
If you have osteoporosis and take medicine for it, are you having side effects from the medicine?

Self-Care/Prevention Procedures

To prevent or slow osteoporosis, take these steps now:

• Plan to get enough calcium every day: The Recommended Dietary Allowance (RDA) for females aged 11-24 is 1,200 milligrams (mg)/day. For women 25 years and older, the RDA is 800 mg/day. The National Osteo-porosis Foundation recommends 1000 milligrams a day for adult women and 1,500 milligrams a day for post-menopausal women not on hormone replacement therapy.
  
• Choose high calcium foods daily:
  
  • Skim and low-fat milks, yogurts and cheeses.
    

    [Note: If you are lactose intolerant, you may need to use dairy products that are treated with the enzyme lactase or you can add this enzyme with over-the-counter drops or tablets].
    

  • Soft-boned fish and shellfish, such as salmon with the bones, sardines and shrimp.
    
  • Vegetables, especially broccoli, kale, collards.
    
  • Beans and bean sprouts as well as tofu (soy bean curd, if processed with calcium).
    
  • Calcium-fortified foods such as some orange juices, apple juices and ready-to-eat cereals and breads.
  
  
• Get adequate vitamin D. You can get vitamin D from exposure to sunlight and from foods such as vitamin D-fortified milks; salmon, tuna and shrimp. The RDA for vitamin D ranges form 250 to 500 IU (Internations Units) per day for females. Vitamin D helps your body absorb calcium.
  
• Check with your doctor about taking calcium and vitamin D supplements.
  
• Follow a program of regular, weight-bearing exercise at least three or four times a week. Examples include: Walking, jogging, low-impact or non-impact aerobics.
  
• Do not smoke. Smoking makes osteoporosis worse and may negate the beneficial effects of estrogen replacement therapy (ERT).
  
• Limit alcohol consumption.
  
• Pay attention to your posture. Keep your back straight when you sit, stand and walk.
  
• Take measures to prevent falls and injury to your bones.
  
  • Use grab bars and safety mats or non-skid tape on your tub or shower.
    
  • Use handrails on stairways.
    
  • Stay off icy sidewalks and wet or waxed floors.
    
  • Don’t stoop to pick up things. Pick things up by bending your knees and keeping your back straight.
    
  • Wear flat, sturdy, non-skid shoes.
    
  • If you use throw rugs, make sure they have non-skid backs.
    
  • Use a cane or walker if necessary.
    
  • See that halls, stairways and entrances are well lit. Put a night light in your bathroom.
    
  • Avoid taking sedatives or tranquilizers or be careful when you take them as prescribed. They can increase the risk of falls.