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Bone Health

Bone health is a term used to define a lifetime commitment to taking care of your bones. No matter what your age, it is vital that you take steps to protect the health of your bones. Ideally, it should begin when you’re young and continue on through all of your adult years, to lessen the effect of natural bone loss that occurs as you age.

It’s never too late. Here are some basic steps that women of all ages should follow to promote optimal bone health:

Dietary steps include:
  • Eat foods rich in calcium and vitamin D
  • Do weight-bearing exercise
  • Don't smoke
  • Limit alcoholic beverages

Healthy foods that are rich in calcium and Vitamin D include:

  • Low-fat dairy products such as cheese, yogurt, and milk
  • Canned fish with bones you can eat, such as salmon and sardines
  • Breads made with fortified flour

If you have osteoporosis or broken bones after the age of 50, or if you have significant risk factors for fracture, consider using calcium and Vitamin D supplements.

Calcium from both diet and supplements for women past menopause should be no more than 1200 mg daily; and for all other women, no more than 1000 mg per day. Diuretics (pill to reduce water in the body) and medications for acid reflux (stomach acid in the esophagus, (passageway from mouth to stomach) interact with calcium supplements. When discussing calcium supplements, notify your provider if you take any of these medications or have gastrointestinal disease.

Vitamin D deficiency is a common problem, particularly when diet lacks Vitamin D sources. It is produced in your skin with exposure to sunlight, but production stops in the late fall and winter months in many climates. To optimize bone health, both men and women should have approximately 800 to 1,000 international units (IU) of Vitamin D each day.

When discussing Vitamin D supplementation, notify your provider if you take any medications for kidney or liver disease, if you have gastrointestinal disease, or if you’ve undergone gastric bypass surgery. Dosages may need to be increased.

Weight Bearing Exercise
  • Exercise builds bone and muscle, helps prevent bone loss and improves coordination to prevent falls.
  • Weight-bearing exercises, done on a regular basis, are best for preventing osteoporosis. Walking, jogging, and playing tennis are all good weight-bearing exercises.
  • Always check with your health care provider before starting a new exercise program.
  • Osteoporosis

    Osteoporosis means "porous bones." This condition is characterized by fragile or weak bones that break easily. A combination of heredity, diet, hormones, age and lifestyle factors all contribute to this condition. Osteoporosis attacks bones slowly and silently until a fracture occurs, usually in the hip, spine, or wrist. Women are four times more likely than men to develop this condition because of the loss of estrogen (blocks or slows down bone loss) at menopause. More than half of all women over the age of 65 have osteoporosis.

    Osteoporosis, a major public health threat for the nearly 25 million Americans with low bone mass (80% are women), can progress without visible symptoms for many years. The loss of estrogen after menopause is an important contributor to bone loss in women, and osteoporosis leads to 1.3 million fractures each year.

    Osteoporosis usually is preventable. Parents need to take steps to protect their children’s bone health through the teenage and young adult years. Building strong bones at a young age will lessen the effect of the natural bone loss that occurs with age.

    Screening for Osteoporosis

    As part of a bone health assessment, your physician or nurse practitioner will check family medical history and your bone mass measurements. Ask your doctor to help you better understand your own risk and become aware of prevention and treatment options.

    Most women will be screened for osteoporosis beginning at age 65 and older by bone mineral testing. These testing devices use x-ray technology to examine bone loss in the hip and spine.

    Often a bone fracture is the first sign of osteoporosis. Other symptoms that might prompt earlier screening include: estrogen deficiency, a fracture in a minor injury, low body weight, small body frame, loss of height, medical conditions known to cause bone thinning, and medications that prevent calcium absorption.

    Treatment for osteoporosis is based on severity of the osteoporosis, other health problems you may have, personal preference (pill, liquid, nasal spray injection, or IV) and side effects. Medications are classified either as Calcitonins which inhibit calcium loss in the bone, estrogen and hormonal therapies that also prevent bone loss, biphosphonates which prevent loss of bone mass, or teriparatides, a hormone that causes new bone to form.

  • Bone mass in women

    Most skeletal growth and mineralization occurs during the first two decades of life. There is rapid bone growth during fetal development and the first year of life. This continues at a slower rate throughout childhood and approaching puberty. Young adolescents obtain 60% of their total bone mass during the pubertal growth spurt. This slows toward completion around age 18, but small amounts of mineralization continue until age 30 or so. This is the time of peak bone mass, when the lifetime maximum amount of bone mineralization is achieved.

    For a woman, from the time of peak bone mass until she permanently stops menstruating (menopause), there is very little change in bone mass. However, after menopause, there usually is rapid bone loss for a few years. This eventually slows down and is more consistent with the losses experienced in men due to normal aging.

    Predictors of low bone mass:
    • Increased age
    • Female gender
    • Caucasian race
    • Low weight and body mass index (BMI)
    • Menopause (especially if early)
    • Other estrogen deficiency
    • Family history of osteoporosis
    • Late age at first menstruation
    • Use of alcohol and caffeine-containing beverages, and smoking cigarettes is inconsistently associated with decreased bone mass. (This may correlate with nutritional deficits in heavy users.)
    Factors affecting peak bone mass:
    • Gender – peak bone mass in males is usually higher
    • Race – African-American females achieve higher bone mass than Caucasian and Asian females.
    • Hormonal factors – estrogen exposure positively influences bone mass; early menarche (age of 1st period) and/or use of oral contraceptives seem to correlate with higher bone mass. On the other hand, estrogen losses negatively influences bone mass.
    • Nutritional factors – calcium is the predominant mineral in bone. Dietary shortages in calcium may cause a 10% difference in peak bone mass. Females from adolescence through adult life are less likely than males to get the recommended daily allowance of calcium.
    • Physical Activity – weight bearing exercise correlates strongly with achieving maximum peak bone mass.

    Osteopenia is an early sign of bone loss that can progress to osteoporosis.  Osteopenia is considered a marker or early identifier for risk of fractures due to bone loss. Risk factors for developing osteopenia are the same as osteoporosis.  Since osteopenia is only an indicator of bone loss, treatment will be individualized, based upon the rate of bone loss, history of fractures and other medical conditions that markedly increase the risk of developing osteoporosis.

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