Louise Chang, MD
One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime. Yes, osteoporosis ("porous bones") affects men, too. Yet the advanced effects of bone loss -- a humped upper back or easily shattered limbs -- does not have to be in the future of people who eat wisely and exercise regularly.
Bones are living tissue. They contain nerves, blood vessels, and marrow, where blood cells are created. Bones are constantly tearing down and rebuilding themselves, like a freeway construction project that never ends. Without this repair and reinforcement of even minor weak spots, we would break bones on a regular basis.
"When a person is under 20 years of age," explains Felicia Cosman, MD, medical director of the Clinical Research Center at Helen Hayes Hospital in New York and clinical director of the National Osteoporosis Foundation, "you are forming more bone cells than you are losing." But when women near menopause, rebuilding new bone slows down. A woman's bone density begins to decrease.
Bone density is measured by a painless, low-radiation X-ray, which is translated into what Cosman describes as a "sort of confusing number" called a T-score. Basically, the patient's bone density is compared to that of an average person between 20 and 30 years old -- the time of peak bone density in a woman's life. The lower the score the greater the risk of having a fracture.
A T-score of -2.5 or below should concern a woman. It indicates osteoporosis and can justify medication. A normal score is -1 or higher. A score between -1.0 and -2.5 indicates low bone density (osteopenia).
To prevent porous, breakable bones as you age, you need to have sufficient calcium and vitamin D. The body uses calcium for a number of functions and will take it out of the bones faster than it can be laid down if your diet does not pump enough calcium into the pipeline. But calcium is not the only component -- bones are also one-third collagen, which is a protein that gives bones their flexibility.
Annemarie Colbin, PhD, author of Food and Our Bones: The Natural Way to Prevent Osteoporosis, urges us to look at the animals with the largest bones -- cows, elephants. "What do they eat?" she asks. "Leafy plants."
The biggest component of a bone-healthy diet is leafy greens, both cooked and raw, according to Colbin. "Greens give you not only calcium, but vitamin K, potassium, and other minerals and nutrients you need to lay down bone. My first three recommendations are vegetables, vegetables, vegetables," she says with a laugh.
Vitamin D is also important for strong bones, and a good source is, believe it or not, the sun. Colbin recommends being out 20 minutes a day with no sunblock, but Cosman vehemently disputes the wisdom of ever going out without sunblock and recommends a multivitamin or vitamin D supplement.
Another building block of strong bones is protein (remember that collagen?). Colbin says mix it up -- beans, fish, chicken. "You can't eat the same boring diet every day." Again, she urges you to select good-quality, properly raised, antibiotic-free protein sources. She also recommends making your own stock from animal bones -- add a tablespoon of vinegar to 8 cups of water to pull the calcium out of the bones. Throw in a carrots, onions, pepper -- and all you need is some garlic bread! If that isn't enough richness, Colbin recommends adding kombu or canten, mineral-loaded, flavorless seaweeds found in health food stores.
Whole grain bread or pasta is helpful, too. "This gives you magnesium," Colbin says. Magnesium helps maintain strong bones.
It's almost a mantra -- drink milk for strong bones. Colbin is low-key on milk. "You see the most fractures in countries that drink a lot of milk," she says. "I am not too keen on dairy."
Cosman is also not enthused. "A lot of people drink milk, but I am not big on that," she says. "Maybe low-fat milk or yogurt. Those calcium-enriched juices are good."
Not so good are sugar (increasing secretion of calcium and trace elements), caffeine (ditto), stress, and habitual dieting, which can "starve" your bones.
So what does that leave? Besides veggies and fruits, many women, at least women over 50, may need some calcium supplements.
Women over age 50 need about 1,200 mg a day, according to the Institute of Medicine.
Should you take calcium citrate or calcium carbonate? Despite the raging debate on this, Cosman says the data are not conclusive. Consult your healthcare provider for a decision.
Incidentally, if you do take a calcium pill, take it at a time of day when you did not just eat a lot of calcium. If you have milk and fortified juice at breakfast, Cosman recommends taking the calcium pill at lunch.
Bones last longer if you stress them more. It's one of those medical conundrums. Exercising -- putting the weight of your body or an outside weight on the bone -- makes it lay down more bone material to strengthen it. "Use it or lose it!" quips Colbin. "Any exercise is better than none."
Cosman agrees. "Ideally, several times a week -- and you need aerobic, weight bearing, and resistance."
But be careful -- heavy weights or too vigorous exercise in women with osteoporosis might trigger a fracture.
Colbin even recommends against big, fat running shoes. "You don't want that cushioning for this," she says. Basically, she says, walk a lot and carry stuff.
It works. A study done the University of Toronto shows that aerobic exercise, such as walking, jogging, or dance, improved the amount of calcium in the upper body and upper thighs, two areas at risk for fractures.
If you have suffered bone loss, a number of medications exist to slow the resorption cycle so more bone remains. A medication called Forteo is the first to build bone. "It's very potent," says Cosman, "and is only for those diagnosed with osteoporosis, not for prevention." For one thing, Forteo is given by a daily injection.
A more commonly prescribed class of medications for bone loss are bisphosphonates. They have been shown to reduce the risk of fractures but are a little tricky to take orally (you have to sit up afterward to prevent burning of the esophagus).
What about good old hormone replacement? Hormone replacement therapy is approved for prevention of postmenopausal osteoporosis, but a much publicized study was stopped because it increased the risk of breast cancer, serious blood clots, and other maladies. Cosman recommends against taking estrogen just for bone health.
Instead of a shelf full of pills, most people only need a well-stocked refrigerator. The process of bone remodeling is complicated but is hooked into the nutrients available to maintain your bones.
"You can't put every little molecule in cauliflower into a pill," Cosman says. "It's simpler to eat the cauliflower." Words to live by.
SOURCES: Felicia Cosman, MD, medical director, Clinical Research Center, Helen Hayes Hospital, New York; and clinical director, National Osteoporosis Foundation. Annemarie Colbin, PhD, author, Food and Our Bones: The Natural Way to Prevent Osteoporosis. National Osteoporosis Foundation web site. Institute of Medicine.
The Health News section does not provide medical advice, diagnosis or treatment. See additional information.