Osteoporosis: Things My Doctor Taught Me

by mulberry

Osteoporosis effects millions of people and it can be severely debilitating. However, many people have somewhat dangerous misconceptions about it that need to be cleared up.

The Facts About Osteoporosis

Osteoporosis is a condition in which the bones become more porous, brittle, and generally fragile. The result is that an individual's bones will break more easily, their mobility can become more limited, and they can lose height as well. This is what most of us know.

 

We also know that women, especially smaller women, are prone to this condition as they age. We know that after menopause, the risk of developing osteoporosis is much greater. However, because of what we know, we sometimes make the wrong assumptions and these assumptions can lead us to avoid making good choices when it comes to assuring good bone health and realizing the real risks.

 

My mother has severe osteoporosis and I know that I have low bone mass (osteopenia), therefore I have spent some time discussing this topic with my physician trying to get the facts that can allow me to help myself and my mother as well.  I would like to share a few bits of information that may be useful to others and may clear up any dangerous misconceptions.

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A Few Things You Really Need to Know About Osteoporosis

Although I consumed plenty of dairy products in my diet, around the age of 40 I began taking a 600mg calcium supplement each morning.  I knew that my mother had been diagnosed with osteoporosis and it just seemed prudent to begin taking precautions. Friends told me I was being paranoid, after all, I was probably a decade away from menopause and that's when they said I had to begin to worry.

When I turned 50, I dutifully had a bone mineral density scan done as recommended by my physician. Just a routine scan done for women at that age. The results showed that I had low bone mass (osteopenia) but not osteoporosis. I had not yet gone through menopause, but the signs were clearly there in my eyes, that this was something that needed to be addressed.

My physician ordered me to begin taking 1200mg of calcium supplements daily. I researched things a bit and then had a discussion with my doctor. Here is what I learned that I feel more people need to understand.

Small, white and Asian women aren't the only ones who develop osteoporosis
According to the National Osteoporosis Foundation, nearly 52 million people in the US have low bone mass or osteoporosis. That is 35 million women and over 17 million men. Studies show that African-American women experience osteoporosis at half the rate of caucasian women, but obviously that number is still significant. Certainly, osteoporosis in children is rare but it can be caused by certain medical disorders and medications. For instance, people of any age group who are treated with corticosteriods run the risk of developing it.

Osteoporosis does not begin at menopause
It can begin during childhood when your bones are forming. Building good bones should begin in childhood and continue throughout your life. We reach peak bone mass in our 20's or 30's.  Waiting until you are 40 or 50 years old is really too late to lay the foundation for good bone health. While it's true that the hormonal changes which occur at menopause are a factor in bone loss, it's would seem waiting until that point to consider bone health would be unwise.

 

Taking calcium supplements is not the solution
Although taking calcium supplements is important for those at risk of having or who have been diagnosed with osteoporosis, it's not enough. There is the question of how well your body absorbs the calcium that you get from supplements. Obviously, ingesting calcium and having your bones absorb it can be two different things.

There are different types of calcium supplements such as citrate, carbonate, and so forth. A discussion with a physician should help in choosing which is best for you as an individual.  However, it is also important to assure your body will be able to absorb the supplement. To be absorbed, some types of supplements need to be taken on an empty stomach while others require they be taken with a meal. If you want your treatment to be successful, it's important to know the specific instructions for your supplement.

 

The dosage of the supplement is also important. For instance, 1200mg is a common daily dosage but taking that entire quantity at one time isn't beneficial. Instead, breaking it in to 2 or 3 doses over the course of a day is better. The body generally can't absorb 1200mg at once, and when it's not absorbed, the body merely excretes it.

Other nutrients matter too. Calcium is better used by the body when accompanied by vitamin D. Like calcium, our body's ability to absorb Vitamin D is reduced as we age. Thus a good calcium supplement provides Vitamin D as well.  Certainly, changes to our diet to increase calcium and vitamin D intake are also important. Other nutrients known to promote calcium absorption and better bone health are Vitamins E, C, K, magnesium, and boron.

Knowing what to eat or supplement is important, but so too, is knowing what to avoid
There are many things that can block the absorption of calcium.  This is important to understand not only when taking supplements, but even in general as it blocks calcium consumed in your diet. Certainly, tobacco use, excessive caffeine, and alcohol consumption are known to block calcium uptake.   Phosphoric acid, sodium, and sugar are other reported problems; this is one reason why drinking many "sodas" and even fruit juices is discouraged. Some elements that block calcium are found in healthy foods and are even essential for overall health. Foods with phytic acids (sweet potatoes, beans, nuts, spinach, celery, and so forth) shouldn't be consumed at the same time as a calcium supplement. Iron and protein are other examples of calcium blockers. Clearly, eating foods that provide iron and protein are critical but excess should be avoided and they should be consumed separately from any calcium supplement.

 

More than your diet can effect your bone health
While your diet and any supplements you consume can effect you bone health, there are other critical things to consider. A sedentary lifestyle can be dangerous for those at risk for osteoporosis. Exercise is important but not just any exercise. While swimming is great for your cardiovascular system and perfect for those with arthritis, it isn't optimal for those with low bone mass or osteoporosis. These individuals need weight bearing exercise and muscle strenthening exercise. Walking, dancing, weight lifting, resistance exercises, low impact aerobics, and even bicycling are better choices. They help limit both muscle and bone loss. Ideally, people should engage in these types of activities for at least 30 minutes a day.

As mentioned above, other non-dietary factors also are important to consider. Smoking, excessive alcohol and caffeine consumption, use of many antacids or antidepressents, extreme or frequent dieting, eating disorders, chemo therapy, radiation therapy, and the use of corticosteroids are also considered contributors to bone loss. While some of these may be necessary in the face of other health challenges, a conversation with your physician to determine how to try to reduce the negative effects is warranted.

 

Increasing calcium intake through diet changes and oral supplements isn't the only treatment option
If osteoporosis is diagnosed, there are other treatment options. Certainly there are patches that can be used as well as annual infusions such as Reclast. Hormone replacement therapy is sometimes useful too. Compression fractures are a common result of severe osteoporosis and treatment via procedures such as balloon kyphoplasty can effectively reduce or eliminate pain and prevent collapse of the spine. (It's not within the scope of this article to discuss treatment options, but these links should help.)

Osteoporosis can mean more than broken bones
While most of us know that weakened bones due to osteoporosis can break more easily and that over time people can get shorter due to this process, there is more to the picture. In severe cases, compression fractures can occur very easily in the spine. When not repaired, these fractures heal spontaneously but are collapsed. While height decreases, so too does the space in the cavity where the lungs, stomach, and other organs reside. This means that over time it is possible for osteoporosis to have a negative effect on breathing, eating, and perhaps even bowel and bladder functions.

The Take Away on Osteoporosis

In my opinion, the first take away is that bone health is something that needs to be considered beginning in childhood. Kids need to be active and eating a balanced diet, including plenty of calcium and Vitamin D. Sugary drinks should be avoided.  This healthy lifestyle needs to follow you throughout your life. The time to focus on bone health is before you are diagnosed with a problem. 

The second take away, is know your risk factors. Know your family history and know what other things contribute to this condition. 

And finally, get tested if you find significant risk factors. (Age is a risk factor, so screening at 50 or older is certainly recommended.) I would advise that anyone who finds they have low bone mass or osteoporosis should research thoroughly what they can do to help improve their bone health. Many physicians will provide the diagnosis and perhaps prescribe a calcium supplement.  Figuring out how to help assure that your supplement works well and that your bones benefit from it may be up to you if your physician can't have that conversation with you.

You can't change your DNA but many other factors are under your control and should help in lessening the overall risks. 

Updated: 08/18/2011, mulberry
 
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mulberry on 09/09/2011

I took some related course work way back in school, but no, I'm not a nurse. (I was a therapist and then in management in health care)

barbarab on 08/31/2011

beautiful content and well presented...are you sure you aren't a nurse? :)

nightbear on 08/19/2011

Very important information. So important especially as we age. Well done Christina.

kajohu on 08/19/2011

This is very useful information for me, since I'm also over 50, and small-boned. Yoga (which I practice) is another good exercise to help keep bones strong, but it should be combined with other good practices as you wrote about in your excellent article.

samsons1 on 08/19/2011

Very well written and researched article. I liked it so much I had my wife read it also. Thanks for this valuable, useful and timely information...

theherbivorehippie on 08/18/2011

This is very thorough. I'm glad you mentioned that there are things that block the absorption of calcium. Many think they can still eat what they want and drink soda,coffee, etc., as long as they take vitamins and this is just not true. Great information here!

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