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Information About Osteoporosis from S.Ferzola, RPh. OSTEOPOROSIS IS PREVENTABLE, EVEN WHEN IT RUNS IN FAMILIES. The best way to prevent osteoporosis is to begin early -- in childhood. Adults who start out with denser bones ...

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Information About
Osteoporosis from S.Ferzola, RPh.


The best way to prevent osteoporosis is to begin early -- in childhood. Adults who start out with denser bones can afford to lose more bone mass before reaching the fracture stage. From childhood up until age 30 or 35, the body builds more bone than it loses, and a calcium-rich diet during this time can set the stage for a healthy future. However, if you are already past age 35, it's not too late to lower your risk.

Here are the steps you should take to keep your bones healthy:
Get enough calcium

Calcium not only helps to build and keep strong bones, it is vital for the functioning of nerves and muscle. If the blood level of calcium is too low, the body will pull it from the bones to make up the difference. Over 75 percent of American women get fewer than 800 milligrams of calcium a day, and one out of four gets fewer than 300 milligrams -- far below the current recommendations for women:

Teens to mid-twenties: 1,200 milligrams Before menopause: 800 milligrams Pregnant and breast-feeding women: 1,200 milligrams After menopause: 1,000 milligrams for women on estrogen replacement therapy; 1,500 milligrams for women not receiving hormone replacement therapy.

Food sources

The best sources of calcium are dairy products, such as cheese, yogurt, and milk, because they contain vitamin D and lactose, two substances that aid calcium absorption. People with lactose intolerance have trouble digesting the milk sugar lactose and tend to avoid dairy products. This puts them at greater risk of osteoporosis: Although only 15 percent of Americans have lactose intolerance, 60 percent of women with osteoporosis have it. If you are lactose intolerant, consider using commercially available enzyme products, like LactAid.

In addition to dairy products, there are other good sources of calcium: canned fish with edible bones, such as salmon and sardines; dark green leafy vegetables, such as kale, collard, and broccoli; and calcium-fortified foods, such as orange juice and breads made with calcium-fortified flour.

Even if your diet is loaded with calcium, many factors can reduce the amount available to your body. These include:

A high-protein diet Alcohol (more than two drinks a day) Coffee (four or more cups a day) Fasting or crash dieting Oxalates (in spinach, chard, beet greens, rhubarb) Phytates (in the bran of whole grains)

There's no reason to avoid eating spinach or whole grains because of oxalates and phytates; if you have other rich sources of calcium in your diet, you should be fine.

If you don't get enough calcium from your food, or you can't digest milk, you might think about taking a calcium supplement. Calcium is best absorbed if taken in 250 to 500 milligram doses throughout the day. To lessen side effects, it's best to time supplements with meals or a bedtime snack. (Avoid taking calcium with fiber or iron supplements.) Taking calcium before bedtime has the added benefit of counteracting the normal calcium excretion that occurs during the overnight fast.

The five most common forms of calcium are carbonate, citrate, lactate, phosphate, and gluconate:

Calcium carbonate (Caltrate 600, Os-Cal, Tums) has the most calcium per tablet and is also the cheapest. However, it requires acid to be absorbed and isnt a good choice for people taking antacids or other medicines that decrease stomach acid. This form of calcium can trigger gas, bloating, and constipation.

Calcium citrate (Citracal, Nutravescent) has about half the calcium per dose as calcium carbonate, meaning you need to take higher doses or more pills to get an equivalent amount. However, it is easily absorbed by people with reduced stomach acid (such as the elderly) and doesn't need to be taken with meals.

Calcium phosphate isn't the best choice because the average diet is already too high in phosphorus. Calcium lactate and calcium gluconate have only a small amount of calcium per tablet. (Calcium lactate should not be taken by people who are lactose intolerant.)

Avoid supplements derived from oyster shell, bone meal, or dolomite, since these may contain heavy metals, such as LEAD. Always check with your doctor before taking any dietary supplement.

Get enough vitamin D
You can't absorb calcium without enough vitamin D. The current daily recommendation for vitamin D is 400 I.U.

Food sources
The best natural food sources of vitamin D are fish oils, butter, cream, egg yolk, and liver. Milk is the only food fortified with appreciable amounts of the vitamin. Still, you'd need to drink four glasses to get your day's vitamin D needs.

Other sources
There's a precursor of vitamin D in the skin that gets converted to the vitamin upon exposure to ultraviolet light. (In theory, the skin can make up to 10,000 I.U. a day of vitamin D!) Aim for about 10 to 15 minutes in the sun, two to three times a week (between 8 a.m. and 4 p.m.) without wearing sunscreen on your skin. Dark-skinned people don't make as much vitamin D, probably because melanin in the skin blocks more ultraviolet rays. Most people, however, who follow the above advice will get enough vitamin D -- unless it's winter. In that case, it's important to get the vitamin from your diet.

If you don't drink milk, take a multivitamin or a vitamin D supplement. If you're over 70, aim for 600 I.U. of vitamin D a day. But don't get more than 1,000 I.U. a day from all of your food and supplement sources. Excessive amounts can actually increase your risk of osteoporosis. Again, check with your doctor before taking supplements.

When you exercise, your muscles pull on your bones, strengthening them. Walking, jogging, dancing and playing tennis are all good weight-bearing exercises. (Inactivity, by contrast, causes bone loss. When a person is bedridden, he or she may lose as much as 5 percent of bone mass per month!) Weight-bearing exercises, done on a regular basis, are recommended for preventing osteoporosis. But researchers are increasingly stressing the benefits of a different kind of exercise: weight lifting. A 1994 study in the Journal of the American Medical Association found that women as old as 70 could avoid the typical loss of bone -- and even increase their bone mass a bit -- by lifting weights twice a week for a year. So convincing is the research on the benefits of weight lifting that we've created a program called Boning Up to help you get started.

Stop smoking
Smoking can bring on menopause as much as two years earlier than it would naturally occur, putting a woman at even greater risk of osteoporosis because she spends fewer years with the protective benefits of estrogen. Smoking also interferes with the body's use of calcium. Smokers, in fact, have higher rates of vertebral fractures than nonsmokers.

Watch your step!
People with weak bones have to be particularly careful to avoid falling. The chances of falling rise if you have a history of fainting or falling, have problems with balance or muscle coordination, have impaired vision, or take medication for high blood pressure, sleep disorders, or depression.

Besides watching out for slippery floors and steps, you should do the following to "fall-proof" your home:

Anchor rugs (get rid of throw rugs). Minimize clutter. Use nonskid mats near the kitchen sink and stove. Remove all electrical cords and loose wires that can cause tripping. Install handrails in bathrooms, halls, and along stairways. Light hallways, stairwells, and entrances. Use night lights in bedrooms and bathrooms. Wear sturdy, nonskid low-heeled shoes. Clean up spills at once.

Improve your posture
Even if your spine is already curved, improving your posture and building up muscle strength can help prevent falls and reduce your risk of fracturing a bone. Ask your doctor to refer you to a physiatrist, a doctor who specializes in the diagnosis, treatment, and prevention of disabilities. A physiatrist can help you learn what exercises you can do safely

Medical treatment

Osteoporosis has no cure, but it is preventable, and there are treatments. Following are descriptions of the most common therapies available today -- and some you may see in the future.

Hormone therapy
Doctors sometimes prescribe estrogen to replace the hormones lost during menopause and slow the rate of bone loss. This therapy is called hormone replacement therapy (HRT). HRT can reduce the risk of spine, hip, and wrist fractures by up to 70 percent. It works best if taken during the five to ten years immediately following menopause, or in the case of surgical menopause, when the ovaries are removed. But HRT offers bone benefits to women even if they start taking it much later in life. Once the therapy is discontinued, however, bone loss resumes.

Experts do not know all the risks of long-term use of HRT. Women should discuss benefits, risks, and possible side effects of HRT with their doctors.

Bone-saving drugs

A variety of drugs are available to slow bone loss or build up bone, but all require adequate calcium to work effectively.

Alendronate (Fosamax)
Alendronate prevents bone from being resorbed. The drug appears to build up a woman's spine by 3 percent a year for three years. In five studies, involving 1,602 women, the drug was found to reduce fractures by nearly 30 percent. In particular, it can prevent three kinds of fractures: forearm fractures, hip fractures, and vertebral collapse (which leads to loss of height).

Typically, a woman will take one 10-milligram tablet daily, with plain water on an empty stomach. The worst side effect of the drug is that it can irritate the esophagus, but gastrointestinal upset can be lessened if you take the drug when you first gets up, at least 30 minutes before breakfast, and stay upright during that time.

The Food and Drug Administration (FDA) has approved the use of Alendronate for treating osteoporosis but not for preventing it. Studies to date have lasted only four years, and since the drug is actually bound into the bone, there's some concern about its long-term safety. That's why Alendronate is usually reserved for women who can't take estrogen. For its benefits to last, Alendronate must be taken for life.

Calcitonin is a naturally occurring hormone that increases bone density in the spine by one and a half percent per year for two years. Studies have found no benefit to the hip or forearm after two years.

The drug comes in two forms: injection (Calcimar, Miacalcin) or nasal spray (Miacalcin). It's a protein, so if it were taken orally, it would be digested before it could work. In its injectable form, calcitonin has been studied for more than a decade and has been found to have few side effects. (It leaves the body within a matter of hours.) A nasal spray, however, may irritate the nasal passages or inflame the sinuses if used for years. Calcitonin doesn't build as much bone as Alendronate, but because it has a pain-killing effect, it's a good post-fracture treatment. It is also a good alternative for women who don't want to take hormone-replacement therapy or Alendronate. Both Alendronate and calcitonin must be taken for life to be beneficial.

Raloxifene (Evista)
This "designer estrogen,"otherwise known as a selective estrogen receptor modulator, was approved by the FDA in December, 1997, as an alternative to HRT. In a study of 13,000 women, raloxifene increased bone density by 1 to 2 percent, but did not stimulate the breast tissue, meaning it would not raise the risk of breast cancer. It also does not stimulate uterine tissue and would therefore not raise the risk of uterine cancer either. When the researchers examined how the drug affected cholesterol levels, they found that raloxifene lowered levels of total cholesterol and "bad" LDL cholesterol, but did not raise "good" HDL levels. (It does increase hot flashes at the start of treatment, though these tend to be mild.) Finally, the drug is taken orally once a day and doesn't have to be timed to coincide with meals, as do some hormone-replacement medications.

Etidronate (Didronel) is a member of the same family of drugs as Alendronate. The FDA has not approved this drug for treating osteoporosis, although it is approved in Canada.

Slow-release sodium fluoride
Slow-release sodium fluoride is a mineral that builds up a woman's spine by 5 percent and her hips by 2.4 percent a year. In one small study, slow-release sodium fluoride reduced fractures by a third, and the women taking it experienced few side effects. (An early version of the drug -- not slow-release -- available in the 1980s built bone, but the bone was brittle and prone to fractures.) The drug, taken as tablets, has not yet been approved by the FDA, and given the few studies done, many researchers would rather wait for more evidence that the benefits outweigh the risks.

This hormone stimulates the osteoblasts, the cells that build up bone. It's been widely used throughout the world but has never been approved for treating osteoporosis in the United States. (A synthetic form called Rocaltrol is used in this country to treat a bone disorder that results from kidney dialysis.) Part of the concern is that in high doses the drug can cause kidney stones.