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Osteoporosis and Bone Health PATIENT EDUCATION SERIES

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Osteoporosis and Bone Health PATIENT EDUCATION SERIES Osteoporosis and Bone Health PATIENT EDUCATION SERIES What is osteoporosis? Many factors affect the remodeling process. A defi- Osteoporosis, which means “porous bones,” is a ciency of the hormone estrogen appears to increase condition of the skeleton in which the amount of bone loss. This occurs naturally after menopause calcium present in the bones slowly decreases to but can also occur with surgical removal of the ova- the point where the bones become less dense and ries. Intense exercise such as marathon running af- more prone to fracture. Contrary to popular belief, fects hormonal levels and may lead to osteoporosis. it is not just a disorder of the elderly woman. It can Severe underweight and undernutrition problems occur in the college-aged population. People with that occur in patients with eating disorders can eating disorders, high performance athletes or pa- lead to hormonal deficiencies which cause amenor- tients on certain medications may be at the greatest rhea (absence of menstrual periods) and severe risk. Even if you have no present high risk factors, osteoporosis. building strong bones today may prevent osteoporo- sis from occurring in the future. What are the signs and symptoms of osteoporosis? How does it occur? Early osteoporosis may have no symptoms. Symp- Our skeleton provides structural support for our toms occurring LATE in the disease include: muscles and organs. In addition, it serves as a • Fractures of the vertebrae, wrists or hips follow- storage depot for 99% of the body’s calcium. The ing very minor trauma remaining 1% is free to circulate in the blood and is • Low back pain essential for crucial body functions including mus- • Neck pain cle contraction, nerve function and blood clotting. • Bone pain or tenderness • Loss of height over time (may be as much as 6 Bone is not a lifeless structure. It is a living, inches) growing tissue. In order to meet our body’s needs • Stooped posture (“dowager’s hump”) it is constantly being remodeled, broken down and reformed again. The breakdown is done by What factors increase your risk of cells known as osteoclasts which dig holes into the developing osteoporosis? bone, releasing the small amounts of calcium into For women the bloodstream that are necessary for other vital • Being female (80% of osteoporosis occurs in functions. Cells called osteoblasts then rebuild the women) skeleton, first by filling in the holes with collagen • Increasing age: after 65 about 30% of women have and then by laying down crystals of calcium and osteoporosis phosphorus. • Being postmenopausal, either due to natural or surgical menopause (decreased estrogen) From childhood to adulthood, bone is made faster • Estrogen deficiency due to abnormal absence of than it is broken down and bones become larger and menstruation. This can occur in persons with denser. Peak bone mass occurs by the mid 20’s. eating disorders or high performance athletes. The remodeling process begins to change as early as In fact, over half of anorexics have osteoporosis age 35, so that bone is broken down faster than it with bones resembling those of women in their is made. This results in precipitous bone loss after 70s or 80s. menopause. It is crucial that young adults “bank” • Ethnic heritage - Caucasian and Asian women are enough calcium in their bones to draw on later at highest risk. Risk is lower for African American in life to prevent osteoporosis. A person who has and Latino women. exceptionally dense bones to begin with will prob- • Thin, slight body frame ably never lose enough calcium to reach the point • Lifestyles that increase the risk of osteoporosis where osteoporosis occurs. However, a person who include smoking, alcohol use, high caffeine use, has low bone density could easily develop osteoporo- lack of exercise and low intake of calcium and sis despite losing only a relatively small amount of vitamin D. calcium. • Certain medications may increase risk including steroids, excessive thyroid medications, antico- agulants, antiepileptic drugs and immunosup- pressants. BROWN UNIVERSITY HEALTH SERVICES | www.brown.edu/health | 401.863-3953 • Certain metabolic diseases can cause secondary Increasing calcium intake to 1500 mg per day, osteoporosis. increasing vitamin D to 800 IU per day and main- taining normal weight and exercise patterns to For Men restore hormonal balance are thought to be helpful Men start with higher bone density and lose cal- in preventing further bone loss. cium at a slower rate than women, which is why their risk is lower. However, men can develop Bone Health osteoporosis. In men, a testosterone deficiency may How can I keep my bones healthy and contribute. Many of the risk factors, such as ethnic strong? heritage, body frame, lifestyle and medication risks Be sure to get the recommended amount of listed above, are the same as for women. However, calcium and Vitamin D. College students should men typically develop osteoporosis at a later age have an intake of 1200 mg of calcium daily. Vi- than women (after 60). tamin D helps the gastrointestinal tract absorb calcium. The recommended vitamin D intake is 400 What tests can be done to confirm the to 800 IU per day. Although some of our vitamin D diagnosis of osteoporosis? is manufactured in our skin after exposure to sun- Osteoporosis can be confirmed by bone-density test- light, we cannot rely on the sun to produce all the ing. This is usually suggested for women over 65, vitamin D we need, especially in northern areas like postmenopausal women with risk factors of osteo- New England. Diet is the best source of vitamin D. porosis or who have had a fracture. Young women Supplements may be necessary , but vitamin D from who have risk factors for osteoporosis such as all sources should not exceed the recommended having an eating disorder or absence of menstrua- limit. tion from over-exercising should also consider being tested. What are the best sources of calcium in food? Currently, the most accurate technique for deter- Nutritionists believe that it is preferable to choose mining bone density is dual x-ray absorpitometry food over calcium supplements if possible since (DEXA). The measurements are made by detect- calcium rich foods contain many other nutrients ing the extent to which bones absorb photons that that work with calcium to keep your bones healthy. are generated by very low-level x-rays. This test is Also, calcium from supplements is not as well ab- painless and quick. When the bone mineral density sorbed by the body as calcium from dairy products. is 2.5 standard deviations below the average for young adults, a diagnosis of osteoporosis is made. Milk Group If the bone mineral density is between 1 and 2.5 The milk group is the best source and you should standard deviations below the norm, a patient is di- try to get “4 a day.” About four servings of dairy agnosed with osteopoenia, a slightly less advanced (each about 300 mg) approach the daily goal of form of weakened bones. One standard deviation 1200mg calcium. Women with osteoporosis or os- below the norm in a measurement of hipbone den- teopoenia need 1500 mg calcium daily. Three serv- sity is equivalent to adding 14 years to a person’s ings plus a 500mg calcium supplement would also age-related risk of fracture. give you the needed amounts. Dairy products are a particularly good source of calcium because they are How is osteoporosis treated? also fortified with vitamin D. Treatment cannot eliminate osteoporosis, but medi- cines may be able to slow down the loss of bone. Appropriate calcium content of selected foods Most of the medicines available today are primarily aimed at treating osteoporosis in the postmeno- Milk pausal woman. Studies are presently underway All types of milk 1 cup 300 mg investigating therapies for the younger patient with Calcium-fortified soy milk 1 cup 300 mg osteoporosis. Oral contraceptives have not been Low-lactose milk 1 cup 300 mg found to be effective in treating osteoporosis due to anorexia. Investigational studies are looking Yogurt at insulin-like growth factor-1, testosterone, and a All yogurts 1 cup 300 mg postmenopausal osteoporosis medication as possible (top off your baked potato or add fruit to make a therapeutic agents for young women. smoothie) BROWN UNIVERSITY HEALTH SERVICES | www.brown.edu/health | 401.863-3953 Cheese and Ice Cream • Calcium supplements exist in different com- Swiss cheese 1.5 oz 300 mg pounds, all available over the counter. Al- American cheese 2 oz 300 mg though all of these provide calcium they have Cheddar cheese 1.5 oz 300 mg different calcium concentrations, and absorption Mozzarella cheese (skim) 1.5 oz 300 mg may differ. (top off your salad) • The best choices for calcium supplements Parmesan cheese, grated 1 oz 300 mg include: (top off your pasta) • Calcium citrate or maleate pills, especially Low-fat cottage cheese 1/2 cup 80 mg those with vitamin D. These are more expen- Typical ice cream 1/2 cup 90 mg sive but are absorbed better in general. There is some absorption on an empty stomach. Meat/Protein Group • Calcium carbonate pills, especially those that Sardines with bones 3 oz. 200 mg include vitamin D. These should be taken with Canned Salmon with bones 3 oz 200 mg food in order to be absorbed. (good substitute for tuna) • Chewable forms of calcium, such as “Viactiv,” Almonds 1/3 cup 120 mg or similar generic brands. Tofu (calcium-fortified) 1/2 cup 150 mg • Remember that calcium and iron supplements (or vitamins with iron) should not be taken Vegetable Group together as the body will preferentially absorb Kale 1/2 cup 90 mg iron and the calcium will not be absorded.
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