Osteoporosis
Osteoporosis
24 Ways to Stronger Bones
An estimated 24 million Americans have osteoporosis. Many do not even know it. They are not all old. They are not all women.
Anyone can get osteoporosis, but women are much more likely to get it than men. Women develop less bone mass than men. Then, for several years after menopause, women also lose bone at an increased pace because their bodies are producing less estrogen.
But this doesn't have to happen. Anyone can take major steps to prevent osteoporosis without ever going to a doctor. And anyone who already has this bone-weakening disease can do a lot to halt its progress.
Unfortunately, the weakening of bones can be taking place very quietly for years, even decades. In his book Preventing Osteoporosis, researcher Kenneth Cooper, M.D., refers to osteoporosis as the "silent destroyer."
"Most people reach their peak bone mass in the spine between the ages of 25 and 30 and reach their peak bone mass in the long bones—such as the hip—from age 35 to 40," says Dr. Cooper. "After we pass this peak bone mass age, and especially after about age 45, all the bones in the body begin to lose density."
Because official diagnosis of osteoporosis often comes too late—after a fracture—the strategy is to start fighting bone loss early and to never let up.
As you are about to see, you have many weapons in your arsenal.
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Exercise to build bone. "If you don't exercise, you lose bone," says Robert Heaney, M.D., John A. Creighton University Professor at Creighton University.
But there is even more reason to exercise. "A number of studies support the theory that weight-bearing exercise can actually increase bone mass," says Paul Miller, M.D., an associate clinical professor of medicine at the University of Colorado Health Sciences Center School of Medicine.
One of those studies, a Stanford University project, examined male and female long-distance runners and compared them with a nonrunning group. The researchers found that both the male and female runners had about 40 percent more bone mineral content than the nonrunners.
Even walking helps your bones, doctors say. Walking is an excellent, not to mention safe, way to get your bones the exercise they need. They suggest walking at least 20 minutes a day, three or four days a week.
Of course you can't always immediately see the difference exercise can make. So if you're someone who lives by a "seeing is believing" motto, take notice of a right-handed tennis player's right forearm. Chances are good it will be considerably larger than his "passive" forearm. This is visible proof that if you use your muscles and put your bones under stress, the density and size of those bones will increase.
And you're never too old to start exercising, says Dr. Cooper. Research shows that menopausal women taking up exercise can increase their bone density.
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Get enough calcium in your diet. Some scientists believe that a chronic shortage of dietary calcium is a contributing factor in developing osteoporosis.
A Yugoslavian study offers strong evidence to support calcium's importance. In one region of Yugoslavia, where dairy products were not consumed, women had half the daily calcium intake of women who lived in an area where dairy products were regularly consumed. The researchers discovered that the women who took in more calcium had substantially greater bone mass and fewer fractures after the age of 65 than did the women who had low-calcium diets.
Studies of American women with osteoporosis have supported the earlier Yugoslavian study, notes Morris Notelovitz, M.D., author of Stand Tall! The Informed Woman's Guide to Preventing Osteoporosis. Today the U.S. Recommended Daily Allowance (USRDA) is 1,000 milligrams of calcium. That's not enough, says Dr. Cooper and many others. He advises up to 1,500 milligrams daily. "Calcium phosphate in milk is an excellent source," he adds.
But hardly the only source. Low-fat cheeses and yogurts are also high in calcium. And skim milk offers the same calcium as regular milk without the fat, says Lila A. Wallis, M.D., a clinical professor of medicine at Cornell University Medical College. Other high-calcium foods include red salmon, sardines, nuts, and tofu. Also, some citrus juices are now being sold as calcium fortified.
Fortify your meals. Add powdered nonfat dry milk to soups, casseroles, and beverages, suggests Dr .Notelovitz in his book. Every teaspoon is worth about 50 milligrams of calcium. And no fat!
Make soup. According to Dr. Notelovitz, if you use a little vinegar when preparing stock from bones, the vinegar will dissolve the calcium out of the bones. One pint of your soup, then, will be equal to about a quart of milk in calcium content.
Pinch-hit for butter. For both good taste and calcium content, Parmesan cheese is a fine substitute.
If you can't get enough calcium in your diet, take a supplement. Calcium supplements can work small wonders—especially for people who have trouble absorbing natural sources of calcium. There are a host of calcium supplements on the market, but what works for cousin Bessie may not work for you.
"However, calcium carbonate is well absorbed in the stomach by most people if taken in divided doses and with meals," Dr. Miller says.
There are other supplements, but most doctors recommend you try calcium carbonate first because it is typically the least expensive and offers the highest amount of calcium per tablet. Ask your doctor if a supplement program would be of benefit to you.
Test your calcium supplement at home. "Many of the generic brand supplements are so badly formulated, they don't disintegrate adequately," says Dr. Heaney.
To test your supplement, Dr. Miller suggests dropping two of the tablets in 6 ounces of vinegar and waiting for 30 minutes, while stirring every 2 or 3 minutes.
"If the tablets break up into small fragments, it's probably dissolving well in the stomach," he says. "If it stays in tablet form, take it back and get a new supplement."
Get enough vitamin D. "It's essential to calcium absorption," says Robert M. Levin, M.D., an associate professor of medicine at Boston University School of Medicine and chief of the endocrinology clinic at Boston City Hospital in Massachusetts.
Vitamin D is important to calcium in two ways. First, it increases absorption of calcium in the intestines, notes Dr. Notelovitz. And second, it increases reabsorption of calcium through the kidneys.
If you spend a lot of time in the sun, you may think you're getting more than enough vitamin D. "But because we wear clothes," says Dr. Miller, "maybe 10 percent of our needed vitamin D comes from the sun."
How much do we need? A minimum of 400 international units per day. "People above age 65," Dr. Miller says, "may need 800 international units daily if they don't get outdoors frequently and they don't eat dairy products."
You can get vitamin D in some of the same places you get calcium. An 8-ounce glass of milk contains about 125 international units. Salmon, sardines, and tuna, however, are our best natural sources of vitamin D. Four ounces of canned salmon, for example, typically contains about 565 international units.
Also be sure to read the labels of calcium supplements. Some of them contain vitamin D, too. Doctors generally do not recommend vitamin D supplements, as high levels can be toxic.
Restrict alcohol consumption. "Alcohol reduces bone formation," Dr. Cooper says, adding that research has shown that alcoholics are especially prone to losing bone density. Drink only in moderation—no more than one or two drinks per day for men, and no more than one drink per day for women, Dr. Wallis advises.
Don't smoke. As if you needed another reason. Still, here it is—cigarette smoking lowers estrogen levels, Dr. Cooper says, and women with lower estrogen levels are at increased risk for developing osteoporosis.
Put a limit on caffeine. "We've done a lot of the caffeine research, and there appears to be a slight effect on calcium being lost in the urine," Dr. Heaney says. "But two or three cups of coffee a day is no problem."
Don't eat too much meat. This doesn't mean you have to eliminate meat from your diet. But don't overdo. "We now know that protein increases calcium excretion more than it increases calcium absorption, thus leading to an overall loss of calcium from the body," writes Dr. Notelovitz.
Watch your fiber intake. A high-fiber diet may bind calcium in the stomach, thus restricting the amount of calcium that is absorbed, Dr. Cooper says.
"Certain kinds of fiber may bind calcium, but how much and what kinds is unknown," adds Conrad Johnston, Jr., M.D., a professor of medicine at the Indiana University School of Medicine.
So unless your diet is abnormally high in fiber—few Americans have this problem—don't go to the other extreme and drastically reduce fiber intake; just consider reducing it a little. After all, "There are a lot of good things about fiber," says Dr. Levin. "It's good for gut motility and it helps lower cholesterol."
Put down the salt shaker. "The more sodium in your diet, the more sodium you excrete—and the more sodium you excrete, the more calcium you excrete," writes Dr. Notelovitz.
"What probably happens is that as calcium is being excreted in the urine, the blood levels of calcium drop, causing the release of parathyroid hormone, which breaks down bone to restore calcium levels."
Watch your phosphate intake. "There is general belief, but not proof, that phosphate, such as in soft drinks, will bind calcium to the gut and prevent absorption," Dr. Miller says.
In animal studies, high doses of phosphate appeared to contribute to bone loss, Dr. Johnston adds. "But the big problem with soft drinks," he emphasizes, "is that if people are drinking them all day, they are not drinking milk and not getting enough calcium."
Ideally, "calcium to phosphorus intake should be a one-to-one ratio," says Dr. Levin. To achieve that ratio, you need much more calcium in your diet than phosphorus because calcium isn't as easily absorbed.
PANEL OF ADVISERS
Kenneth Cooper, M.D., a medical researcher, is president and founder of the Aerobics Center in Dallas, Texas, and author of Controlling Cholesterol, Preventing Osteoporosis, and other books.
Robert Heaney, M.D., is John A. Creighton University Professor at Creighton University in Omaha, Nebraska.
Conrad Johnston, Jr., M.D., is a professor of medicine at the Indiana University School of Medicine in Indianapolis.
Robert M. Levin, M.D., is an associate professor of medicine at Boston University School of Medicine in Massachusetts. He also is chief of the endocrinology clinic at Boston City Hospital.
Paul Miller, M.D., is an associate clinical professor of medicine at the University of Colorado Health Sciences Center School of Medicine in Denver.
Lila A. Wallis, M.D., is a clinical professor of medicine at Cornell University Medical College in New York City. She also is president of the American Medical Women's Association and founder and first president of the National Council on Women in Medicine.