Working Healthy

Outsmarting Osteoporosis

Have you been lackadaisical about getting enough calcium? Slacking off on your exercise? Considering that one of every two women in the US will develop osteoporosis, the question is: do you feel lucky?

“Some of the calcium supplement tablets prepared in the 1980s were not soluble,” he explains. “That’s why doctors got in the habit of recommending them.” Most of those supplements have been pulled from the market or reformulated, he says, and today it’s simply a matter of choice (though he does recommend putting one of your supplements in a glass of vinegar if you have any questions; if it dissolves it is considered soluble). A good calcium supplement also should provide 400 to 800 IU of vitamin D per day.


Work That Body

If you find yourself lacking motivation to get in shape, perhaps it will help to know weight-bearing exercise, which causes muscles to work against gravity, not only improves your overall health and increases your metabolism (thereby burning more calories even at rest), but it helps to build strong bones. Jogging, tennis, stair climbing, weight training, walking, and dancing are all examples of weight-bearing exercise. Additionally, Dr. Cosman points out that all of these forms of exercise improve agility, strength and balance, reducing your risk of falling no matter what your age.

“The magnitude of change in bone density is pretty small, along the lines of 1% to 2%,” notes Steven Harris, M.D., an endocrinologist and chief of the osteoporosis program at the University of San Francisco, but he adds that just a 1% increase significantly reduces the risk of fracture.

“People who have jobs that keep them on their feet and up and down stairs don’t have to worry as much, but those who sit behind a desk need to incorporate a specific weight-bearing exercise program into their day,” Dr. Cosman says.


Hormone Replacement Therapy, or Not?

Unfortunately, NOF and NIH emphasize that even eating right and exercising cannot eliminate a person’s risk of osteoporosis. “It’s good to optimize your lifestyle, but there is still some concern about later development,” Dr. Harris explains. Which leads to the third leg of Dr. Heaney’s stool: hormones.

According to the Foundation for Osteoporosis Research and Education (FORE), women can lose as much as 20% of their bone mass in the five to seven years following menopause clue to losing the protection provided by estrogen.

Though there’s no question that menopause and the resulting loss of the body’s natural ability to create estrogen contributes to bone mass loss, hormone replacement therapy for postmenopausal women is somewhat controversial. On the one hand, research has demonstrated that hormone replacement significantly lowers the risk of osteoporosis and heart disease. On the other hand, research also has proved that it significantly increases the risk of breast and uterine cancers.

According to the experts we interviewed, women should discuss their risks for developing osteoporosis with their physician. And if you’re entering or have already gone through menopause, you should talk to your doctor again. According to FORE, most authorities feel that estrogen should be continued for 10-15 years after menopause to prevent osteoporosis. Another option may be to consider a bone density test — the only way to determine what is happening to your bones — as part of the decision-making process. Regardless, both Drs. Harris and Cosman say the general recommendation is that women over age 65 should have a bone density test.


Help Is on the Way

Currently, hormone replacement therapy provides the most protection against osteoporosis, but Dr. Harris says that a number of alternatives have been approved by the Food and Drug Administration over the past five years. “I think all of these agents now have the ability to decrease the risk of fracture and to increase bone density, not only for healthy post-menopausal women, but for those who’ve already experienced fractures.”

Even more promising treatments are in the investigation phase. For example, Dr. Cosman recently presented the results of her most recent research efforts at the World Congress on Osteoporosis 2000.

According to Dr. Cosman’s new study, parathyroid hormone — an investigational bone-forming agent unlike any of the currently available medications for osteoporosis — was shown, in combination with hormone therapy, to dramatically increase bone mass throughout the skeleton. Specifically, it was shown to decrease vertebral fracture risk. “Most importantly, a full year after the drug was discontinued the women had retained nearly all the bone mass they had gained, as long as the estrogen was continued,” she says.


Don’t Become a Statistic

Even though osteoporosis research shows promising results with new drug therapies, remember the women with osteoporosis that NOF polled earlier this year: Nine out of 10 wish they had known how to avoid developing the disease.

“These healthy lifestyle choices have to be made today,” Dr. Cosman emphasizes. “If you start today and continue the rest of your life, you will have the biggest impact. And women in their 30s and 40s should make sure their mothers have a bone density test. Because we know that if” you’re genetically predisposed to osteoporosis, no amount of diet or exercise will stop it.” Caught early enough, though, today’s medications can stop further bone loss. And Dr. Cosman’s research provides hope of reversing it in the near future.


Are You at Risk for Osteoporosis?

According to the National Osteoporosis Foundation, anyone can develop osteoporosis, but certain people fall into a higher risk category. So-called risk factors include:

  •  Being female
  •  Having a thin or small frame
  •  Advanced age
  •  A family history of osteoporosis
  •  Post menopause, including early or surgically induced menopause
  •  Abnormal absence of menstrual periods
  •  A history of eating disorders such as anorexia nervosa or bulimia
  •  A diet low in calcium
  •  Use of certain medications, such as corticosteroids and anticonvulsants
  •  Low testosterone levels in men
  •  An inactive lifestyle
  •  Cigarette smoking
  •  Excessive use of alcohol
  •  Being Caucasian or Asian, though African Americans and Latinas are at significant risk as well.



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