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?

Editor’s note: The line between our personal and professional lives is at best a fine one, at least in terms of our health. Hence this fourth installment in our occasional series on women’s health issues. In this series we’ll tip you off to the top medical conditions affecting women and what can be done to prevent, detect, and treat them. In the coming months the series will include articles on depression, thyroid disease, and autoimmune disorders, to name a few. After you read each piece, we encourage you to share them with your coworkers, your clients, and your friends. Because the way we see it, your health is your most precious resource both on and off the job. See our piece in a recent issue on Breast Cancer.


Of every two women who read this article, one will develop osteoporosis (which literally means “porous bone”) in her lifetime. In fact, a woman’s risk of hip fracture is equal to her combined risk of breast, uterine, and ovarian cancer. Sure, we all have known someone whose grandma or grandpa broke a hip or fractured a vertebra, but most of us chalked it up to old age.

In reality, we should chalk it up to osteoporosis, a disease characterized by low bone mass and structural deterioration of bone tissue. In this country alone osteoporosis is responsible for more than 1.5 million fractures every year, including 300,000 hip fractures, 700,000 vertebral fractures, and 250,000 wrist fractures.

“Contrary to what many people think, osteoporosis is not an inevitable part of aging, but is preventable for most people if they take steps throughout their lives,” says Sandra Raymond, executive director of the National Osteoporosis Foundation (NOF).

Yet, partly because it’s a “silent” disease (bone loss occurs without symptoms), people tend to remain unaware and unconcerned — until their first, painful fracture. By then bone mass has deteriorated so far that the sudden strain, bump, or fall that should have caused no more than a bruise or a strained muscle instead resulted in a fractured hip, wrist, or vertebra.

“Hip fractures are not only disabling, they can also be life threatening,” Raymond says. “Vertebral fractures may lead to stooped posture, loss of height, chronic pain and disability, and may cause compression of the lungs and stomach.” By the time the first fracture occurs, she adds, the disease is advanced and additional fractures are more likely.

NOF hopes that the regrets of mothers and grandmothers will be heard by their daughters and granddaughters while there’s still time. This past May, NOF released the results of a national survey conducted exclusively among women who suffer from osteoporosis. The survey revealed that only 33% of women with osteoporosis had taken steps to prevent it. Most (91%) now wish they had known how to take preventive action, while virtually all respondents (97%) agreed that all women should take action against developing it.


Start Investing at a Young Age

According to the Foundation for Osteoporosis Research & Education, osteoporosis is a disease of the 20th century. In the 19th century, the average woman died within five years of menopause. Today, a woman who reaches the age of 50 — the average age at which menopause occurs — can expect to live into her 80s.

That doesn’t mean developing osteoporosis is inevitable. In fact, the medical community agrees it can be prevented, but you have to start young — in childhood, in fact, according to a panel of experts at a recent NIH Consensus Conference on Osteoporosis.

“Think of bone as a bank account where you make ‘deposits’ and ‘withdrawals,’ “explains NOP in its Bone Basics for Young Women pamphlet. “During childhood and adolescence, much more bone is deposited than withdrawn, so that the skeleton grows both in size and density. The amount of bone tissue in the skeleton, known as bone mass, can continue to increase until you’re around 30.”

Those deposits are funded, so to speak, by adequate intake of calcium and vitamin D, as well as exercise. Before age 30, the calcium you take in daily is used first, for your body’s daily needs, and the excess is deposited in your bones. After age 30 the savings account closes, so to speak, but you still need to supply your body’s daily needs (i.e., your checking account).

Unfortunately, NOF estimates that most women — young and old — get as little as half of the calcium their bodies need daily, which means their bodies raid their bones for shortfall.

But calcium and vitamin D deficiencies aren’t the only cause of osteoporosis, says Robert Heaney, M.D., primary investigator emeritus at Creighton University Osteoporosis Research Center (Omaha, Neb.).

“Bone health is analogous to a three-legged stool,” he explains. “It takes all three legs to be strong; simply emphasizing one or the other isn’t adequate.” Dr. Heaney identifies the one as calcium and vitamin D intake; the second as lifestyle factors that encompass not only diet and exercise, but factors such as smoking and alcohol abuse. Finally, hormones play an important role.

“There are three ways in which hormones are pertinent. First, at menopause women lose their female hormone [estrogen]. Second, thyroid hormones can be bad for your bones if they’re not in balance. Third, body weight — women who are excessively thin often have a hormone problem.

“You really can’t substitute one leg for any of the others,” Dr. Heaney observes. In other words, you can exercise daily, but without adequate intake of calcium it would be like trying to build a house without 2´4s.


Got Milk?

Adult women need 1,000-1,200mg/day of calcium, which is the equivalent of three to four 8-oz. glasses of milk. But according to Dr. Heaney, most American women take in just one-third to one-half of the calcium they need daily for healthy bones. If you don’t have milk in your life, other ideal “natural” sources for calcium include broccoli, cottage cheese, yogurt, and cheese.

Nor is it as hard to include those sources in your daily diet. For example, NOF suggests adding a dairy product to every meal by grating cheese over a salad, adding slices of low-fat cheese to your sandwich, and drinking milk instead of other beverages. For those people who are allergic to dairy products or who are lactose-intolerant, food-makers have recently begun fortifying many other types of food with calcium. For example, you can now buy calcium-enriched juices, breads, and cereals, to name a few.

“Personally, I favor judicious fortification because it’s very difficult for us now to have a diet that gives us all we need,” Dr. Heaney says. “Fortification is a more efficient way to meet those needs.”

Calcium supplements are another viable alternative, says Felicia Cosman, M.D., an osteoporosis specialist at Helen Hayes Hospital (Haverstraw, N.Y.) and clinical director of NOF “One misconception about supplements, though, is that you need 1,000 to 1,200 mg,” she says, explaining that you have to take into account the calcium that you do get from daily meals and snacks and use supplements to cover the deficit.

Not everyone is so enthusiastic about supplements, though. “The problem with supplements is that if you’re low in calcium you’re most likely deficient in several other nutrients as well,” Dr. Heaney argues. “The best and easiest way to fix that is with food.”

Another confusing point of supplements is what type to take? In researching this article we found several recommendations that women take only chewable supplements, but Dr. Heaney says that advice is outdated.

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