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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“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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