Preventing Bone Loss and Disability
By: Dr. Sandra Farland
It seems that the guidelines change every week about bone loss and prevention. Too much vitamin D can hurt you. Not enough and you won’t absorb calcium. And bisphosphonates, well, some say they’re risky too.
What’s a person to do?
Here’s what I tell my patients, especially my female patients, at Wake Forest Baptist Medical Center, about preventing bone loss.
[Read more: Aging changes in the bones, muscles and joints.]
Osteoporosis is a leading cause of disability in the country, accounting for 1.5 million fractures a year. And in spite of the contradictory headlines, prevention really isn’t complicated at all.
Start with calcium supplements – as early as possible – that combine calcium with vitamin D so your body can absorb the calcium. And take them every day, as regularly as you brush your teeth.
The guidelines for calcium and vitamin D changed last November, and some of my patients found that confusing. Health officials now recommend 1,200 mg of calcium a day for adults combined with 800 international units of vitamin D. Not every supplement contains the recommended dose, so read the label. That’s it. I can’t guarantee that if you take your calcium you won’t break a hip when you’re older. Some of us are prone to bone loss. But supplements will slow the course of bone loss and greatly reduce your risk for a debilitating fracture.
I advise my patients to start taking calcium and vitamin D supplements as teenagers. Dairy foods, fortified orange juice and cereals and some green, leafy vegetables contain calcium. But health officials say teenagers need 1,300 mg of calcium a day, slightly more than adults. That’s four or five servings of dairy products a day, which means most teenagers and adults, need a supplement. The extra calcium helps your body build bone mass so that as you age there’s less risk of osteoporosis.
Women and men start losing bone around the time they turn 30. But as they age, women face the greatest risk because of the relationship between estrogen and bone loss. As a woman approaches menopause and her estrogen level falls, she begins losing bone mass at a rate of 1 to 3 percent a year. That loss – 1 to 3 percent a year – continues so that by the time a woman is 75 years old she may have lost 50 percent of her bone mass.
So it’s no surprise that older people, especially women, break their bones so easily. I’ve had patients break a hip simply by losing their balance. They don’t fall, but the impact of catching themselves is strong enough to fracture the hip. A minor fender bender can leave some people with a hairline fracture in their spine, orthopaedic surgery, and possibly a lifetime of pain. Even a bad cough can fracture a rib.
Hip fractures are by far the most debilitating fractures associated with osteoporosis. Most patients require orthopaedic surgery after a hip fracture to repair or replace the joint, and many recover with rehabilitation. But many patients don’t. According to the Centers for Disease Control, one in five patients who break their hip will not survive the year.
Family history puts patients at risk for osteoporosis. Women whose mothers have broken a hip are at greater risk of an injury than women with no history of bone loss in their families. Caucasian and Asian Americans are at greater risk of bone loss than African and Hispanic Americans. Thin people are at greater risk for bone loss than heavier people because carrying extra weight forces your body to build bone mass. Smoking also puts people at risk for bone loss.
I come from a family of nurses and I worked as a trauma nurse before I decided to go to medical school. So I believe in prevention. I start with a supplement. Weight-bearing exercise also builds bone strength. Swimming is great exercise, but it won’t do much for your bone mass. On the other hand, running, strength training, tennis – even taking the stairs – will strengthen your bones.
I start screening patients for bone-mass density at age 65. Patients with a family history of osteoporosis and fracture should be screened at a younger age. About 25 percent of my patients over the age of 65 take a bisphosphonate to prevent further bone loss. These drugs don’t replace bone mass, but they slow the progression. Some of my patients worry about side effects, but most can control the most common side effect of heartburn by taking the medicine before eating.
Many of my older patients, especially those with a family history of brittle bones, live in fear of breaking a hip or fracturing a rib. I can help them slow their disease and prevent fractures, and there’s plenty they can do with exercise and diet. But there’s no way to replace the lost bone.
The best prevention begins in childhood – or young adulthood – with a healthy diet and a calcium supplement combined with vitamin D.