Bone is
a living, growing tissue. It is made mostly of collagen, a
protein that provides a soft framework, and calcium phosphate, a
mineral that adds strength and hardens the framework.
This combination of collagen and calcium makes bone both, flexible
and strong, which in turn helps it to withstand stress. More than 99
percent of the body's calcium is contained in the bones and teeth.
The remaining 1 percent is found in the blood.
Throughout your lifetime, old bone is removed (resorption) and new
bone is added to the skeleton (formation). During childhood and
teenage years, new bone is added faster than old bone is removed. As
a result, bones become larger, heavier, and denser. Bone formation
outpaces resorption until peak bone mass (maximum bone density and
strength) is reached around age 30. After that time, bone resorption
slowly begins to exceed bone formation.
For women, bone loss is fastest in the first few years after
menopause, and it continues into the postmenopausal years.
Osteoporosis - which mainly affects women but may also affect men -
will develop when bone resorption occurs too quickly or when
replacement occurs too slowly. Osteoporosis is more likely to
develop if you did not reach optimal peak bone mass during your
bone-building years.
About
Osteoporosis
Osteoporosis, or porous bone, is a
disease characterized by low bone
mass and structural deterioration of bone tissue, leading to bone
fragility and an increased risk of fractures of the hip, spine, and
wrist. Men as well as women are affected by osteoporosis, a disease
that can be prevented and treated.
Facts and Figures
·
Osteoporosis is a major public health threat for 44
million Americans, 68 percent of whom are women.
·
In the U.S. today, 10 million individuals already have
osteoporosis and 34 million more have low bone mass,
placing them at increased risk for this disease.
·
One out of every two women and one in four men over 50
will have an osteoporosis-related fracture in their
lifetime.
·
More than 2 million American men suffer from
osteoporosis, and millions more are at risk. Each year,
80,000 men have a hip fracture and one-third of these
men die within a year.
·
Osteoporosis is responsible for more than 1.5 million
fractures annually, including 300,000 hip fractures,
approximately 700,000 vertebral fractures, 250,000 wrist
fractures, and more than 300,000 fractures at other
sites.
·
Based on figures from hospitals and nursing homes, the
estimated national direct expenditures for osteoporosis
and related fractures total $14 billion each year.
Osteoporosis is often called the "silent disease" because
bone loss
occurs without symptoms. People may not know that they have
osteoporosis until their bones become so weak that a sudden strain,
bump, or fall causes a hip to fracture or a vertebra to collapse.
Collapsed vertebrae may initially be felt or seen in the form of
severe back pain, loss of height, or spinal deformities such as kyphosis (severely stooped posture).
For some people the first sign of osteoporosis is to realize they
are getting shorter, or to break a bone easily. Don’t wait until that
happens to see if you have osteoporosis.
Following a comprehensive medical assessment, your doctor may
recommend that you have your bone mass measured. A bone mineral
density (BMD) test is the best way to determine your bone health.
BMD tests can identify osteoporosis, determine your risk for
fractures (broken bones), and measure your response to osteoporosis
treatment. The most widely recognized bone mineral density test is
called a dual-energy x-ray absorptiometry or DXA test. It is
painless - a bit like having an x ray, but with much less exposure
to radiation. It can measure bone density at your hip and spine.
Bone density tests can:
·
Detect low bone density before a fracture occurs.
·
Confirm a diagnosis of osteoporosis if you already have
one or more fractures.
·
Predict your chances of fracturing in the future.
·
Determine your rate of bone loss, and/or monitor the
effects of treatment if the test is conducted at
intervals of a year or more.
Certain
risk factors are linked to the development of osteoporosis and
contribute to an individual's likelihood of developing the disease.
Many people with osteoporosis have several risk factors, but others
who develop the disease have no known risk factors. There are some
you cannot change and others you can.
Risk factors you cannot change:
·
Gender - Your chances of developing osteoporosis are
greater if you are a woman. Women have less bone tissue
and lose bone faster than men because of the changes
that happen with menopause.
·
Age - The older you are, the greater your risk of
osteoporosis. Your bones become thinner and weaker
as
you age.
·
Body size - Small, thin-boned women are at greater risk.
·
Ethnicity - Caucasian and Asian women are at highest
risk. African American and Hispanic women have a lower
but significant risk.
·
Family history - Fracture risk may be due, in part, to
heredity. People whose parents have a history of
fractures also seem to have reduced bone mass and may be
at risk for fractures.
Risk factors you can change:
·
Sex hormones - Abnormal absence of menstrual periods
(amenorrhea), low estrogen level (menopause), and low
testosterone level in men can bring on osteoporosis.
·
Anorexia nervosa - Characterized by an irrational fear
of weight gain, this eating disorder increases your risk
for osteoporosis.
·
Calcium and vitamin D intake - A lifetime diet low in
calcium and vitamin D makes you more prone to bone loss.
·
Medication use - Long-term use of glucocorticoids and
some anticonvulsants can lead to loss of bone density
and fractures.
·
Lifestyle - An inactive lifestyle or extended bed rest
tends to weaken bones.
Millions of Americans have osteoporosis. They are mostly
women, but more than 2 million men also have this disease.
White and Asian women are most likely to have osteoporosis.
Other women at great risk include those who:
·
Have a family history of the disease,
·
Have broken a bone while an adult,
·
Had surgery to remove their ovaries before their periods
stopped,
Have not gotten enough calcium throughout their lives,
·
Had extended bed rest,
·
Used certain medicines for a long time, or
·
Have a small body frame.
The risk of osteoporosis grows as you get older. At the time
of menopause women may lose bone quickly for several years.
After that, the loss slows down, but continues. In men the
loss of bone mass is slower. But, by age 65 or 70 men and
women are losing bone at the same rate.
Conventional medications prescribed for osteoporosis may
include: Bisphosphonates (such as alendronate and
risedronate), Calcitonin, hormone replacement therapy (HRT),
Teriparatide, or Tamoxifen. A hip protector may also be
worn to provide extra protection for the hip bone
especially if an elderly person is prone to falling. In
cases where osteoporosis is severe and compression
fractures have occurred, surgical procedures such as
vertebroplasty or kyphoplasty are likely to be
performed.
Natural remedies
Herbal and Homeopathic remedies used together with a
diet high in calcium, healthy lifestyle, and exercise
can reduce the symptoms of osteoporosis and offer
natural support without side effects during perimenopause and menopause.
Herbs such as Cimicifuga racemosa (Black cohosh) and
Pulsatilla vulgaris (Pasque flower) are excellent
supportive ingredients for the nervous system and female
reproductive system, helping to support the body in a
natural and gentle manner. Therapies such as physical
therapy, acupuncture, or tai chi may also be useful in
improving the symptoms of osteoporosis, while also
providing great ways to de-stress.
·
Angelica Sinesis (Dong Quai) a powerful Chinese tonic herb
which has an adaptogenic effect on the female hormonal
system.
·
Cimicifuga racemosa (Black cohosh): This herb is
a supportive ingredient for the nervous system and has
been used over the ages as a remedy to provide support
for female gynecological health. Cimicifuga racemosa has
as its main constituent's triterpene glycosides,
cinnamic acid derivatives, chromone, isoflavones,
tannins and salicylic acid. This ingredient has also
been researched for its ability to support routine
temperature regulation in the female body. Black Cohosh
has also been studied for its ability to routinely
support estrogen balance in the body.
·
Pulsatilla vulgaris (Pasque flower): This herb
has a natural tonic effect on the nervous system and is
also a soothing and supportive herb for the female
reproductive organs.
Nutrition: The foods we eat contain a variety of vitamins,
minerals, and other important nutrients that help keep our bodies
healthy. All of these nutrients are needed in balanced proportion.
In particular, calcium and vitamin D are needed for strong bones,
and for your heart, muscles, and nerves to function properly.
·
Calcium: An inadequate supply of calcium over a lifetime
contributes to the development of osteoporosis. Many
published studies show that low calcium intake appears
to be associated with low bone mass, rapid bone loss,
and high fracture rates. National nutrition surveys show
that many people consume less than half the amount of
calcium recommended to build and maintain healthy bones.
Good sources of calcium include low-fat dairy products,
such as milk, yogurt, cheese, and ice cream; dark green,
leafy vegetables, such as broccoli, collard greens, bok
choy, and spinach; sardines and salmon with bones; tofu;
almonds; and foods fortified with calcium, such as
orange juice, cereals, and breads. Depending upon how
much calcium you get each day from food, you may need to
take a calcium supplement.
Calcium needs change during one's lifetime. The body's
demand for calcium is greater during childhood and
adolescence, when the skeleton is growing rapidly, and
during pregnancy and breastfeeding. Postmenopausal women
and older men also need to consume more calcium. Also,
as you age, your body becomes less efficient at
absorbing calcium and other nutrients. Older adults also
are more likely to have chronic medical problems and to
use medications that may impair calcium absorption.
Ages
mg/day
Pregnant or Lactating
mg/day
Birth-6 months
210
14 - 18 years
1300
6 months-1 year
270
19 - 50 years
1000
1 - 3 years
500
4 - 8 years
800
9 - 18 years
1300
19 - 50 years
1000
51 or older
1200
·
Vitamin D: Vitamin D plays an important role in calcium
absorption and in bone health. It is made in the skin
through exposure to sunlight. While many people are able
to obtain enough vitamin D naturally, studies show that
vitamin D production decreases in the elderly, in people
who are housebound, and for people in general during the
winter. Depending on your situation, you may need to
take vitamin D supplements to ensure a daily intake of
between 400 to 800 IU of vitamin D. Massive doses are
not recommended.
·
Magnesium: For magnesium, eat avocado, banana,
cantaloupe, honeydew, lima beans, low-fat milk,
nectarine, orange juice, potato, spinach
Alcohol: Regular consumption of 2 to 3 ounces a day of
alcohol may be damaging to the skeleton, even in young
women and men. Those who drink heavily are more prone to
bone loss and fractures, because of both poor nutrition
and increased risk of falling.
·
Salt: Short-term increases in dietary salt result in
increased urinary calcium loss, which suggests that over
time, salt intake may cause bone loss. Increasing
dietary salt has increased markers of bone loss in
postmenopausal (though not premenopausal) women.
Although a definitive link between salt intake and
osteoporosis has not yet been proven, many doctors
recommend that people wishing to protect themselves
against bone loss use less salt and eat fewer processed
and restaurant foods, which tend to be highly salted.
·
Caffeine: Caffeine also increases urinary loss of
calcium. Caffeine intake has been linked to increased
risk of hip fractures and to a lower bone mass in women
who consumed inadequate calcium. Many doctors recommend
decreasing caffeinated coffee, black tea, and
caffeine-containing soft drinks as a way to improve bone
mass.
·
Soft drinks: People who consume soft drinks have been
reported to have an increased incidence of bone
fractures, although short-term consumption of carbonated
beverages has not affected markers of bone health. The
problem, if one exists, may be linked to phosphoric
acid, a substance found in many soft drinks.
Exercise: Exercise is an important component of an
osteoporosis prevention and treatment program. Exercise
not only improves your bone health, but it increases
muscle strength, coordination, and balance, and leads to
better overall health. While exercise is good for
someone with osteoporosis, it should not put any sudden
or excessive strain on your bones. As extra insurance
against fractures, your doctor can recommend specific
exercises to strengthen and support your back.
Weight-bearing exercise is the best for your bones
because it forces you to work against gravity. Examples
include walking, hiking, jogging, stair climbing, weight
training, tennis, and dancing.
·
Avoid medications that cause bone loss: The long-term use of glucocorticoids (medications prescribed for a wide range
of diseases, including
arthritis,
asthma,
Crohn's
disease, lupus, and other diseases of the lungs,
kidneys, and liver) can lead to a loss of bone density
and fractures. Bone loss can also result from long-term
treatment with certain antiseizure drugs - such as
phenytoin (Dilantin1) and barbiturates; gonadotropin-releasing
hormone (GnRH)
drugs used to treat endometriosis;
excessive use of aluminum-containing antacids; certain
cancer treatments; and
excessive thyroid hormone. It is
important to discuss the use of these drugs with your
physician and not to stop or change your medication dose
on your own.
·
Fall Prevention: Preventing falls is a special concern
for men and women with osteoporosis. Falls can increase
the likelihood of fracturing a bone in the hip, wrist,
spine, or other part of the skeleton. In addition to the
environmental factors listed below, falls can also be
caused by impaired vision and/or balance, chronic
diseases that affect mental or physical functioning, and
certain medications, such as sedatives and
antidepressants. It is important that individuals with
osteoporosis be aware of any physical changes that
affect their balance or gait, and that they discuss
these changes with their health care provider. Here are
some tips to help eliminate the environmental factors
that lead to falls.
Outdoors:
·
Use a cane or walker for added stability.
·
Wear rubber-soled shoes for traction.
·
Walk on grass when sidewalks are slippery.
·
In winter, carry salt or kitty litter to sprinkle on
slippery sidewalks.
·
Be careful on highly polished floors that become slick
and dangerous when wet.
·
Use plastic or carpet runners when possible.
Indoors:
·
Keep rooms free of clutter, especially on floors.
·
Keep floor surfaces smooth but not slippery.
·
Wear supportive, low-heeled shoes even at home.
·
Avoid walking in socks, stockings, or slippers.
·
Be sure carpets and area rugs have skid-proof backing or
are tacked to the floor.
·
Be sure stairwells are well lit and that stairs have
handrails on both sides.
·
Install grab bars on bathroom walls near tub, shower,
and toilet.
·
Use a rubber bath mat in shower or tub.
·
Keep a flashlight with fresh batteries beside your bed.
·
If using a step stool for hard-to-reach areas, use a
sturdy one with a handrail and wide steps.
·
Add ceiling fixtures to rooms lit by lamps.
·
Consider purchasing a cordless phone so that you don't
have to rush to answer the phone when it rings, or so
that you can call for help if you do fall.
Indoors: