Anjali Tate, M.D.,  Gynecology, Obstetrics , San Jose, Silicon Valley, California

Osteoporosis

 

 

 

 

Osteoporosis, a disease process characterized by low bone mass, resulting from deterioration of bone architecture.

Osteoporosis leads to bone fragility and an increased risk of fracture. It affects over 20 million women in America. 

Women are most susceptible to developing osteoporosis after menopause, when estrogen levels decline.

Bone is a living organ that continually regenerates itself through a process referred to as bone remodeling. Embedded in our bones are two important types of bone cells called osteoclasts and osteoblasts. These cells perform the critical function of bone remodeling, in which old or damaged bone is taken away and new, healthy bone is created in its place.

Throughout childhood and into our twenties, bone formation exceeds bone breakdown, so that we are building stronger and healthier bones. By age thirty, most of us have achieved our peak bone mass. At about the age of thirty, for reasons that are not completely well understood, but is estrogen dependent in women, this process starts to reverse; bone breakdown begins to slightly outweigh bone formation. As men and women age, the rate of bone loss begins to accelerate. In postmenopausal women, this decline in bone mass can be up to 2% to 3% yearly.

Bone Health

Osteoporosis does not need to be inevitable, it is preventable and treatable. Good bone health begins in childhood with the proper intake of calcium and vitamin D. Throughout a persons lifetime, bone can be maintained with a healthy lifestyle, proper calcium intake and exercise. If your dietary calcium is not adequate calcium supplements with Vitamin D may be used. 

The recommended daily allowances for calcium for adult women are listed below:

Pregnant or nursing women:

1200-1500 mg/day

25-49 year olds (Premenopausal):

1000 mg/day

50-70 year olds who are on estrogen therapy:

1200 mg/day

50-70 year olds who are not on estrogen therapy:

1200 mg/day

Women over 70:

1200 g/day

Adapted from the National Academy of Sciences (1997)

Dietary sources of Calcium

Food, serving size

Mg. of calcium

Milk, 8 oz.

300

Low-fat yogurt, 8 oz.

415

Part-skim mozzarella, 1 oz

183

Low-fat cottage cheese, 1 cup

155

Vanilla ice cream, 1/2 cup

 85

Collards, 1 cup

357

Broccoli, 1 cup

178

Kale, 1 cup

179

Calcium fortified Orange juice, 1 cup

300

Cheese pizza, 1 slice

290

Risk Factors for Osteoporosis

While some of the risk factors may be determined, many of the risk factors are as a consequence of ones lifestyle. The National Osteoporosis Foundation has categorized risk factors for osteoporotic fractures into modifiable and non-modifiable characteristics.

Non-modifiable factors are:

Modifiable factors are:

Personal history of a fracture as an adult

Cigarette smoking

History of fracture in a first-degree relative

Low body weight (<127lb.)

Caucasian race

Estrogen deficiency

Advanced age

Low lifelong calcium intake

Female sex

Alcoholism

Dementia

Impaired vision

Poor health and/or frailty

Recurrent falls

Diagnosing bone loss

Diagnosing bone loss can be done by a simple noninvasive test. A dual-energy x-ray absorptiometry (DXA), the most common test used, is a painless test used to assess bone mass in certain portions of the skeleton—usually the hip and spine. 

The National Osteoporosis Foundation recommends bone density testing for:

  • Postmenopausal women under 65 with at least one risk factor;
     
  • All women over 65;
     
  • Post menopausal women with a history of a fracture;
     
  • Women considering therapy and the test result will help them decide.

Treatment and prevention

Current options for the treatment and prevention of osteoporosis include estrogen therapy, the bisphosphonates risedronate (Actonel) and alendronate (Fosamax), raloxifene (Evista), a selective estrogen receptor modulator and calcitonin (Miacalcin). The treatment of choice should be tailored to each individual and reviewed with your physician.

Exercise and Osteoporosis

Both weight-bearing and resistance exercises have been shown to increase bone density.

Weight-bearing exercises such as walking, jogging, dancing, hiking, stair and climbing work against gravity by transmitting weight throughout your bones. Your bones respond to this force by growing stronger. Bike riding and swimming, are good exercises but are not weight-bearing. Weight-bearing exercises should be performed at least three to five times per week.

Resistance exercises place muscle tension on the bones. This also strengthens the muscles and stimulates the bones to grow stronger. Exercising with weights or resistance bands are examples of this type of exercise. Resistance exercises should be performed two to three times a week.

If you have osteoporosis, make sure to review your training program in advance with your physician. 

For more information see Osteoporosis - FAQ
 

To explore treatment options, I invite you to call for an appointment

Dr. Anjali Tate

 

4/15/04

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