10 Things I’ve Learned About Bone Health

PJ Hamel Health Guide
  • Nearly 3 years ago, I was diagnosed with osteopenia as a result of breast cancer treatment. For those of you just starting down the osteoporosis path, here are the 10 most significant things I’ve learned about bone loss.

    And for those of you who’ve been dealing with osteo for years – I invite you to add your own favorite “nuggets of truth”!

    Osteopenia probably doesn’t need to be treated with drugs.
    Osteopenia, a gray area between healthy bones and full-blown osteoporosis, is characterized by T-scores between -1 and -2.5.  Up until recently, common practice was to treat osteopenia with osteoporosis drugs, in an attempt to halt it in its tracks.

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    But a study published last year concludes that statistically speaking, 270 women diagnosed with osteopenia would need to take an osteoporosis drug for 3 years in order for one of them to avoid a single vertebral fracture.

    That means 99.996% of women taking drugs for osteopenia are potentially receiving no benefit.

    Worth it? If I could go back and do it over, I wouldn’t take drugs for ostepenia; I’d just make sure my diet and exercise program were both up to snuff.

    Bisphosphonates are a pain in the neck – and belly.
    I took Actonel (a bisphosphonate drug) for 1 year, as the result of my osteopenia diagnosis. I figured, how hard could it be, 1 pill once a week?

    Harder than I thought. The “no food, no liquid except water, remain upright” routine threw a big monkey wrench into my daily exercise plan. Worse than that, Actonel made me nauseous, and gave me diarrhea – at unpredictable times. It impacted my life. “Do I dare make this 2-day trip? What if I’m sick on the plane?”

    For me, no more drugs. I’m jumping rope 20 minutes a day, lifting weights 5 days a week, and getting plenty of calcium and vitamin D. And that’s as much physical and mental energy as I care to commit to osteopenia.

    Weight bearing exercises – what are they?
    Once you start researching osteoporosis, you read a lot about weight-bearing exercises, and how good they are for you. But what exactly are they? Here’s a list of weight-bearing exercises from the National Osteoporosis Foundation (NOF):

    •High impact exercise: jogging, stair climbing, tennis, soccer, basketball, dancing, hiking… These are deemed best for building bones in people who aren’t yet experiencing osteoporosis. If you’re in full-blown osteoporosis and at risk for fracture, these might not be for you. 
     
•Low-impact exercise: elliptical machine, low-impact aerobics, stair-step machine, brisk walking.
      
•Resistance and strengthening exercises: lifting weights, elastic exercise bands, push-ups/pull-ups, and functional movements (e.g., rising on your toes).

    Swimming? Biking? Apparently it’s critical that your bones bear your full weight (“weight-bearing”) if you expect to gain strength; thus biking and swimming don’t qualify.

    Hormone replacement therapy might be appropriate for some women at high risk for osteoporosis.
    Prior to 2002, hormone replacement therapy was commonly prescribed for women to lower the risk of fractures due to decreased bone density. Studies showed that HRT reduced the risk of hip fracture by 40%, and other fractures by 30%.


  • But the massive Women’s Health Initiative (WHI) study, completed in 2002, showed that HRT actually increased a woman’s risk of heart attack, stroke, blood clots, and breast cancer. And, after results of the study were released in 2006, HRT use dropped by two-thirds.

    Now, further studies have revealed that HRT is an appropriate and effective osteoporosis treatment for women who meet the following criteria:
    •those experiencing severe menopausal symptoms;
    •those at significantly increased risk of osteoporosis;
    •those without underlying risks that would prevent taking hormone replacement drugs.

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    A low dose of HRT for the first 2 to 3 years after menopause starts seems to be the safest, most effective way to lower osteoporosis risk for these women.

    Osteoporosis can be truly devastating.
    I used to think osteoporosis was an “old lady’s disease” – something that made you walk a little slower, or feel a bit more frail.

    Now I know how serious it can be. About 1 in 2 women age 50 or older will have an osteoporosis-related fracture in their remaining lifetime. A vertebral (spinal) fracture can be painful; it can cause loss of height, deformities (the widow’s hump), and stooped posture.

    And what about hip fracture? Here’s some information from the NOF Web site:

    “A woman's risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer. At six months after a hip fracture, only 15 percent of hip fracture patients can walk across a room unaided. An average of 24 percent of hip fracture patients aged 50 and over die in the year following their fracture.”

    Now THAT’S serious.

    Osteoporosis isn’t just for older people; young people can get it, too.
    Surprisingly, young women who exercise to excess, and don’t consume enough calories, are at great risk for osteoporosis. First, they’re probably not getting enough calories, calcium, or vitamin D to support their bones. And second, they may not be having a regular period; excessive fitness can lead to amenorrhea – “absent menstruation.” This in turn leads to lack of estrogen, which leads to bone loss.

    Skinnier isn’t always healthier…

    The best foods for keeping bones healthy are…
    First, foods high in calcium and/or vitamin D. And if you’re thinking that means milk, milk, and more milk – think again. Check our 10 Easy Ways to Add Calcium to Your Diet.

    Once you’re on track with your calcium and vitamin D, there are other vitamins and minerals key to bone health. Find out what they are in Beyond Calcium and Vitamin D: Five Things to Track in Your Daily Diet.

    Osteoporosis is silent. There are no obvious outward symptoms. 
    Unlike arthritis, osteopenia or mild osteoporosis don’t make your bones ache or your joints creak. In fact, one of the most common ways a person discovers she has osteoporosis is diagnostic testing as a result of a fracture, which is often the first obvious sign of osteoporosis.

    The best way to make sure you’re not suffering greater than normal bone loss is regular screening via a DEXA scan. It’s recommended women get a baseline screening at age 65 (younger, if they’re at increased risk due to family history or other diseases). Based on the results of this baseline DEXA, your family doctor will decide how often it should be repeated.


  • Old age isn’t the only risk factor for osteoporosis.

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    Bone loss occurs quite naturally as we age. But as mentioned above, younger women can suffer fairly severe bone loss as a result of excessive dieting and exercise. And Type 1 diabetes, celiac disease, kidney or thyroid problems, and chronic autoimmune diseases (e.g., rheumatoid arthritis) can all lead to bone loss. In addition, excessive smoking or alcohol consumption are known bone-thinners.

    Certain drugs encourage bone loss, as well. Chief among these are corticosteroid drugs, often used to treat asthma, autoimmune diseases, and multiple sclerosis; and the aromatase inhibitor drugs used to prevent breast cancer recurrence.

    Osteoporosis lacks the media attention necessary to help prevent it.
    There are many ways we can work to head off bone loss. Between exercise, diet, lifestyle changes (quitting smoking, for instance), and drugs (if necessary), significant bone loss isn’t a given.

    But when is osteoporosis ever in the news? Compared to breast cancer, it’s a non-player in the media arena. Most of you probably know that October is all about pink ribbons: Breast Cancer Awareness Month. But how many realize that May is Osteoporosis Awareness and Prevention Month?

    As with any disease, public awareness and education are key to prevention. As we Boomers age, osteoporosis has the potential to become a major public health crisis. Let’s all do what we can to raise awareness: 10 Ways YOU Can Make a Difference.



Published On: September 22, 2010