Osteoporosis is no longer just a disease of the aged. Because its effects are so drastic, it pays to focus on bone density now and for a lifetime
Cindy Murphy’s DEXA scan, showing ostopenia, or poor bone density.
Last year, as a favor to a friend, forty-two-year-old Cindy Murphy participated in a benefit walk for osteoporosis. At the walk, she got a free ultrasound scan of the bone in her heel. When the results revealed that Murphy had the bone density of a much older woman and needed to see a doctor, though, she laughed.
“I thought, ‘How accurate can those machines be?’ ” she recalls.
But shortly afterward, Murphy wasn’t laughing. Her doctor encouraged her to have a complete physical along with her Pap test—a good idea for any woman over forty. During that physical, nurses discovered Murphy had lost nearly an inch of height. Height loss is a key marker symptom for osteoporosis, a disorder that results in increasingly brittle and breakable bones.
Doctors performed a computerized axial tomography (CAT) scan on Murphy’s spine. That test showed even less bone density than the heel scan. Suddenly, doctors were telling her she had a disease that she equated with old age and fragility, with inevitable decline.
Osteoporosis—literally, “porous bone,” —is a crippling disease because porous bones break more easily and repair themselves more slowly. Bones lose density slowly, day after day and year after year. But without the medical tests that “see” into bones, there’s no way to tell that it’s happening.
Weak bones in the spine can fracture without a fall, resulting in chronic back pain, poor posture, or a loss of height. Falls that wouldn’t harm someone with good bone density can result in fractures of the wrist or hip, both of which can be extremely painful. Hip fractures can be debilitating.
Ten million Americans have osteoporosis, according to the National Osteoporosis Foundation. Another 18 million have low bone density, which places them at increased risk of developing osteoporosis. The condition affects men as well as women, although not as many. The foundation estimates that one in every two women and one in every eight men who are over age fifty now will experience an osteoporosis-related fracture in their lifetime.
Women in Murphy’s age group usually don’t worry about their bone density. But osteoporosis can strike at any age. In otherwise healthy people, it usually doesn’t turn up until menopause in women or about age seventy in men. Among the risk factors unrelated to menopause are having a small or thin frame, sedentary lifestyle, eating disorders or “yo-yo” dieting, use of corticosteroids and anticonvulsants, smoking, absent menstrual periods, and low calcium intake.
Doctors have become concerned about poor bone density in premenopausal women because of the condition’s tendency to be symptomless until bones are already weakened. By that time, it can be too late to make radical improvements in bone density. Osteoporosis is a disease that is much easier to prevent than it is to treat. For the best results, prevention starts in the teen years.
Naturopathic physician Sheila Dunn-Merritt likens bone density to a bank account. “In your teens, your twenties, your thirties, you really want to bank bone,” she says. “If you go into menopause with a big account, then you can afford to lose a little.”
Unfortunately, during those youthful years, bone density is often the farthest thing from a woman’s mind. In addition, the lifestyle trends that lead to weak bone—lack of exercise, overemphasis on weight loss, and a diet that’s mainly junk foods and caffeine—have worsened significantly in the past few decades.
“If you read the medical journals from the turn of the century, you realize that osteoporosis was a curiosity back then,” says Alan Gaby, M.D., an expert on nutritional healing and a professor at Bastyr University. These days, Gaby calls osteoporosis an epidemic. “It was far more prevalent in 1950 than in 1900, and was twice as prevalent in 1980 as it was in 1950.”
When her CAT scan showed that Murphy had osteoporosis, her doctor scheduled a final test, a dual energy x-ray absorptiometry (DEXA) scan. Because of its accuracy, this test is called the gold standard of bone scans. To her relief, her DEXA scan showed that she did not have osteoporosis. She did, however, have osteopenia, or poor bone density for her age.
The test results kicked off a quest for Murphy—a search for information about how she got osteopenia and what she could do about it.
Murphy swam competitively in high school and college. “My body fat was so low I would miss periods routinely,” she says. “Once I went for thirteen months without a period—which, at the time, I thought was great!” But missed periods are a woman’s signal that exercise is suppressing her production of estrogen, and estrogen is key for building bone. “It just might be that my bone density never built up to as high as it should have been,” she says. “Young female athletes should understand how devastating amenorrhea [the cessation of the menstrual cycle] is to bone density.”
Murphy is fine-boned; she has tiny wrists and ankles. “But so does my mother, and her bone density is excellent,” she says.
Murphy’s research suggested that an episode of steroid use might have played a small role. Four years ago, she had an allergic reaction to penicillin that was so severe that doctors prescribed Prednisone. She took it for only a few months, but still wonders whether it affected her bone density. Those who take steroids or some thyroid drugs for the long term are at higher risk of osteoporosis.
People who do have osteoporosis or low bone density need to address it in several ways, most doctors agree.
Exercise. Only weight-bearing exercise builds bone. Murphy’s sport was swimming, which is non-weight bearing.
After her CAT scan, however, Murphy began a program of strength training almost immediately. She works out on weight machines four times per week and walks or jogs two miles daily.
Miriam Nelson, Ph.D., in her book Strong Women, Strong Bones (Putnam, 2000), recommends a specific program of strength training along with stretching, balance,and flexibility exercises. According to the book, walking may be helpful, but if women can jog, run, or jump, they’ll build bone faster. Balance-building exercises are important because falls are a major cause of fractures in older women with osteoporosis.
Diet. Back in the 1980s, prevention of osteoporosis focused on adding high-calcium foods such as cheese, yogurt, and canned salmon with bones. Those foods won’t do much good unless the rest of your diet is sound, most natural healers point out.
Half of all women and one in every eight men who are over age fifty now will experience an osteoporosis-related fracture in their lifetime.
First, ditch caffeine, say both Gaby and Dunn-Merritt. Murphy, a coffee lover, was counseled to give up her beloved lattes.
Caffeine, alcohol, and tobacco all cause bones to dump calcium into the bloodstream in order to keep the blood’s delicate chemistry balanced, says Dunn-Merritt. Doctors disagree on whether the phosphorus in cola drinks damages bone density. (Some small studies suggest a link between fractures in teenagers and consumption of cola drinks.) But they do agree that, in addition to being high in sugar, colas are a poor substitute for water or other more healthful beverages. If you’ve got to have fizz, Nelson’s book points out that club soda is both sugar- and phosphorus-free.
If you have symptoms such as bloating after eating, a feeling of fullness after moderate meals or a feeling that meat just sits in your stomach, weak nails, or thinning hair, your stomach may not be producing enough hydrochloric acid, says Gaby. However, he urges that people not experiment on their own with hydrochloric acid supplements even though they’re available without a prescription. Other conditions can cause the same symptoms as low acid; supplementing when you already have enough acid can harm the stomach. Instead, Gaby recommends testing by a nutrition-oriented doctor. Food allergies can also impede absorption, he says.
Supplements. Most people have heard of calcium supplements and know it’s important to take calcium in an absorbable form. Nelson’s first choice is citrate; her second is carbonate. But she’s also adamant about pointing out that such supplements don’t help prevent fractures unless the person taking them also gets enough vitamin D.
Younger women, if they eat healthy food, likely get enough vitamin D from their diet and from sun exposure, according to Nelson’s book. But by age fifty, the ability of a woman’s body to manufacture vitamin D from sunlight has declined.
Even less well-known, according to Gaby, are the roles that a host of other nutrients play in the building of bone. Gaby, author of Preventing and Reversing Osteoporosis (Prima, 1994), says that any nutritional program for bone health needs to provide enough of ten other substances: vitamin K, magnesium, manganese, folic acid, vitamin B6, zinc, copper, silicon, boron, and strontium.
In addition, ipriflavone, a laboratory-synthesized soy supplement, has garnered a lot of attention for the treatment of osteoporosis. The compound targets bone cells but does not stimulate breast or uterine tissue, an occasional side effect of hormone replacement therapy and some other drugs for menopausal symptoms.
“Ipriflavone prevents bone loss, but it also builds bone,” Dunn-Merritt says. Sixty formal studies have shown that ipriflavone can halt bone loss and slightly increase bone density. The supplement is available at health-food stores.
Pharmaceuticals. Women going into menopause with low bone density or who already have osteoporosis will want to consider their condition, along with their overall health, in their decision about whether to undergo hormone replacement therapy (HRT). There are several drugs available to combat osteoporosis; if these are appropriate for you, discuss them and their potential side effects with your doctor. And keep an eye out for new developments. As the baby boom generation ages, interest in preventing osteoporosis will certainly grow. A study this June suggested that statin-type drugs, used to lower cholesterol, may also reduce fracture risk.
Being diagnosed with osteopenia has changed Cindy Murphy into a crusader for bone health. She has been interviewing her doctors and learning more about osteoporosis so that she can speak about it to other women.
“A lot of women don’t want to talk about having this disease,” she says. “They don’t want people to think they’re old.”
Murphy’s prognosis is good. Because she is healthy, premenopausal, active, and is taking all the necessary supplements, she’s probably not losing bone density at this moment. Whether her lifestyle changes can increase her bone density is an unknown at this point. She’ll have a follow-up DEXA scan of her lower back and hip a year from now to monitor any changes. And she plans to stay off of coffee and her occasional Dr. Pepper. However, she has discontinued taking alendronate (Fosamax), because while the drug helps retain and even build bone in postmenopausal women, it hasn’t yet been proven to help premenopausal women.
This year, Murphy will head a team of walkers for America Walks for Strong Women, the charity walk at which she had her first heel scan a year ago. The walk takes place in late summer and early fall in three major cities and benefits the National Osteoporosis Foundation. And Murphy says she has become quite an evangelist for bone scans in her Colorado Springs, Colorado, neighborhood.
“I think [the disorder] is going to become more and more common,” she says. “There are probably a lot of women out there who have it, but just don’t know.”
‰ Women are two to three times more likely than men to experience a hip fracture.
‰ A woman’s risk of hip fracture is equal to her combined risk of breast, uterine, and ovarian cancers.
‰ The one-year mortality rate after a hip fracture is twice as high in men as it is in women.
‰ In all hip fracture patients age fifty and over, nearly one quarter die in the year following their fracture.
‰ Another quarter of those who were ambulatory before a hip fracture require long-term care after their fracture.
By Susan Clotfelter
Susan Clotfelter is editor of Herbs for Health.
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