Osteoporosis - Questions & Answers
What is Osteoporosis?
Osteoporosis (porous bone) is a degenerative bone disease. Healthy bones are rich in calcium-a mineral that contributes to their density and strength. After about the age of 30, calcium is taken from the bones faster than it can be replaced by diet. As a result, the bones become less dense. This is normal. When excessive bone loss occurs, leaving the skeleton abnormally vulnerable to breaks, this is called osteoporosis.
How serious is Osteoporosis?
Bones significantly weakened by osteoporosis are brittle enough to break under pressures that would not jeopardize healthy bones. Slight falls, blows, and lifting-even hard coughs or hugs-all present a risk. Each year, at least 1.2 million fractures occurring in the United States are related to osteoporosis.
The areas of the body most vulnerable to osteoporosis are the forearm (near the wrists), spine, and hips. Twenty to twenty-five percent of elderly patients with hip fractures die within a year from such complications as pneumonia and heart failure. Spines affected by osteoporosis become rounded in shape when the vertebrae "crush" and collapse inwardly. Though the back is still functional, normal movement is restricted.
To reduce the risk of injury, people with osteoporosis should take extra precautions against falls and other accidents. Hazards to be eliminated or avoided include slippery walking surfaces, steep stairs, loose wires, loose rugs, poor lighting, and unstable furniture. Thin, shock-absorbent pads designed to protect the hips are expected to be marketed for use by osteoporosis patients.
Who's at increased risk?
Anyone can get osteoporosis. However, certain factors increase one's susceptibility to the disease. Among these factors are:
3. Over the age of 45.
4. Family history of osteoporosis.
5. Early menopause (before age 48).
6. Surgical removal of ovaries before menopause.
7. Low calcium intake.
8. Sedentary lifestyle.
9. Heavy cigarette smoking.
10. Excessive alcohol intake.
11. Slender, underweight or small-boned women.
12. Chronic use of certain drugs, such as corticosteroids, tetracycline, diuretics,
antacids containing aluminum.
13. Certain medical conditions, such as diabetes, hyperthyroidism, hyperparathyroidism,
Cushing's disease, rheumatoid arthritis, gastrectomy.
Why do more women get Osteoporosis?
Men are born with a higher bone mass, and their bones tend to grow denser because generally they are more physically active than females. Men don't live as long as females, so there is less time for osteoporosis to develop. But perhaps most significantly, men don't experience the sudden loss of the hormone estrogen at menopause-the "change of life" that women go through between the ages of 45 and 55. One third of women over 65 will have a fracture of the spine. By age 90, one third of women will have had a hip fracture-almost twice the rate for men.
Menopause slows the production of estrogen in a woman's body. The deficiency of this bone-protecting hormone speeds up bone loss. The most rapid losses occur in the three to seven years following natural menopause or surgical menopause (removal of the ovaries). Men's sex hormones stay relatively stable until about the age of 70, then they too begin to experience bone loss at an increased rate.
Can Osteoporosis be prevented?
People who enter middle age with strong bones are less likely to get osteoporosis. There are two known ways of building healthy bones:
1. Getting adequate calcium intake throughout life.
2. Staying physically active throughout life.
3. Maintain the normal amounts of sex hormone levels.
Heavy smoking and excessive alcohol intake should be avoided because they are associated with increased risk of osteoporosis. Excessive caffeine intake is suspected of increasing risk, though the evidence is inconclusive.
Since calcium cannot be manufactured internally, the body relies on diet to provide
it with foods rich in calcium. When diet fails to supply the needed amount, the body
takes calcium from the bones, where 99 percent of calcium reserves are stored.
Prolonged depletions of calcium from bones results in osteoporosis.
The Recommended Daily Dietary Allowances (RDA) of calcium are listed on page 4.
It should be noted that many experts, including the National Research Council and the
National Osteoporosis Foundation, are in favor of higher RDAs for adult men and women.
Daily calcium intake exceeding 1,500 milligrams a day is not advised for anyone, unless
recommended by a physician. It should also be noted that half the women in this country
get less than 500 mg of calcium a day; another quarter get less than 300 mg.
RDA's FOR CALCIUM Age milligrams 0-6 months
6 months-1 year
25 years onward (men)
25-50 years (women)
51 years onward (women)
Certain foods are naturally high in calcium. Many of them are listed here. Another
way to increase calcium is to add powdered nonfat dry milk to other foods. Some
processed products, such as bread, juice, and cereal, are "calcium fortified," meaning
they contain added calcium; however, the evidence is not conclusive on the calcium-delivering
ability of many of these foods. Milk, by contrast, is a reliable source of calcium because
it contains Vitamin D and lactose, which enhances the body's ability to absorb and use the mineral.
People with lactose (milk sugar) intolerance can drink milk treated with the enzyme lactase.
They may be able to tolerate yogurt, cheeses, and buttermilk, because the lactose in these
foods is already partially broken down. Of course, they can also get calcium from nondairy sources.
Many over-the-counter antacids are high in calcium.
SOME FOODS NATURALLY HIGH IN CALCIUM Food milligrams 8 oz nonfat yogurt
1 cup skim milk
1 cup buttermilk
1 oz cheddar cheese
1 cup leaf spinach
1 cup chopped turnip greens
1 cup chopped collards
1 cup chopped broccoli
3 oz sardines
13-19 medium oysters
10 dried figs
1 cup rhubarb
1 oz whole almonds
1 cup navy beans
Osteoporosis is one of the many reasons why a healthy lifestyle should contain a moderate
amount of exercise. Bones adjust to the demands put on them. Athletes and those who exercise
regularly, therefore, tend to have denser bones than those who lead sedentary lives. In space-a
weightless environment-astronauts suffered bone loss at a rate similar to bedridden people until
someone invented special exercise equipment for them to use. Weight-bearing exercises that
influence bone strength include walking, jogging, tennis, basketball, and aerobics.
What about Calcium supplements?
Calcium supplements vary in their effectiveness, depending on the type of calcium used (carbonate, citrate, lactate, gluconate, phosphate) and the way the pill is manufactured (uncoated pills that contain starch dissolve more readily and therefore are more readily absorbed). If you suspect your diet is lacking the proper amount of calcium (perhaps due to lactose intolerance), talk to your doctor. If a supplement is recommended, he or she can help you make an appropriate selection.
Can you take too much Calcium?
There is no evidence that taking significantly more calcium than is recommended is any better for the body. In fact, like other minerals (and vitamins), it is possible to overdose on calcium. Too much calcium can interfere with iron absorption and lead to kidney stones. Excess Vitamin D, contained in dairy products and added to calcium supplements to facilitate mineral absorption, can also be hazardous.
Can Osteoporosis be treated?
The two approved methods of treating osteoporosis involve taking female hormones in conjunction with calcium. The length of treatment varies, but is usually prolonged. Women at high risk of developing osteoporosis are the most likely candidates for osteoporosis therapy. There are some newer medicines that appear to be beneficial in decreasing bone loss. You should discuss these with your doctor.
Hormone Replacement Therapy (HRT)
HRT prevents accelerated bone loss in later years but the therapy cannot rebuild bone mass
to any significant extent. The patient takes estrogen pills over a prolonged period. If the woman
still has a uterus (has not had a hysterectomy), an additional hormone, progesterone, may be
given because it is believed to counteract estrogen's tendency to increase the risk of uterine cancer.
A drawback of HRT therapy is continued menstruation and its associated symptoms.
Another osteoporosis treatment uses a hormone called calcitonin. Like estrogen/progesterone
therapy, calcitonin successfully retards accelerated bone loss, but does not rebuild bone mass
to any significant degree. Calcitonin, however, is injected, rather than swallowed as a pill.
Possible side effects of calcitonin include nausea, gastrointestinal upset, and flushing and/or
warmth in the face and hands. Calcitonin does not promote menstruation.
Analgesics may be recommended for patients in persistent pain due to osteoporosis.