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By SALLY ANDERSON
© St. Petersburg Times, published September 25, 2001
The bone-thinning disease known as osteoporosis is, at its conception, very much an invisible disease, progressing on a resolute path of slow destruction, without leaving a trace of pain or discomfort in its wake. Only when the disease reaches the point where fractures occur do many people detect it; by the time osteoporosis shows up on an X-ray, about 30 percent of the bone has already been lost. In recent years, more efficient ways to test bone density have been developed.
Every year, 1.5-million fractures are attributed to osteoporosis. It is predicted that about one in three women and one in five men will experience some form of osteoporosis in their lifetimes. Beginning around age 35, the average woman can expect to lose up to 1 percent of bone mass every year. If there is no bone-loss intervention, fractures of the spine, hips, wrists, etc., can occur as aging progresses.
Although many people believe osteoporosis to be strictly a female disease, men also can be affected. However, if they develop osteoporosis, it is usually much later in life, perhaps not until their 80s. This delayed reaction is attributed to the fact that men enter middle age equipped with much stronger and heavier bones than women. Testosterone, the male hormone that stimulates bone and muscle development, while it does decrease with age, does not drop as sharply as do estrogen levels in women. Our bodies are continually building and losing bone, with the younger years being the most productive for bone-building; more bone is formed than lost.
Beginning between ages 30 and 40, often referred to as Stage 1, the tide begins to turn. Very gradually, the amount of bone loss becomes greater than the amount of bone being built; this thinning of the bones is osteoporosis in its earliest and most silent form. Since the bones remain strong, and there is no pain or discomfort, the disease can go undetected for many years; however, the process of bone reduction has been set in play.
Not only can osteoporosis be a silent disease, but many people also seem to know very little about its cause, treatment or prevention. A 1998 survey of women found that 92 percent of women questioned were unaware that the most common osteoporotic fracture is a compression fracture of the spine, the kind that causes your spine to collapse and leads to loss of inches in height and stooped posture. One-third of the women surveyed did not know that a fracture of the spine is even a possible consequence of osteoporosis.
Stage 2 usually has its beginnings after age 35. The bone has been thinning continuously through the years, but the remaining bone is still strong; severe fractures from minor injuries are not yet occurring. Life activities may continue to be enjoyed as usual while osteoporosis continues to remain silent; this is the stage when osteoporosis can first be detected through testing.
At Stage 3, osteoporosis with bone fractures begins to occur. Around age 55 (earlier, if there are several risk factors involved), enough thinning of the bones has occurred so that minor injuries that once caused no problems can now result in fractures. Any bone in the body may be affected: with the most common fractures being located in the spine, hips and wrists.
Stage 4 brings more fractures and pain. The areas most often affected are the spine, particularly the middle and lower back. Compression fractures in the vertebrae cause a loss of height. The familiar "dowager's hump" and stooped-over appearance is seen during this stage, the end result of many years of osteoporosis.
Aging often is blamed for many of life's problems. The drastic losing of muscle and bone strength does not happen simply because we are getting older. There are many things that we can personally do to help our bones last a lifetime.
Bones are living tissue made up of minerals and protein. Their strength of them is dependent upon how dense they are; the density is determined by the amount of calcium and other minerals within the bones. Naturally, when the desired levels of these minerals decrease, strength decreases, causing loss in the internal support system.
The old saying "You are what you eat" can most definitely be applied to maintaining healthy bones. All the calcium in our bones comes from the foods we eat, but don't forget -- our bodies cannot absorb the calcium without the presence of Vitamin D, obtained from exposure to sunlight (as little as 15 minutes a day) and some foods: bran flakes, raisin bran, eggs, egg substitutes, fortified milk, canned salmon. Here are the daily calcium and Vitamin D recommendations for both men and women from the Institute of Medicine at the National Academy of Science:
Ages 19-50: 1,000 mg calcium, 200 IU Vitamin D.
Ages 51-70: 1,200 mg calcium, 400 IU Vitamin D.
Ages 71 and older: 1,200 mg calcium, 600 IU vitamin D.
Studies show that most people eat less than half the amount of the recommended calcium needed for healthy bones. If you are not getting enough calcium from foods, it would be prudent to take calcium supplements. Eat less meat protein and more plant protein. The more animal protein you eat, the more calcium you will excrete through urine, as the kidneys need to use the calcium for neutralizing the acids produced from the digestion of meat. Too much refined flour and sugar produce the same negative effect; in fact, they can encourage bone loss. Eating veggies, raw or cooked, is good for maximum calcium retention.
Other steps we can take toward osteoporosis prevention are to say no to cigarette smoking, avoid excessive drinking habits and drink caffeine in moderation. Smoking decreases estrogen levels; women with a history of smoking have lower bone density and are known to lose bone more rapidly after age 40.
Seven is the limit. Consuming more than seven drinks of alcohol a week will begin to mess up your calcium metabolism and will contribute to a loss of bone density.
Limit your caffeine intake. Caffeine can act as a diuretic; any excessive elimination of fluid from the body will cause a loss of calcium. Providing your diet includes enough calcium, two or three cups of coffee per day is considered okay. If you are a big coffee drinker, you might want to drink a daily glass of milk; it helps to offset the negatives of the coffee. Be conscious of how many cola drinks you consume; drinking large amounts will lower bone density.
Long-term use of certain medications -- such as prednisone, cortisone and dexamethasone -- can negatively impact the bones; check with your physician. Lack of exercise looms large as a risk factor for osteoporosis. Bone, just as muscle, will become stronger when confronted with physical stress and will atrophy (waste away) from sedentary living.
A recent report in the journal Medicine and Science in Sports and Exercise concluded that strength training is generally the best bone-builder. Strength training offers other advantages as well. By developing strength, you will improve your balance and help to prevent falls that could lead to bone fractures. Strength conditioning and aerobic weight-bearing exercises such as brisk walking or jogging are a winning combination for bone protection, as well as for general good health. If you have physical limitations and cannot jog or walk, get yourself some light weights. Just using light hand weights (1 to 3 pounds) for muscle-endurance exercises will increase bone mass in women older than 50. When doing strength exercises, you should work all the major muscles of the body, placing an emphasis on hips, spine and wrists, areas that are high on the risk list for fractures from weakened bones. A sampling of exercises:
Squats strengthen lower body muscles. Place your feet a comfortable distance apart, about hip distance, and slowly sit on a chair. Then slowly stand up; don't let your knees go beyond your toes. Repeat eight to 10 times. After you are comfortable doing this exercise, add hand-held weights.
Seated overhead press strengthens front of shoulders. Sitting on a chair, hold weights at shoulder level, palms facing to the front, and slowly lift the weights up over the shoulders. Do not lock the elbows. Return arms to shoulder level and repeat eight to 10 times.
Ball squeeze strengthens wrist and fingers. Hold a rubber ball in your hand, palm facing upward, and squeeze for three to four seconds, maintaining a straight wrist. Build up to eight to 10 squeezes per hand.
One-legged stand is good for improving balance. Stand next to a sturdy support. Standing on right foot, bend left knee and lift it off the floor. Holding leg off the floor, swing right arm forward and left arm backward, and repeat arm swings 10 times. Repeat, standing on left foot.
Side leg lifts strengthen outer thighs and hips. Lying on your side, head resting on your extended arm, lift the top leg off the floor about hip height; hold, then release and repeat eight to 10 times. Eventually add ankle weights.
Standing calf raise strengthens calves and ankles. Standing near a table for balance, raise up on the balls of your feet, then release; repeat 12 to 15 times. After a while, try wrapping one foot around an ankle, then raise up on one foot.
-- Note to readers: Those who have tried to e-mail me recently have had their mail returned, because I have been unable use my computer. I had a flood in my home and had to move out. After I returned, lightning struck my house and tore a hole in the roof; rainwater poured in, and I had to move again. I am now back at home, waiting for repairs and a new computer.