The Doctor is IN Menopause Mondays: Osteoporosis and Bone Health with Dr. Diane L. Schneider

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From Ellen. You know, I’ve never bought into the notion that I have to limit my self in any way. OK, maybe for brief periods – like my first 2 years of perimenopause – but I always find a way to snap out of it. :>) When we reach a certain age, all of the information fired at us sound like a thousand clucking tongues. Advice, risks of this or that, the ought to’s, the should have’s – all start to pile up. It’s just easier to bury our face in a bowl of ice cream. In order not to be limited by ill health, we have to pay attention, stay informed, and be actively involved in keeping ourselves healthy. Can I get an “Amen” in here? Maybe you’ve done this your whole life. Great for you! (Seriously!) For others, perimenopause and menopause can be the turning point when we start caring about our bodies and our selves. If you dive into all of our health issues at once, you’re likely to become overwhelmed, and fast. So, take it bit by bit. That’s why I’m here. If this is the first time you’ve read Menopause Mondays, welcome. Let’s tackle the subject of osteoporosis.
Disheartening though it may be, 25 million Americans suffer from osteoporosis. As women enter perimenopause and menopause, we need to be especially aware of our bone health. (Osteoporosis isn’t just a woman’s problem, though – men should take note, too!) Today, I speak with Dr. Diane L. Schneider, MD, MSc. She’s so committed to bone health, you could say she’s a bone activist. She is the author of The Complete Book of Bone Health and cofounder of
Doctor, How can we prepare for and fight the loss of bone mass?
Dr. Schneider: Unless you break a bone, you may not be paying attention to your bone health. Bone loss is a silent process. The transition to menopause is the time when bone loss accelerates due to the loss of estrogen. By optimizing your bone health you may lessen the impact of menopause on the bone.
As a geriatrician and epidemiologist (“disease detective”), my career has focused on the prevention and treatment of osteoporosis. Awareness and education about simple measures can make a difference but few Americans are meeting the daily recommendations for calcium, vitamin D, and exercise. As a lifelong educator, I put together a comprehensive resource titled, The Complete Book of Bone Health published by Prometheus Books in the Fall of 2011 to help you navigate and learn about what you can do for your bone health.
Ellen: What should we be doing to ensure optimal bone health?
Dr. Schneider: Focus on the basics that I refer to as the ABCs of bone health:
Engage in regular physical activity. Bone requires physical activity to stay in shape. Mechanical strain on the bone provided by activity helps to maintain bone. A total of 30 to 60 minutes of moderate-intensity exercises on most days of the week is recommended. If you are already active, turn it up a notch by increasing the time and intensity.
Do something you like. But impact and resistance exercises are the best to promote bone building. Incorporate weight-bearing and weight-resistive exercises in your exercise routine.
Vary your routine. Do a combination of cardiovascular exercises, stretching, weight training, and resistance work. Alternate days of cardio and muscle strengthening or focus on separate muscle groups, such as upper body one day, lower body the next.
Spend more time on your feet. Maintaining good bone requires more time than just time in the gym. During the day stay active and avoid long periods of sitting. Everything you do while in motion counts as physical activity including household work, gardening, and walking.
Build and maintain core strength. The goal is to prevent falls and make you more stable on your feet. In later life, 90 percent of broken hips are a result of falling. Keep engaging your core muscles to work on improving your balance.
Start with simple balance exercises. Walk heel-to-toe. Balance on one leg. Then close your eyes while balancing on one leg.
Know your target daily calcium intake. Recommendations are based on your age and gender. (Refer to chart.)
Track your daily calcium. Add up your calcium from your foods. Dairy products are the highest in calcium. Learn about other foods that are rich in calcium such as broccoli, kale, turnip greens, bok choy, black beans, and almonds.
Check “Nutrition Facts.” Calcium on food labels is given as % Daily Value or DV. Since the daily value for calcium is 1000 milligrams, just add a zero to the percent for the amount in milligrams. For example, a one-cup serving of whole milk is 30%, which would be 300 milligrams.
Calcium Recommended Daily Intakes 2010 Institute of Medicine
Count food first. Supplements mean just that, you are supplementing your diet. If you don’t reach your goal with food, fill the deficit with a calcium supplement.  Don’t exceed the upper level of calcium intake. (Refer to chart.)
Don’t count on the sun. Although sunshine is the main source of vitamin D, you can’t expect sun to be your primary source in all seasons of the year. Sunscreen also blocks the production of vitamin D.
Eat vitamin D-rich foods. Unfortunately, few foods contain vitamin D. The highest natural sources are fatty fish like wild salmon, herring, and sardines. Other foods may be fortified with vitamin D. All milk is fortified but not all milk products are fortified with vitamin D.
Check “Nutrition Facts.” Vitamin D on food labels is given as % Daily Value or DV. The daily value for vitamin D is 400 IU (International Units). Multiply the percent by 4 for the amount in IUs. For example, a one-cup serving of milk is 25%, which would be 100 IUs.
Ensure adequate vitamin D status with supplements. The amount of vitamin D needed is hotly debated. Refer to the chart for the latest general recommendations. However, your individual needs may vary. In general, taking 1000 to 2000 IUs a day provides adequate vitamin D status. Talk with your specialist about checking a vitamin D level to be sure.
Vitamin D Recommended Daily Intakes 2010 Institute of Medicine
Consider restoring the estrogen support of bone that is lost with the transition to menopause. Estrogens are approved by the Food and Drug Administration (FDA) for prevention of postmenopausal osteoporosis.
If you are at higher risk for breaking a bone, estrogen decreases the risk of fractures. In research studies, use of estrogen in women with low bone density lowers the risk of having a spine or hip fracture.
Use the lowest dose required to control your menopausal symptoms. Changes in bone density may be related to the dosage of estrogen. Low dose estrogen maintains bone density and lowers your risk of breaking a bone.
Ellen: Some women turn to bone-building drugs to make sure they don’t lose mass or fall into osteoporosis.  What is your opinion?
Dr. Schneider: The answer to this question is far from certain. Let me state at the beginning, there are no definitive answers. The evidence is thin in this area. In this “data-free” zone, expert opinion has driven the changes for managing patients on long-term bisphosphonate therapy with stopping their medicine for a year or two then resuming it, known as a drug holiday, or switching to another medicine, which is called sequential therapy.
Long-term treatment with bisphosphonates is under evaluation by the FDA. The release of an updated assessment by the FDA is expected soon.
I look forward to sharing more tips and facts on bone health on future Menopause Mondays. It’s time to bone up!
Ellen: Thank you, Dr. Schneider, for this great information about bone health. Though bones are the very structure of our bodies, we often forget how important they really are! Make sure you talk with your perimenopause and menopause specialist about the effects of estrogen loss on your bones. Get your bone mineral density tested. Instead of allowing health problems to limit what we can do or viewing subjects like bone density as a huge downer, why don’t we use a little perspective and keep our possibilities limitless by taking care of ourselves and staying healthy!
Remember: Suffering in silence is OUT! Reaching out is IN. 
Share your experience by commenting below: What’s your favorite exercise and what’s your favorite way to reward yourself?
Additional resources:
Bisphosphonate Treatment: How Long Is Long Enough?, by Diane L. Schneider, MD, MSc,
• For more great information from Dr. Schneider on bone health, check out her book, The Complete Book of Bone Health!



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After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

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