Unless you break a bone, you may not be paying attention to your bone health. Bone loss is a silent process.
The National Osteoporosis Foundation (NOF) estimates that a total of 54 million U.S. adults age 50 and older are affected by osteoporosis and low bone mass.
I have received numerous emails from readers who have recently been diagnosed with Osteoporosis. As our estrogen levels decline, bone loss may accelerate. Many women suddenly find themselves in a quandary as to whether to go on medication or not.
I thought I would share one women’s story with you. For the purpose of this blog, we shall call her Jeanne. Jeanne has avoided any pharmaceutical use because her mother took DES while she was pregnant with her. Recently, Jeanne was diagnosed with Osteoporosis. Her doctor says her case is severe and he recommends she go on a drug called, Forteo.
To help support Jeanne, I turned to osteoporosis expert Diane L. Schneider, MD, a geriatrician, epidemiologist, co-founder of 4BoneHealth.org, and author of The Complete Bone Book.
According to Dr. Schneider, “Osteoporosis is the result of bone loss that occurs silently and progressively creating a fragile skeleton that puts one at risk of breaking a bone or having a fracture.”
Dr. Schneider graciously shared her review and thoughts on Jeanne’s options:
Jeanne, age 60, was diagnosed with osteoporosis by bone density scan. Her lowest skeletal site was the lumbar spine (low back) with T-score of -3.7 and her total hip was -3.2. The T-score is comparison of your bone density measurement with young women at peak bone mass. The T-score along with assessing risk factors for breaking a bone provides a fracture risk assessment.
Risk Factors and Lifestyle
In discussing her risk factors, Jeanne had never broken a bone, she considers herself in excellent health with no chronic illnesses, and she is taking no medicines. She has been diligent in taking calcium supplements, getting regular exercise, and followed a vegan diet for the past six years. She felt that she was doing “everything right” to lower her risk of osteoporosis that debilitated her mother. Her family history is her major risk factor.
The results of her bone density plus her family history of osteoporosis puts Jeanne at high risk for breaking a bone. One concern is the level of her bone density at her age. A thorough investigation should look to uncover any additional problems that may be contributing to her low bone density. For example, screening for celiac disease, overactive thyroid, calcium loss in the urine and multiple myeloma to name a few.
Before discussing medicines, other general measures of calcium, vitamin D, nutrition, and exercise should be addressed as well. I find discussion of these areas are often left out of one’s interaction with their healthcare professional. So be sure to bring these up with yours.
On review of her diet, Jeanne was consuming 700 milligrams of calcium a day from various foods and drinks. She took a calcium supplement that contained 600 milligrams twice a day. Her once-a-day multivitamin contained 500 milligrams of calcium. All together her diet and supplements totaled 2400 milligrams of calcium.
For women over age 50 and men over age 70, the latest recommendation from the Institute of Medicine is 1200 milligrams a day of calcium from all sources. At 2400 milligrams a day, Jeanne was taking double what she needed. Excess calcium ends up in your urine putting you at risk for kidney stones.
Keeping in mind that Jeanne should only consume 1200 milligrams of calcium, her calcium supplement was stopped entirely. With an average of 700 milligrams in her diet and 500 milligrams more from her multivitamin, she met the 1200 milligram recommended target. Taking the separate calcium supplement put her way over and is not needed; but that’s what her primary care doctor had recommended without asking what else she was taking or obtaining a dietary history.
Jeanne had 400 IU of vitamin D in her multivitamin and 500 IU in each tablet of calcium. Since I suggested to stop her calcium supplement, she would need to take a separate vitamin D supplement. The best guide to determine whether she needed more or less than 1000 IU she was getting in the calcium supplement is using a vitamin D blood level.
Jeanne considers herself a lifelong healthy eater. She strictly follows a vegan diet and prior to that was ovo-lacto vegetarian. However, in review of her usual foods for meals, she was not consuming enough protein. The recommended daily amount of protein for an average adult women is 46 grams or 0.8 grams per kilogram per day. Remember protein is needed to support your bone, it’s not just made up of minerals.
Exercise and Fall Prevention
Jeanne walks regularly and practices yoga. Stressing your bone through weight-bearing and weight-resistive exercises are key. The exercise must be of high enough intensity to produce mechanical strain. I recommend walkers change up their speed and intensity intermittently. Try walking up steps or a hill, or walking faster for a block then repeat every couple of walks.
Yoga is good for improving balance and core strength. Yoga poses may need to be modified to avoid loading the spine in bending forward postures.
Over 90% of wrist, shoulder, and hip fractures are a result of a fall. The key is not to fall. Improving core strength and balance will help lower the risk of falling.
Fortunately, we now have choices for women and older men who have been diagnosed with osteoporosis or are at high risk for fractures. Jeanne had avoided any medicines but she was basically doing well in following healthy lifestyle. My comments above are just small modifications. Unfortunately, these general measures are not enough to lower her risk of fracture and improve her bone density.
I recommended that she consider starting therapy with Forteo (teriparatide) for the following reasons. Her spine skeletal site was lower than her hip. Forteo has a good response at the spine with an average increase of almost 10% in two years of use. It is the only medicine that stimulates the bone-building cells, called osteoblasts. Connections are made in the bone microstructure that had broken, new bone is formed, and bone volume is increased. As a result, fracture risk is reduced. Forteo is “natural”-it is the first portion of parathyroid hormone. It produces a short burst of parathyroid hormone action that achieves these effects.
The medicine is a daily injection using a click pen-like device. This route of delivery dissuades some people from starting the medicine but it is simple and is practically painless. In addition, its use is limited to two years then followed by one of the other medicines to maintain the gains achieved on Forteo.
According to Dr. Schneider, if you are at high-risk for fracture, general lifestyle measures are limited in decreasing fracture risk. Medicines play an important role in the treatment of postmenopausal women and men with osteoporosis. Consult your healthcare practitioner to discuss the best options for you.
Remember: Suffering in silence is OUT! Reaching out in IN!
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