Dr. Gaudet: Fighting Osteoporosis

According to the National Osteoporosis Foundation, osteoporosis, or low bone mass, threatens more than half of Americans above age 50, particularly women. A woman's risk of fracturing a hip due to osteoporosis equals her risk of breast, uterine, and ovarian cancer combined.

The effects of osteoporosis often remain hidden until late in life. In fact, most of us associate bone problems with the stereotypical dowager's hump seen in some older women. We don't get the dramatic wake-up call of a friend or colleague being diagnosed, as with breast cancer, and our bones don't get the daily attention in front of the mirror that our skin does. Many women don't even know they have osteoporosis until they break a hip or a wrist.

Women start to lose bone mass as early as age 35, so it's imperative to start following preventive measures as soon as possible. After all, our bones carry us around our whole lives; they need a little love in return.

Keep Bones Strong

• Exercise. Physical exercise can make your bones stronger and denser. Get weight-bearing exercise (such as walking, jogging, and dancing) every day and perform resistance training (such as lifting weights) three times a week.
  
  
• Reduce caffeine and alcohol intake. Both reduce bone density when consumed in excess.
  
  
• Quit smoking. Studies of twins have shown that long-term smoking increases fracture risk by about 40 percent.
  
  
• Take magnesium supplements. Magnesium supports calcium absorption and also counteracts the constipating effects that calcium supplements can have. Take 200 mg twice a day; many supplements offer both calcium and magnesium.
  
  
• Consume calcium. Aim for 1,500 mg a day from a combination of food and supplements. I usually recommend 600 mg of calcium citrate twice a day, but you may need less depending on the foods you eat. Milk can be a good source, but keep others in mind: A cup of cooked collards provides 360 mg of calcium, a cup of low-fat yogurt 350 mg, a half cup of firm tofu 258 mg, and 2 ounces of canned sardines 220 mg.
  
  
• Take vitamin D. It helps your body absorb calcium. People who don't get enough D have lower bone density and a higher risk of fractures. As a bonus, intake of D3 has also been associated with a decreased incidence of colon, breast, and ovarian cancers. Supplement with 1,000 mg of vitamin D3 daily.

Prevent Falls
The real risk of osteoporosis lies in that it makes bones more susceptible to breaks. One of the best ways to prevent fractures is to reduce your risk of falls -- and for that, you need to develop strong muscles and good body awareness and balance.

Conventional medical thinking about osteoporosis tends to focus on the molecular structure of bone and on creating new drugs to improve bone density. Medications can be helpful, but to prevent fractures, it makes more sense to focus attention on strategies to prevent falls.

In addition to these bone-building exercises described above, it's important for women of all ages to work on balance. When doing your resistance training, be sure to work on the muscles of your hips and ankles, according to Shipp, strengthening these areas helps you maintain balance.

And consider incorporating tai chi or qigong, both excellent practices for improving awareness and equilibrium. In fact, a 2007 study of more than 700 people published in the "Journal of the American Geriatrics Society" found that weekly tai chi classes improved balance and helped prevent falls among healthy adults age 60 and older. (Two other small studies showed that tai chi also may help reduce bone loss in postmenopausal women.)

The sooner you start building your balance, the better. While you're at it, you'll gain other benefits; tai chi can reduce your stress levels and may even enhance immunity.


Get Tested
Get regular bone evaluations. When a primary-care doctor tells a patient she doesn't need a bone-density test, he is following standard advice; the U.S. Preventive Services Task Force recommends routine screening with bone density testing at age 65 and older.

In my view, the need for screening depends on each patient's individual bone density around the time of menopause is very helpful. This gives you and your doctor a baseline for comparison before the drop in estrogen levels and subsequent bone loss that often occur after menopause.

The Dual Energy X-ray Absorptiometry (DEXA) is the most commonly used bone-density test. While it isn't perfect and can be confusing, the results will give you and your doctor a good snapshot of your current bone health. This information can then factor into discussions about possible lifestyle changes (as well as hormonal therapy) and guide decisions about future screening.

Text by Dr. Tracy Gaudet