Osteoporosis

What is Osteoporosis?

Osteoporosis literally means “porous bones.”  It occurs when bones lose so much of their mass and strength that they become weak, brittle, and very susceptible to fractures. Osteoporosis is sometimes called the “silent disease” because many patients are not even aware they have it until they experience a bone fracture. Sometimes a minor movement such as a sneeze or a cough can cause a bone fracture in folks with advanced osteoporosis. The condition is found most often in post-menopausal women, but from age 75 and beyond, it is equally common amongst men and women.

Osteoporosis is very widespread. It is estimated to affect approximately 28 million people in the United States alone. Osteoporosis is linked to 1.5 million bone fractures annually. The most common fractures are those of the hip, spine, and wrist. Many of the hip and wrist injuries are the result of a fall. Broken hips require major surgery and can be very risky for senior citizens. Spinal fractures can lead to loss of height as the vertebrae collapse on themselves. This is the cause of the hunchbacked appearance of some elderly folks, especially women. Sometimes this condition is called “widow’s hump” or “dowager’s hump.”

Bones are composed of a dynamic living tissue that is constantly changing. In a process known as remodeling or bone turnover, old bone tissue is broken down (resorption) and new bone is produced to replace it (formation). These cycles repeat every 2-3 months. Resorption utilizes specialized cells calledosteoclasts, and formation involves cells called osteoblasts. During childhood and the young adult years, more bone is produced than removed, and the body reaches maximum bone density and strength at about the age of 35. After that, the process begins to reverse itself, and the body slowly loses bone mass faster than it gains it. This is part of the aging process, but most osteoporosis occurs when this process happens faster than normal. This is known as primary osteoporosis. When osteoporosis occurs due to other health conditions it is called secondary osteoporosis.

What Are the Risk Factors for Osteoporosis?

There are quite a few factors that can increase one’s chances of developing osteoporosis. The most common ones are:

• Gender:  Women are five times more likely than men to suffer from osteoporosis, and twice as likely to experience a bone fracture from osteoporosis. The reasons behind this are:

• • Women generally have smaller, thinner bones than men.
  • Most females live longer than males, and therefore have more time to develop osteoporosis.
  • After menopause, usually around the age of 50, women lose bone density faster than men. This is due to a significant drop in estrogen production at this point in their lives. Estrogen plays an important role in protecting the bones. Women may lose up to 20% of their total bone mass during the first 5-7 years after menopause.
  • Statistically, women will lose more bone mass (30-50%) over their lifetimes than men (20-33%).
  • After the age of 75, males and females both tend to lose bone mass at equal rates. As men are living longer, osteoporosis is becoming more of a health concern for them.

• Age:  The bones naturally weaken with age. All other factors aside, the older you get, the more your risk for osteoporosis increases.
• Race:  Caucasians and Asians have the highest incidence of all races. African Americans and Hispanics are still susceptible to osteoporosis, but their risk is less.
• Frame Size:  If you are thin and small-boned, your risk is higher because you have less bone mass to begin with. Shorter people also have a greater risk for the same reason.
• Family History:  Researchers are not quite sure of why, but if you have a parent or sibling with osteoporosis, you have a better chance of getting it than if you do not. Another interesting statistic is that if you also have a family history of bone fractures, your risk for osteoporosis is even greater.
• Exposure to Estrogen:  The more a woman is naturally exposed to estrogen, the lower her risk is. For example, if she begins to menstruate earlier than normal or has a later than normal menopause, her risk is decreased.
• Other Disorders:  There are a number of other medical conditions that can increase the risk for secondary osteoporosis:
  • Eating Disorders:  Individuals with anorexia nervosa or bulimia mayhave an increased risk due to a lack of critical nutrients, especially calcium, in their bodies. They are particularly susceptible to lower back and hip problems because of low bone densities in these areas.
  • Thyroid Disorders:  An excess of thyroid hormones can cause bone loss and increased risk for osteoporosis. This can occur from an overactive thyroid (hyperthyroidism) or from the medication given to treat an under active thyroid (hypothyroidism).
  • Alcoholism:  Chronic alcoholics are at increased risk. Heavy drinking impairs bone formation and lessens the body’s ability to absorb calcium.
  • Depression:Chronic depression has been linked to increased bone loss. The reason for this is not fully understood.
  • Breast Cancer:  Women who have a history of breast cancer and have been treated with certain chemotherapy drugs have increased risk. These include estrogen suppressors such as anastrozole, letrozole, and exemestane.
  • Other Medications:  If you have a condition that has been treated with certain types of drugs your risk may be increased. These include: heparin (a blood thinner), diuretics (causing the kidneys to excrete abnormal amounts of calcium in the urine), steroid medications (used for treating arthritis, psoriasis, and asthma), and some anti-seizure medications.
  • Antacids:This drug deserves special mention. Antacids that contain aluminum can contribute to bone loss. Be especially careful of these. Many people take these for heartburn, and think they are also getting extra calcium to help conditions like osteoporosis. The drug companies have done a great job of marketing this, but it is a misrepresentation. They don’t tell you about the risk from aluminum. They also don’t tell you that this form of calcium is not absorbed readily by the body and therefore cannot help fight osteoporosis, and may even worsen it. I have known some people who take these antacids on a daily basis whether they have heartburn or not, just for the calcium. This is a mistake. Stay away from these drugs.

So far we have discussed factors that we are generally not able to be changed. Some factors for osteoporosis can be changed by the choices we make:

• Smoking:  Research indicates that tobacco use weakens bone tissues. The details of how are not exactly understood, but the bone mass of smokers is generally lower than that of non-smokers.
• Drinking:  Heavy drinking interferes with calcium absorption. Either give up alcohol altogether, or limit it to no more than two drinks per day to minimize your risk.
• Soft Drinks:  These are a no-no for several reasons. First off, many soft drinks contain high levels of phosphoric acid (phosphates), which contributes to calcium loss. When phosphate levels are high and calcium levels drop, the body draws out calcium from the bones to compensate, causing them to weaken. Secondly, foods high in refined sugar, such as soda pop, stimulate the body to excrete more calcium in the urine. Again the body will try to compensate by pulling calcium from the bones. The third concern about soft drinks is that most of them are high in caffeine. Caffeine acts as a diuretic, and can cause the body to excrete abnormal amounts of minerals, such as calcium, in the urine. This is true for other caffeinated drinks as well, such as coffee or tea.
• Exercise:  A sedentary lifestyle is bad for your overall health, and can significantly increase risks for osteoporosis. Teach children while they are young to get consistent regular exercise. This life long habit is one of the best defenses against osteoporosis. Cardiovascular exercise is always good for the body, but when we are looking specifically at osterporosis, weight-bearing exercise is critical. This type of activity helps to build muscles and bones in the parts of the body that support the bulk of our weight: legs, hips, and lower spine. Jumping exercises are thought to be especially helpful, such as skipping, jumping rope, or bouncing on a trampoline. Combining these with strength-training exercises using weights is a great one-two punch against osteoporosis.
• Diet:  Diet is of critical importance in fighting osteoporosis.
  • One of the things you want to avoid is getting too much protein. Excess protein stimulates the body to rid itself of more calcium. One study showed that high protein diets can double the amount of calcium excreted. Vegetarian diets are thought to be an excellent choice. Studies have shown that vegetarians have a higher bone mass later in life than omnivores. This is thought to be due to decreased bone loss over the course of their lifetimes. Be careful though. Too little protein can be a risk factor for osteoporosis as well. Another reason a diet with little or no meat or dairy foods might be beneficial is because most vegetables and fruits are more alkaline than acid. High acidity in the body causes it to excrete more calcium in the urine as well.
  • Loading up on certain kinds of foods that are high in Vitamin K1 is also very advisable. K1 is involved in converting a bone protein called osteocalcin into a useful form. Most foods high in K1 are also rich in many important nutrients that affect bone health. These foods include green leafy vegetables from the cabbage family such as kale, collard greens, broccoli, and Brussels sprouts. Green tea is also rich in K1.
  • The best sources of calcium are found in foods. Some suggestions are green leafy veggies, shellfish, sardines, Brazil nuts, and almonds. Do not assume that you will get enough calcium from milk to fend off osteoporosis, despite what the advertising says. Some research indicates that drinking too much milk can actually increase your risk of osteoporosis. The culprit is suspected to be the Vitamin A which is added to milk. High doses of Vitamin A can interfere with bone formation. A study of osteoporosis rates worldwide will show that it is much more common in countries where milk consumption is highest.
  • Be careful with calcium supplements. If calcium is to be absorbed effectively it must be combined with phosphorous. Calcium alone can actually cause phosphorous levels to drop, which can contribute to osteoporosis.