Women and Bone Disease: Osteoporosis
 

A Bone Disease That Plagues Millions of Women First of two parts  By Beth Gilbert  "Drink your milk -- it makes your bones strong!" How many times did we hear that  growing up? What's even harder to swallow than all the milk they pushed on us is the idea that our mothers were some sort of osteoporosis visionaries. But they were right on target. We should  have drunk our milk then and, no matter  how old we are now, we should be drinking  it today -- and eating our yogurt, cheese, broccoli and other calcium-rich foods.  Calcium is one of our best lines of defense against osteoporosis, a silent bone disease without symptoms or warnings. At  this moment, 8 million American women have osteoporosis -- and millions more have low bone mass, which places them in the high-risk category for the disease.  "Essentially, we're dealing with a major public health threat," says Dr. Charles  Chestnut, director of the Osteoporosis  Research Group at the University of  Washington Medical Center in Seattle.  "Osteoporosis isn't something new.  There's evidence of osteoporosis in the remains of Egyptian mummies. It's been a recognized condition for a long time but no one really seemed to care about osteoporosis much." Until we is covered we could take real action against it.

Bones and Osteoporotic-Related Fractures

Bone is a living tissue made mostly of calcium. Our bodies renew bone regularly -- removing the old and replacing it with the new. Until about age 30, new bone is built at a little faster rate than the old bone is removed, so bones grow bigger and stronger. After about age 30, that reverses. The old is removed slightly faster than the new is built. 

When we reach menopause -- usually somewhere between ages 45 and 55 --  we start to lose bone quantity and quality rapidly. That's because our level of  estrogen -- the hormone that helps maintain healthy bone -- is greatly reduced during menopause. And that's when we become at greater risk for osteoporotic-related fractures or bone breaks, especially in our hips, spines and wrists. Spine fractures cause stooped posture and backbone deformities.

In fact, the National Osteoporosis Foundation estimates that there are 1.5 million osteoporosis-related fractures each year, mostly among women. In 1995, Americans paid a whopping $13.8 billion in hospital and nursing home bills to treat osteoporotic-related injuries -- a dollar figure that continues to mount as America ages and healthcare costs rise. 

Prevention

Most medical experts agree osteoporosis is highly preventable. For now, our best lines of defense against osteoporosis are healthy living, exercise and good nutrition. 

"If you smoke, quit. If you drink alcohol, drink moderately. And the earlier you start exercising and eating a diet enriched with calcium and vitamin D, the more positive an impact you will have on your body," says Dr. Felicia Cosman, the clinical director of the National Osteoporosis Foundation. Cosman is also an associate professor of medicine at Columbia University and an osteoporosis specialist with the Regional Bone Center of Helen Hayes Hospital in West Haverstraw, N.Y. (The late actress, Helen Hayes, suffered from osteoporosis.) 

National surveys show that American women are failing themselves at perhaps the easiest measure of prevention: consuming enough calcium each day. In fact, studies indicate we probably only get about half of what our bodies need.

The NOF recommends the following: 1,000 milligrams for women ages 19 to 50; 1,000 milligrams for post-menopausal women taking estrogen and 1,500 milligrams for osteoporotic-menopausal women not taking estrogen. 

In addition, adults also need somewhere between 400 and 800 international units, or IU, of vitamin D each day. Vitamin D is the key that unlocks the door that allows calcium to leave the intestine and enter the bloodstream. 

"I tell my patients if they eat a healthy diet, drink two eight-ounce glasses of  milk and take a 1,600-milligram calcium supplement with 200 IU of vitamin D  each day, they'll meet their daily calcium and vitamin D needs," Cosman says. 

Exercise goes hand in hand with diet in the battle against osteoporosis. Calcium builds bones but exercise makes bone stronger and denser. Two specific types of exercise are key in building bone and maintaining bone mass and density: weight-bearing and resistance. 

Weight-bearing exercises -- such as dancing, jogging, walking, stair climbing and soccer -- place weight on your feet and legs. Resistance exercises -- such as working out with free weights or weight machines -- build up your body's infrastructure by improving muscle mass and strengthening bone. 

Testing and Treatment

Since osteoporosis is a silent disease, the best way to diagnose it prior to a fracture is with a special test called a bone mass measurement, or bone mineral density test. 

There are several methods and machines that measure bone mineral density. They're all safe, painless, noninvasive and becoming more readily available. The tests measure the bone density in your spine, hip and/or wrist. Recently, the Food and Drug Administration approved tests to measure bone density in the middle finger, heel or shinbone. 

Your bone density is measured against two standards: "age matched," or what's typical in someone your age, sex and size; and "young normal," or the optimal peak bone density of a healthy young adult of the same sex. Your test results tell you where you stand within the ranges of normal and determine your risk for fracture. Generally, the lower your bone density, the
higher your risk for fracture. 

Currently, there are four medications approved by the FDA for the treatment of postmenopausal women to either prevent and/or treat osteoporosis. 

"It's good news because we can choose a treatment to meet the needs of our patients," Chestnut says. "In the future, there will be even more and probably better treatments to choose from and we'll be able to combine therapies to further tailor treatments to women's needs." 

Estrogen was the treatment of choice for years. It helps eliminate the hot flashes associated with menopause and helps prevent heart disease. "But there's a real layer of uncertainty concerning estrogen and breast cancer," Chestnut says. "So for some women it's not a good treatment"

Raloxifene is estrogen-like, "but without the breast cancer-risk
baggage of estrogen," Chestnut says. "It works positively on both the heart and on bone. But 1 in 5 still have hot flashes." 

Alendronate, a bisphosphonate, only affects skeletal mass and doesn't do anything for hot flashes. It can cause gastrointestinal problems in some women. Currently, it's taken on an empty stomach first thing every morning. Patients cannot lie down after taking it and they can't eat for about an hour. "Some women don't like it because they have to wait so long to eat," Chestnut says. Eventually, a once-a-week dose will be available. 

Calcitonin is a nasal spray. It works specifically on the skeleton and preserves bone, but also helps reduce pain. "That's something the other treatments don't do," Chestnut says. The drawback is that some patients experience nasal congestion, drippy noses or nosebleeds. 

"We've made great strides in the field of osteoporosis in the past decade because women recognized the serious nature of this condition and started demanding some attention," Chestnut says. "So, we've come a long way. But we've only scratched the surface." 

Beth Gilbert is a veteran free-lance writer and journalist who has worked for several distinguished publications, among them The Miami Herald, Money Magazine and Family Circle Magazine. She lives with her husband and two children in New York City.

Formula Designed for Women Going Through Menopause:
 

 Menopause and Osteoporosis