Osteoporosis

Osteoporosis is a weakening of bones due to loss of bone mass or density. It is characterized by low bone mineral content and increased risk of fracture especially in the spine, hip, and wrist. It is especially common in thin, older women but can affect any person. About 30% of hip fractures, due to weakened bones, occurs in older men.

Here are some of the sobering facts about osteoporosis:

• Osteoporosis is a serious health threat to over 44 million Americans

• 80% of those affected are women

• 20% of whites and Asians over the age of 50 have osteoporosis and 52% are estimated to have low bone mass putting them at increased risk of developing osteoporosis and related fractures

• One in two women and one in four men over age 50 will have an osteoporosis related fracture in their lifetime

• Osteoporosis is responsible for more than 1.5 million fractures annually including 300,000 hip fractures and 700,000 vertebral fractures

• The estimated cost for osteoporosis is $17 billion per year ($47 million per day) and rising rapidly

• Osteoporosis can be prevented in most cases if you develop a healthy lifestyle early in life

Bone Scans. Women past the age of 50 are encouraged to get a bone density test to see if they are at risk. There are medications that can help slow bone loss if indicated. Ask your doctor for advice.

Prevention. There are many protective actions that can be taken to help prevent osteoporosis. Perhaps the most important is to encourage young girls it be active, eat adequate calcium, and get adequate vitamin D during the adolescent years when bone mass is forming. A high peak bone mass in young women is the best defense against early bone loss and fractures later in life. Here are other health practices that can help at any age.

Strategies for Healthy, Strong Bones ^1-3

• Get adequate vitamin D daily. There are two sources, sunshine and diet. If living in Northern climates with less sun in the winter, be sure you get adequate dietary sources. A vitamin D supplement of 5-10 micrograms per day is recommended by the WHO in this circumstance.

• Get regular physical activity. Exercise stimulates calcium absorption and calcium accumulation in the bone. Weight bearing exercises strengthen the hip bones; resistance or weight training help keep the arms and other bones strong. Aim for at least 30 minutes daily. An hour per day of physical activity provides additional benefits for those who are able to meet this goal. It is OK to break this time up into 15 minute segments throughout the day. Activities that improve balance and coordination are also helpful in preventing falls and fractures.

• Get adequate calcium. You need at least 2 servings per day of foods high in calcium such as low-fat milk, yogurt, or an alternate such as calcium fortified orange juice or fortified soy milk. Other foods high in calcium include: dark leafy greens (e.g. broccoli and kale), tofu, traditional tortillas (processed with lime), and fish with edible bones. If you don't get adequate calcium from your diet, take a calcium supplement. Aim for a total intake of about 1,000 mg/day. The average calcium intake for women in the U.S. is about 600 mg/day and about 850 mg/day for men.

• Limit sodium intake. High sodium (salt) intakes increase calcium excretion by the kidney. The WHO recommends a total sodium intake of less than 2,000 mg/day. Read food labels to see how much sodium is in foods.

• Increase consumption of fruits and vegetables. Many are good sources of calcium and they also help lower excretion of calcium in the urine by helping keep the pH of the blood in a healthy range for calcium retention.

• Maintain a healthy body weight. Avoid overweight or underweight. Being too lean increases the risk for osteoporosis. Significant weight loss after the age of 50 also increases bone loss and fracture risk. Increasing calcium intake and activity level during weight loss can help offset the tendency to lose bone mass with weight loss.

• Avoid smoking. Smoking damages the cells that are responsible for laying down calcium in the bones.

• Limit alcohol intake. High alcohol levels are hard on bone cells and increase the risk of falling and causing a fracture.

• Limit a high intake of animal protein. High intakes of animal proteins  increase calcium excretion. Vegetable proteins seem to be more protective, decreasing calcium loss from bones.

• Eat adequate vitamin K daily. People getting high vitamin K (250+ micrograms/day) have less osteoporosis than those eating low intakes (60 micrograms/day) levels. Good sources of vitamin K include greens (collards, kale, broccoli, spinach), Brussels spouts, romaine or red leaf lettuce, and cabbage.

• Avoid getting excessive preformed vitamin A (retinol). Vitamin A is needed for good bone health but high levels, 3,000+ micrograms/day, are linked to greater bone loss and increased hip fracture rates. Beta-carotene (pre-vitamin A) has not been linked to adverse bone health and need not be restricted. Excess vitamin A (retinol) usually occurs due to eating too many vitamin A fortified foods plus dietary supplements with high levels of retinol. The average person in the U.S. is getting about twice the recommended level of vitamin A. The Institute of Medicine (IOM) recommends eating less than 1,000 IU of retinol per day. Getting vitamin A from beta-carotene is a safer source than retinal of bone health.

Links for Further Information

Osteoporosis Fact Sheet - NIH National Osteoporosis Resource Center
NIH National Osteoporosis Resource Center
Nutrition and Bone Health - NIH Fact Sheet