Ask the Doctor: First step to bone health is awareness

By Norma Nehren, M.D.
Special to the Tribune-Star

TERRE HAUTE March 15, 2007 05:39 am

— “With my mom having had a hip fracture that was due to osteoporosis, I need to figure out when to worry about my own bones. I’m over 40 and have drunk milk, so I’m not too concerned yet, but is there a way to make sure it doesn’t happen to me or my daughter?”
Being aware of your risks for developing osteoporosis, or low bone mineral density that can lead to broken bones, is the first step in prevention. If someone in your family has been diagnosed with osteoporosis, then you have increased risk as well, if you do not work on making sure your bones stay strong.
More than 44 million Americans currently have osteoporosis, a number similar to the population that have high blood pressure and high cholesterol.
And just like those diseases which can be silently developing, the presence of osteoporosis is often unknown until it is “too late” and a bone breaks. Then you bear the costs of a hospital stay, surgery, and long recovery time with loss of work and deconditioning. Osteoporotic fractures are also associated with other complicating problems such as pneumonia, infections and blood clots.
Who is at risk? The most likely group of people at risk for osteoporosis are women over the age of 65. It can also be found in both women and men who are on chronic steroid therapy, or in women under 65 who are underweight, smoke, go through menopause before they are 45, and in those with a first-degree relative with such a fracture (like your mother).
To detect osteoporosis or bone loss early, it is recommended that you have a bone density exam after the age of 50. This X-ray exam will measure the thickness of your bones at both your hip joint and in your spine. Then you will receive a score based on your bone thickness compared to the average young adult of 25, same gender.
This bone density score is known as your T-score, and you want it to be on the average at 1.0. Anyone with a T-score of less than -2.5 has full blown osteoporosis and should be treated with bone building medication and calcium supplementation.
T-scores between -1.5 and -2.5 are known as osteopenia (thinning bones) and should be treated if other risks fractures are present like those mentioned for people who develop osteoporosis earlier than the average.
Another good place to start when evaluating your risk for osteoporosis is to check blood work for levels of calcium, phosphorus and vitamin D. There are several other blood tests that are done for people who develop osteopenia or osteoporosis before the age of 65 in which ruling out a secondary cause like celiac disease or problems with cortisol, prolactin or parathyroid hormone becomes important.
Treatment of osteoporosis begins with supplemental calcium and vitamin D. Early studies that seemed to show that supplementation did not make a difference were flawed in that they were done on young people who were already taking in their RDA of calcium and Vitamin D. When supplemental calcium and vitamin D are given to older adults or those with less in their diets, there is a significant and positive difference in bone density.
Adding on a bone builder, really called an anti-resorptive agent, is the next step in therapy. Risedronate (Actonel) and alendronate (Fosamax) protect against fractures at the spine, hip and elsewhere. Ibandronic acid (Boniva), raloxifene (Evista) and estrogen also protect the spine, but show only a small effect on the hip and other areas.
It is not “normal” to start hunching over as we age, and you can avoid the loss of bone density to which you are prone by making sure you are getting enough calcium and vitamin D in your diet or with supplements.
The RDA for calcium is 1,000 to 1,300 mg per day, depending on age. The RDA for vitamin D is 400 to 800 IUs (international units). Never go over 1,000 IU of vitamin D or 1,500 mg calcium a day, this is a case when more is not always better.
Dietary calcium can be found in milk, yogurt, cheese, salmon, kal e and greens. Each serving provides about 300 mg of calcium,1/4 of your daily need.
A supplement like Citracal 600 Plus or the generic at Rite Aid contains 600 mg of calcium and 200 international units of vitamin D and costs between 8-11 cents per tablet. Two of these a day should get you well on the way to prevention of osteoporosis. Then, when it is time, check your bone mineral density and go from there.