Osteoporosis is a skeletal disease in which bone becomes fragile and at risk for fracture. It effects both men women, and can develop undetected for decades before symptoms appear. Although there is no cure at the present time, there are steps you can take at any age to either prevent, stop, or slow down its progress.

WHO'S AT RISK. Although Caucasian women are primarily affected, frail African-American, Hispanic, and Asian women are also at significant risk. Although women are four times more likely than men to develop the disease, osteoporosis is on the rise for men because they are living longer, according to Dr. Steven R.Gambert, MD, AGSF, Chairman and Physician-in-Chief at Sinai Hospital of Baltimore. The National Osteoporosis Foundation reports that two million American men aged 50 and over have osteoporosis, and another 12 million are at risk.

An article published in American Geriatric Society's Annals of Long-Term Care, lists the following additional risk factors for Osteoporosis:

HELP & PREVENTION. It is never too late to start a prevention program. In addition, those already affected by osteoporosis may be able to stop or slow down bone loss, increase bone density, and reduce fracture risk. Studies have shown that bone health can improve at any age with the avoidance of smoking and excessive alcohol, exercise, nutrition which promotes adequate calcium and Vitamin D intake and, in certain circumstances, prescription medicine. A healthy diet which promotes weight gain in under-weight individuals can also help reduce the risk.

Providing sufficient calcium and vitamin D is the basic step to help reduce fracture risk and to slow bone loss. Most American women have a dietary calcium intake below recommended levels, and supplementation is usually required to ensure adequate intake. In a study of 389 men and women over the age of 65, subjects who received 500 mg of calcium and 700 IU of vitamin D daily for three years had a nonvertebral fracture rate 60% lower than the control group, and a moderate decrease in the rate of bone loss.

The absorption of calcium decreases with age, and bone loss occurs in men and women throughout adult life. Since vitamin D is necessary for the absorption of calcium, both are generally recommended.

The National Institutes of Health Consensus Development Panel on Optimal Calcium Intake recommends a daily intake of 1500 mg for everyone over the age of 65. The recommended daily allowance (RDA) of calcium for persons over 50 is 1200 a day. The RDA for vitamin D is 400 IU daily, but 600-800 IU are recommended for individuals who are homebound, since they may not get sufficient amounts of the naturally occurring vitamin from the sun. Both men and women should take the recommended dosages of calcium and vitamin D unless a physician recommends otherwise.

The cessation of smoking can also contribute to healthier bones, according to Virginia K. Lee, APRN, BC, University of Virginia Health System. Research has shown smoking to be an important risk factor for osteoporosis and fracture. In one study of female twins in which one was a smoker and the other a non-smoker, significant differences were found in bone density as well as in concentrations of calcium, parathyroid hormone, and urinary markers of bone resorption. Ms. Lee suggests that smokers gradually reduce their smoking habits or consider using a nicotine patch. Finding interesting, diversionary activities may help reduce the desire to smoke.

Exercise in the later years has a modest effect on slowing bone mineral density loss. Exercise also has a positive effect on muscle strength and mass, even into later years. There is convincing evidence that exercise improves function, helps maintain independence, and promotes quality of life. Recent trials conclude that there is consistent evidence from prospective and case-controlled studies that physical activity is associated with a 20-40% reduced risk of hip fracture relative to sedentary individuals. Exercise, particularly involving balance and lower extremity strength training, may reduce fall risk. The National Osteoporosis Foundation suggests weight-bearing exercise along with other preventive measures. Consult your doctor before beginning any exercise program.

According to a report in the Archives of Internal Medicine, a recent study has shown that drinking certain types of tea may also help keep your skeleton strong. Study participants who consumed one cup of tea (black, green, or oolong) a week for at least 10 years had higher bone density in all areas of the body than those who rarely drank. The researchers think that compounds in tea leaves, such as fluoride and phytoestrogens, may provide the beneficial bone bolster.

Medication may be prescribed to prevent osteoporosis in high-risk individuals or to treat those already affected by the disease. With the advent of new drugs, the options for osteoporosis treatment and prevention have increased. These medications can slow or stop bone loss, increase bone density and reduce fracture risk. The National Osteoporosis Foundation reports that bisphonates (alendronate and risedronate), calcitonin, raloxifene, and estrogens are approved by the US Food and Drug Administration for the prevention and treatment of osteoporosis. Estrogen is often combined with progestin to help prevent endometrial cancer. It should be noted that hormone replacement therapy carry risks as well as benefits, which should be discussed with your physician before starting the therapy.

TESTING FOR BONE MINERAL DENSITY. A Bone Mineral Density test (BMD) measures the strength and density of your bones. If bone mass is found to be very low, you and your physician can decide on appropriate treatment. The test is also used to monitor treatment or to measure the rate of bone loss.

Testing is recommended by the National Osteoporosis Foundation (NOF) for all women who are 65 and older. The NOF also recommends testing for postmenopausal women under 65 with a fracture, and for women who have one or more risk factors for osteoporosis. Joseph Lane, M.D. at the Hospital for Special Surgery in New York recommends BMD testing for all women at the time of menopause and for all men at the age of 70. Men who are at high risk for osteoporosis should be tested earlier. For most people a bone density test may be repeated every 2 - 3 years and compared to earlier tests to help determine how quickly bone mass and density are being lost. Individuals taking certain medications may require testing every 6-12 months.

There are many different ways to measure bone density, but the most popular is the DEXA which, according to Carolyn Becker, M.D., Assistant Director of the Tony Stabile Osteoporosis Center at the NY Presbyterian Hospital-Columbia University, "…is really the gold standard" and the basis upon which treatment recommendations are usually made. Dr. Becker adds, "Most people should have a bone density at some point in their lives." The tests are painless, noninvasive, and safe.
(©Sally Sclair 2002. This article cannot be reproduced or reprinted under any circumstances without the written permission of the author. All rights reserved)