Bones are the body's foundation, the building blocks that support and protect all of our other tissue and organs. Throughout our lives, our body removes old bone(resorption) and new bone is added to the skeleton (formation). During childhood and teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser.
Bone formation continues at a pace faster than resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After age 30, bone resorption slowly begins to exceed bone formation, making it almost impossible to build more bone than we lose.
Bone loss is most rapid in the first few years after menopause but persists into the postmenopausal years. Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs too slowly. Osteoporosis is also more likely to develop if you did not reach optimal bone mass during your bone building years.
Osteoporosis is a major public health threat for more than 44 million Americans, 68 percent of whom are women. In the US today, 10 million individuals already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis Women are five times more likely than men to develop osteoporosis, and 34 million Americans, or 55 percent of the people 50 years of age and older, have low bone mass, which puts them at increased risk of developing osteoporosis and related fractures.
By about age 20, the average woman has acquired 98% of her skeletal mass. Building strong bones during childhood and adolescence can be the best defense against developing osteoporosis later. There are four steps to preventing osteoporosis. No one step alone is enough to prevent osteoporosis but all four may.
- A balanced diet rich in calcium and vitamin D.
- Weight-bearing exercise.
- A healthy lifestyle with no smoking or excessive alcohol intake.
- Bone density testing and medication, when appropriate.
You have a better chance of developing osteoporosis if you have certain risk factors. If you have any of the risk factors below, be sure to talk to your doctor and get a bone density test so you are aware of your bone mass. Remember, osteoporosis can be treated.
- Personal history of bone fracture after age 50.
- Current low bone mass (as determined by a bone density test).
- History of fracture in a first degree relative (mother, father, sibling).
- Being female.
- Being thin and/or having a small frame.
- Advanced age.
- A family history of osteoporosis.
- Estrogen deficiency as a result of menopause, especially early or surgically induced.
- Abnormal absence of menstrual periods (amenorrhea).
- Anorexia nervosa.
- Low lifetime calcium intake.
- Use of certain medications, such as corticosteroids and anticonvulsants.
- Low testosterone levels in men.
- An inactive lifestyle.
- Current cigarette smoking.
- Excessive use of alcohol.
- Being Caucasian or Asian, although African Americans and Hispanic Americans are at significant risk as well.
You are at greater risk if you have:
Surveys have found that adolescent girls are less likely than adolescent boys to achieve the recommended dietary intakes for calcium. Contrary to what is observed in boys, calcium intake in girls begins to decline around the time of puberty.
- Calcium. Calcium is essential for building and retaining bone mass and also is needed for the heart, muscle and nerves to function properly and for blood to clot. National nutrition surveys have shown that many women and young girls consume less than half the calcium recommended to grow and maintain healthy bones. Good sources of calcium includedairy foods such as milk and cheese, and some types of nuts and fish such as salmon. Also see the Calcium Information Resource from GlaxoSmithKline.
- Vitamin D. Vitamin D plays an important role in calcium absorption and in bone health. It is synthesized in the skin through exposure to sunlight. While many people are able to obtain enough vitamin D naturally, studies show that vitamin D production decreases in the elderly, in people who are housebound, and during the winter. These individuals may require vitamin D supplementation to ensure a daily intake of between 400 to 800 IU of vitamin D. Massive doses are not recommended.
- Exercise. Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for your bones is weight-bearing exercise, that forces you to work against gravity. These exercises include walking, hiking, jogging, stair-climbing, weight training, tennis and dancing. Also see Southcoast Sports Medicine.
- Smoking. Smoking is bad for your bones as well as for your heart and lungs. Women who smoke have lower levels of estrogen compared to nonsmokers and frequently go through menopause earlier. Postmenopausal women who smoke may require higher doses of hormone replacement therapy and may have more side effects. Smokers also may absorb less calcium from their diets. [Source: NIH | Smoking and Bone Health] Also see Change of Heart.
- Alcohol. Regular consumption of 2 to 3 ounces a day of alcohol may be damaging to the skeleton, even in young women and men. Those who drink heavily are more prone to bone loss and fractures, both because of poor nutrition as well as increased risk of falling. [Source: NIH | Peak Bone Mass]
- Carbonated beverages High phosphate intakes, especially when combined with low intake of calcium, have been linked to bone loss. Research suggests that excessive consumption of phosphate containing soft drinks (most carbonated beverages) may contribute to loss of bone mass. This is of particular concern during adolescence, when carbonated beverages often take the place of milk.
- Getting shorter in height.
- Developing a curved upper back (dowager's hump).
- Developing back pain.
- Breaking bones (developing fractures). The bones that are most often broken include the small bones in the spine (vertebrae), hip and wrist.
- Bone pain or tenderness.
- Dentures that do not fit as well as they did before.
- Neck pain.
Data from the National Health and Nutrition Examination Survey (NHANES III, 1988-94) demonstrate that approximately 90 percent of girls between the ages of 9 and 18 fail to consume the recommended calcium intake. [Source: NIH | Peak Bone Mass]
Declining calcium intakes in teenage girls may be due to an avoidance of milk, a beverage many girls mistakenly believe causes weight gain.
However studies have found that girls who drink milk experience less weight gain and have lower percent body fat than those teens who take calcium supplements.
Some other factors that impact osteoporosis:
- Remove raised doorway thresholds, throw rugs, and clutter.
- Repair loose carpet or raised areas in the floor that may cause you to trip.
- Rearrange furniture and electrical cords to keep them out of walking paths.
- Use nonskid floor wax and wipe up spills immediately (especially on ceramic tile floors).
- Keep stairways, porches, and outside walkways well lit. Use night lights in areas such as hallways and bathrooms.
- Install sturdy handrails on stairways and grab handles and nonskid mats inside and outside your shower/tub and near the toilet.
- Use shower chairs and bath benches.
- Add extra light switches if needed or use remote switches (such as clap-on switches) or timers on lights by doors and near your bed to reduce or eliminate your having to get up quickly or walk across the room in the dark.
- Put things within easy reach so you do not need to reach overhead for them.
- Keep a cordless phone and a flashlight with new batteries by your bed.