Osteoporosis
Factors affecting bone loss: #1 gender
1. Gender Women have a much greater risk of developing osteoporosis. Estimated 8 million women have osteoporosis Men's skeleton tends to grow larger, stronger and more dense. Peak bone mass is higher and lose less overall. Estimated 2 million men have osteoporosis
Factors affecting bone loss: #9 alcohol and smoking
10. Alcohol and Smoking Both can decrease bone mass Too much alcohol is toxic to all cells Alcoholism in men is a main risk factor However 1 drink/day seems to be positive for bone density by increasing estrogen. Smoking lowers estrogen levels and all of the toxins make remodeling of bone less efficient.
Factors affecting bone loss: #11 caffeine and soda
11. Caffeine and Soda Has a weak negative effect by increasing calcium loss in urine. A concern if drinking 5 or more cups of coffee/day. Offset the loss by increasing calcium intake or at least making certain to get the RDA. Lattes? Soda - main concern seems to be with soft drinks replacing milk, etc in diet.
Factors affecting bone loss: #12 prolonged use of meds
12. Prolonged Use of Medications can weaken bones Steroids taken for asthma, arthritis, increase muscle mass/strength Anticonvulsants Synthetic thyroid hormones
Factors affecting bone loss: #13 excess salt
13. Excess Salt Increases calcium excretion in urine. In order to get rid of the salt, the kidneys are going to get rid of calcium. Already have a borderline calcium intake? Do not consume a diet high in salt. Best idea is to make certain to consume the RDA for calcium and decrease salt intake.
Factors affecting bone loss: #14 excess protein
14. Excess Protein can increase calcium loss in urine but one would need to greatly overdo. In general, protein is healthy for bones, both animal and vegetable. In older adults, BMD is higher in those eating more protein and lowest in those eating the least. (Muscle wasting generally begins in your 30's/ 40's and is continuous throughout life; unless......)
Factors affecting bone loss: #15 vitamin d
15. Vitamin D Essential for the absorption of calcium. No question that inadequate D levels are associated with more rapid bone loss and fractures. D improves bone strength and also improves strength in the legs, so lowers the risk of falling. Increase D receptors in muscle tissue (via treatment with vitamin D) find an increase in the size and number of fast twitch muscle fibers; your 1st responders when losing balance.
Factors affecting bone loss: #2 increasing age
2. Increasing Age At approx 25 years of age we hit peak bone mass. Disease begins it's progression early but we generally won't experience its effects until much later in life. Over 60 risk increases for women Over 70 risk increases for men Over 80, osteoporosis is the rule rather than the exception.
Factors affecting bone loss: #3 early menopause
3. Early Menopause Or even long periods of ammenorhea decrease our supply of estrogen. Low estrogen levels are the leading cause of LBM in women. Without estrogen, cells that dig holes in bone (osteoclasts) are more active than cells that fill them back in (osteoblasts), leading to a faster rate of loss. 3 (a) Manopause - a decrease in muscle mass, decreased sex drive, decreased energy, increased fat in mid section, depressed mood. Estrogen loss as well as testosterone loss affects a man's skeleton Testosterone peaks around 25-30 years Begins to fall approx 1% per year Barely noticeable until decades later
Factors affecting bone loss: #4 frame size
4. Frame Size Having a thin, small framed body, generally leads to a lower peak bone mass so leads to increased risk of osteoporosis and fracture.
Factors affecting bone loss: #5 ethnicity
5. Ethnic Group African Americans tend to have heavier skeletons than other races. However, poor diet and little exercise can increase their risk just like everyone else. Caucasian and Asian women tend to have lower bone density as well as similar bone densities. All ethnic groups are at risk and do develop this disease.
Factors affecting bone loss: #6 family history/heredity
6. Family History/Heredity Have a mother, father, or sibling with a history of fractures or osteoporosis, you could be at increased risk.
Factors affecting bone loss: #10 fractured bone as adult
7. Fractured a Bone as an Adult Not from something high impact like a car accident, but simply a little fall; could point to weakened bones
Factors affecting bone loss: #7 calcium intake
8. Calcium Intake Chronically low is a problem. Adolescence is an especially important time to get enough daily calcium to reach genetic potential for peak bone mass. A negative balance of only 50-100 mg of calcium/day over a long period is sufficient to produce osteoporosis.
Factors affecting bone loss: #8 physical activity and exercise
9. Physical Activity and Exercise Spending a lot of time throughout your life on your feet, doing weight bearing exercise and loading the bones is going to increase your bone mass and keep your muscles strong so as to decrease risk of falling.
Osteoporosis
A disease of low bone mass characterized by weakened and porous bone that have an increased risk of fracture.
Calcium info
Calcium Carbonate - most common and least expensive. Take with food. May cause gastrointestinal problems. Calcium Citrate - absorbed slightly better by the body. Less likely to cause gastrointestinal problems. Do not need to take with food. Do not take: Dolomite, Oyster shell or Bone meal. Coral Calcium - Active ingredient is calcium carbonate. Difference. It's more expensive and may contain high levels of lead.
Absorption of calcium
Calcium absorption efficiency differs from person to person. In general we absorb 20-40% of the calcium from the foods we eat. In times when the body needs extra calcium (infancy & pregnancy) we can absorb 50-75% Young absorb calcium better than old. Why? Postmenopausal women absorb the least, unless on HRT. HRT increases synthesis of Vitamin D which is necessary for calcium absorption.
Old people
Considerations for Older Individuals In addition to the factors previously mentioned, older individuals may want to consider: Women - Either HRT or a Bisphosphonate (powerful bone meds such as Fosamax, Actonel, Boniva) . They can slow, maintain bone loss and sometimes build bone. Also Raloxifene (SERM) which increases BMD while lowering breast cancer risk. Men - Testosterone treatment and/or bisphosphonate.
Measuring bone mineral density
DXA - Dual Energy X-ray Absorptiometry X-ray of spine and hip. Results given as a T-Score and often a Z-Score T-Score compares your results to that of a healthy woman in her 20's T-Score Results Normal = 0 to -1 Osteopenia = -1.1 to -2.4 Osteoporosis = -2.5 and lower
No cure for osteoporosis
Do everything that you can to prevent it. If you have it, do what you can to control it. Make Changes around the house - 60% of falls occur at home. Get rid of throw rugs Put non-slip treads on bare stairs Install grab bars where needed (bathrooms?) Night lights for areas that may be traveled at night Don't wax floors
Men's bone loss
For men, the loss after the peak, is slow and steady. Men can end up losing 20-30% overall.
Exercise
New bone increases with training and maintains with detraining Old bone "can" increase or remain stable with training but greatly decreases with detraining Best program would consist of CV weight bearing exercise and strength training. With either kind the spine responds better as do the hips, when you are in the upright position as opposed to lying down. Sends different signal to bone
Non-weight bearing exercise
Non-weight bearing sports How do athletes who compete in these sports develop low bone density? No stress placed on bones. Not doing any cross training with weight bearing exercises. Not taking in enough calories and/or over-exercising (either one or both) can suppress testosterone and estrogen. Female Athlete Triad=disordered eating, menstrual disruptions and bone loss
Osteopenia and osteporosis
Osteopenia - This is a reading of lower bone density, but not low enough to be diagnosed as osteoporosis. Research points to watching but not treating with bisphosphonates. Not all who develop osteopenia will go on to develop full blown osteoporosis and the powerful meds can have harmful side effects. Osteoporosis - Treat with bone meds. Work on building muscle strength and balance. Do Not Fall !! Women - DXA at 65. Men - DXA at 70. Both should get tested earlier if diet/lifestyle warrants such action.
Calcium
Our body is very good at maintaining proper blood calcium levels. So if necessary your body will pull calcium from your bones to maintain blood levels. But the majority of what we eat and absorb, does go to strengthen our bones and teeth.
Pregnancy and osteoporosis
Pregnancy Associated Osteoporosis Studies looking at pregnancy and bone give conflicting results Not known whether this occurs due to pregnancy or some pre-existing condition, because DEXA's are not done on pregnant women Majority of women with this condition are breastfeeding at time of diagnosis Protective Factors During Pregnancy Absorption of calcium is increased Vitamin D synthesis is increased 3rd trimester estrogen surge occurs Increased skeletal loading due to weight gain May have bone loss during lactation with full recovery by 6 months after weaning. Higher number of deliveries brings an increase in bone density
Protein facts
Protecting bones from fracture requires good BMD and a good amount of Muscle Strength. Protein helps with both. Problem = Diets high in protein (mainly animal) PLUS an abundance of grains (breads, rice, pasta, tortillas, cereal, donuts, etc.) lead to bone loss and muscle wasting in the older population. The high protein plus high intake from grains, makes the body too acidic. Bone and muscle will be broken down to neutralize the acid. Solution? Increase fruits and vegetables. They are broken down into bicarbonate, which adds alkali to the body and will neutralize the acid. In addition, cut back on the grains if a major portion of your diet.
Bisphosphonates
Side effects of Bisphosphonates Possible side effects are: Abdominal pain Headaches Pain in muscles/joints Heartburn Long term use may lead to weaker bones in a some women. These meds should only be used in those with a high fracture risk (3% risk of fracture in 10 years). There may be no benefit in taking for more than 5 years.
Supplementing with calcium
Supplementing with calcium Take no more than 500 mg of calcium supplement at a time. This is what the body can absorb. If you do not get the proper level of calcium from your diet and need to supplement, for example, taking 1,000 mg/day? Take 500 in the morning with breakfast and 500 in the evening with dinner. May find that you only need to supplement with say 300-500 mg/day?
Bone mass
The body continuously lays down bone mass until approx 25 years of age, when we reach our "peak bone mass".
Most common fracture sites
The most common fracture sites are? 1 in 2 females will break a bone in her lifetime 1 in 4 males will do the same 1/3 of all hip fractures occur in men and when they occur, they are much more devastating than in women. Men are twice as likely to die within the 1st year.
Women's bone loss
Then for women, the loss continues slowly until menopause. At menopause it speeds up and the loss continues at a higher rate for the next 10 years or so; after which it falls back to pre-menopausal rates. Women can ultimately give up 30-50% of their bone mass.
Vitamin d continued
Too many of us in the U.S. are deficient in Vitamin D. Sunlight increases the manufacture of D (if not wearing sunscreen). 10-15 minutes of sun a few days/week for lighter skinned individuals. Darker skinned individuals need longer exposure. Maybe 2 times that amount. Live north of LA? Late Fall through much of Spring UV rays are too weak to make D. Need a supplement in addition to regular diet, as it is difficult to get needed amt through diet. RDA's for Vitamin D Up to age 70, 600 IU's/day 70 and beyond, 800 IU's/day.......many experts believe 1,000 IU's is better goal. Look for D3 not D2, which is about 25% less potent.
Supplementing with Vitamin D
Who should supplement? Older Population Those who are homebound Those who live in the northern 1/3 of the U.S. or in Canada People who don't do dairy or eat plenty of other Vit D foods.
Vitamins and minerals needed for strong bones
With Calcium and Vitamin D being the most important Calcium has a function in pretty much every cell in the body It's used for muscle contractions, nerve impulse transmissions, regulating heartbeat, etc.
