The best treatment for osteoporosis, as it is with so many diseases, is prevention. Prevention should start early in childhood …
By Gina DelGiudice, M.D. Special to The Packet
Years ago, osteoporosis and the fractures that came with it were regarded as inevitable symptoms of the aging process. Today, with greater research about risk factors and prevention, people can learn how to protect their bones and enjoy greater bone health throughout their entire lives.
Osteoporosis is a disease which causes the bones to become thin and fragile. It affects 25 million Americans, mostly women who are past menopause. According to the National Osteoporosis Foundation, osteoporosis is responsible for approximately 1.5 million bone fractures each year in the United States. One in 2 women and 1 in 8 men over the age of 50 will experience an osteoporosis-related fracture at some point in their lives.
Though it is hard, bone, like muscle, is a living tissue, which means that throughout a lifetime, new bone is formed and old bone is broken down and lost. From childhood and through the teenage years, bone growth happens at a greater pace than bone loss, making bones larger and more dense. That trend starts to reverse, however, around the age of 30.
For women, the rate of bone loss happens most dramatically in the first few years after they reach menopause because of a drop of estrogen levels in the body.
Women can lose up to one-third of their bone mass during this time. While some are put on estrogen replacement therapy, it is not considered the first line for osteoporosis treatment because of the potential increased risk for breast cancer, heart disease and stroke. There are other drugs that are like estrogen, but with fewer side effects, that are approved for osteoporosis. These medications can slow down the loss of bone and in some cases, even help to build bone back.
The risk factors for osteoporosis are greatest for women who are small-boned or thin. Asian and Caucasian women also have a higher risk for osteoporosis. African-American and Hispanic women have a risk that is lower, but still significant. Other risk factors include excessive consumption of alcohol and caffeine, cigarette smoking, use of certain medications, and eating disorders.
One frightening characteristic of osteoporosis is its stealth nature, since many people start losing bone before they are aware of it. In fact, many people with osteoporosis don’t know they have it until they suffer a fracture.
The most accurate test to determine bone loss is called “Dual Energy X-Ray Absorptiometry” (DXA), which can measure as little as 1 to 2 percent of bone density. A baseline DXA is recommended for women starting at menopause, especially if they have a family history of osteoporosis. DXA is covered by most insurance policies. Medicare approves the first DXA at age 65.
The best treatment for osteoporosis, as it is with so many diseases, is prevention. Prevention should start early in childhood, when the body is building bone most rapidly. This is when it is crucial to eat a diet sufficient in calcium. Good sources are low-fat dairy products — milk, yogurt and cheese. Broccoli, kale, spinach and other leafy green vegetables are high in calcium, and so are nuts, tofu and canned fish, such as salmon and sardines. Children who are fussy eaters can be steered toward calcium-fortified foods such as cereals, breads and orange juice.
As people age, they need more calcium. Children ages 1-12 need 800 mg of calcium a day. For teenagers, that recommendation goes up to 1,200 to 1,500 mg a day. Women between 25 and 50 need 1000 mg of daily calcium before menopause and 1,500 mg after surgical or premature menopause. For women over age 50, 1,500 mg of calcium is recommended if they are not taking estrogen. If they are taking estrogen, the recommended dosage is 1,000 mg. Because kidney stones can form in certain patients when taking calcium supplements, it is important to check with a physician first about proper dosage.
It is best to take calcium with food or milk for better absorption. Sufficient levels of Vitamin D in the body are also important for absorption. Vitamin D can be obtained through a supplement or by exposure to the sun, since the body creates Vitamin D in response to sunlight. The National Osteoporosis Foundation has increased the dosing recommendations from 400-800 IU to 1,000-1,200 IU per day.
Exercise strengthens bone and can help ward off osteoporosis if done regularly. The most effective are weight-bearing exercises such as weight training, running, walking, and dancing, because they force the body to work against gravity.
If you are concerned about possible bone loss or want to know more about preventing osteoporosis, talk to your physician.
There are many specialists who care for osteoporosis, including internists, rheumatologists, endocrinologists and OB-GYNs. For more information, visit the National Osteoporosis Foundation at www.nof.org. To find a physician with Princeton HealthCare System, visit www.princetonhcs.org or call (888) 742-7496.
Dr. Gina DelGiudice will present a lecture on osteoporosis and arthritis at Princeton HealthCare System’s annual Women’s Conference. This year’s keynote speaker is Jamie Lee Curtis. The conference will be held on Dec. 1 from 7:30 a.m. to 2:30 p.m. at the Hyatt Regency Princeton, 102 Carnegie Center, West Windsor. For registration information, call (888) 897-8979 or visit www.princetonhcs.org/calendar.
Gina DelGiudice, M.D., is Specialist in Rheumatology and Internal Medicine, Princeton HealthCare System
Seniors, on the go
Thanks to a subsidy from the Princeton HealthCare System, users of Princeton’s Crosstown 62 transportation service no longer have to pay for trips to and from University Medical Center at Princeton. Crosstown 62 is a door-to- door transportation service for Princeton residents who are over age 62 and/or handicapped with either a permanent or temporary disability that prevents them from driving. Users of the service pay $2 per ride, with the municipalities subsidizing the remainder of the cost. Now, however, the $2 fare for rides to and from UMCP is being paid for by Princeton HealthCare System.
Greater Mercer Ride Provide, the nonprofit agency that operates the service, is finding that passengers are “tickled pink” when they learn that UMCP is paying for their ride.
“The partnership between University Medical Center at Princeton, Greater Mercer Ride Provide, the Princeton Human Services Commission and the Princeton Borough and Princeton Township municipal governments is a wonderful example of how a community can work together to provide access to health care for is residents who cannot drive,” said GMRP executive Director Sandra Brillhart. “Research shows that seniors who do not drive make 15 percent fewer trips to medical care facilities. This partnership reflects the commitment by Princeton hospital, as well as the Borough and Township, to health and well being of the community.”
For more information on Crosstown 62, call (609) 924-6162 or (609) 452-5144.