Build Strong Bones Now for the Future - Calcium, Vitamin D, Physical Activity Are Keys

Build Strong Bones Now for the Future
Calcium, Vitamin D, Physical Activity Are Keys

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BY BLUE RIDGE HEALTHCARE
FOR THE NEWS HERALD

Women need to be mindful of their bones. As a woman ages, she faces a far higher risk than her male counterparts of osteoporosis - a disease characterized by thinning bones and a high risk of fractures in the wrist, hip and spine.

Bones form the scaffolding for the human body. But unlike scaffolding, which is static and over time will rust and decay, our bones are in a constant state of turnover and repair, a process called remodeling. The remodeling process requires raw materials - calcium, vitamin D and exercise - to keep bones in good repair.

Adults reach peak bone mass in their 30s, followed by a slow decline. Women fare worse than men for two main reasons:

because women have smaller frames on average than men they have less bone to start with; and
when they hit menopause in their late 40s or early 50s the rate of bone loss accelerates for a few years, leaving many women vulnerable to fractures.

“A number of strategies can help women counter the accelerated bone loss that occurs shortly after menopause,” said Edward Plyler, MD, a local family physician. “The higher estrogen levels women have prior to menopause promote strong bones, and hormone replacement therapy for postmenopausal women is effective in maintaining bone density.”

But negative findings about the increased risks of heart attack and stroke associated with HRT from the large-scale Women’s Health Initiative have discouraged physicians from prescribing HRT for most patients.

Other prescription drugs are available, however, that can help prevent bone loss and actually increase bone density. Drugs known as biphosphanates, a class that includes Fosamax (alendronate), Actonel (risedronate) and Boniva (ibandronate), have been shown to prevent bone loss and promote the building of new bone.

Just about every woman can presume that she needs to follow the basic guidelines of getting recommended amounts of calcium and vitamin D for her age plus plenty of weight bearing exercise to ensure adequate bone density.

But how does she know if she needs a bone-building drug as well?

Test Measures Bone Density

A non-invasive test known as dual energy X-ray absorptiometry (DEXA) is considered the gold standard for measuring bone density and the future risk of fractures. There’s also instant vertebral analysis (IVA) that can be performed on many DEXA machines that look for occult or “ silent” compression fractures in the spine.

“Regular X-rays do not offer quantifiable statistics on the amount of bone mineral; however bone densitometry does,” said Ivan Vinueza, director of the Imaging Centers at Blue Ridge HealthCare. Both Grace and Valdese Hospitals, as well as several local physician offices, provide DEXA scans. “DEXA can be used to measure bone density at the wrist, hip and spine, all high risk areas for fractures with advancing age.”

The definition of osteoporosis is based on how much bone mineral density varies from the average bone mineral density of a young adult.

Expressed in T-scores, osteoporosis is diagnosed when the T-score is below -2.5. Scores of -1 to -2.5, indicate osteopenia, a less serious condition but one which provides an early warning that either lifestyle changes or medical interventions are necessary.

“The advantage of DEXA is that it can provide an early warning of what is all too frequently a silent disease,” Vinueza said. “The evidence for good osteoporosis screening tests like DEXA scans is outstanding. In a recent study, nearly 5,000 patients were followed for an average of 4.9 years, and the researchers found there were 36 percent fewer hip fractures among patients who had undergone DEXA screening.”

“For many women the first sign of osteoporosis is the broken wrist, hip or spine that comes with a fall,” Dr. Plyler added. “The fall may be a slip on the kitchen floor or a trip on a step that they’ve experienced half a dozen times in the past with no lasting injury. Only this time the consequences are more serious.”

Biphosphonates such as Fosamax, Actonel and Boniva are frequently prescribed for women who have suffered broken bones because of osteoporosis or who have low DEXA scores. In addition to the medication, physicians typically advise patients to take calcium and vitamin D supplements.

“Medications are available and effective, but women can do much to help themselves by making bone health part of their overall focus,” Dr. Plyer said. He recommends focusing on lifestyle risks that can be changed such as:

A sedentary lifestyle - bones need weight bearing exercise to remodel.
Smoking detracts from bone strength - protecting your bones is one more reason to quit smoking.
Excess alcohol consumption - women who drink should limit themselves to one alcoholic drink per day.

Also, adolescent girls and young women need to build peak bone mass as this occurs between ages 25 and 30. To do that requires proper exercises, getting the proper calcium intake and avoiding sodas.

“On the plus side there are simple things you can do to increase bone strength,” Dr. Plyler said.

Try to consume the equivalent of one and one-half pints of milk or milk products per day. Choose low fat products such as skim milk, fat-free yogurt or low fat cheeses. Dried beans, green leafy vegetables and dried fruit are all rich in calcium. And remember that you can buy orange juice that’s fortified with calcium.

Make sure that you’re also getting plenty of vitamin D, which the body needs in order to use calcium effectively.

If you’re not getting enough calcium and vitamin D through diet and sun exposure (which the body needs to make vitamin D), talk to your physician or pharmacist about a supplement.

If you’re planning for good health in the second half of life, make sure you include your bones in the blueprint. They’re the frame that keeps your body strong and mobile. So be as attentive to your bones as you are to your skin. Keep feeding them the raw materials they need to renew and rebuild for a strong and active future.

The second largest employer in Burke County, Blue Ridge HealthCare serves a four-county area and includes Grace and Valdese hospitals, Blue Ridge Home HealthCare, Grace Heights and College Pines Health & Rehabilitation Centers, Grace Ridge Retirement Community, Phifer Wellness Center and a number of physician practices.