HEALTH: Growing Old, With the Bones in One Piece

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An important issue for the disabled community, especially

women affected by other disabilities... prevention starts early on...

 

Growing Old, With the Bones in One Piece

November 13, 2001

 

By JANE E. BRODY

 

 

Bones, once taken for granted, have become a major health

issue now that so many Americans are living well into their

70's, 80's and beyond. For at least half of women and one

in eight men, bones are not bearing up as well as they

should to sustain an active, independent old age free of

debilitating fractures.

 

As a result, osteoporosis - bones seriously weakened by

mineral loss - has become a household word, as familiar to

most people as cholesterol. And the pharmaceutical

industry, supplement makers and now food producers have

responded with products intended to keep Americans from

breaking apart before their time on earth is up.

 

But, judging from the questions I get almost daily, many

people are thoroughly confused about what may be good and,

even more important, what is bad for their skeletons.

Unfortunately, most of the queries come from people already

on the cusp of osteoporotic disaster, rather than from

young people, who have the best hope of preventing the

disorder.

 

Trouble Starts Early

 

 

The best predictor of bone strength in midlife and beyond

is how well the skeleton was constructed in childhood and

adolescence. Maximum bone development ends in one's 20's,

after which bone loss gradually begins to exceed bone

formation. Bone loss accelerates rapidly in women after

menopause.

 

But the habits of young Americans portend a future epidemic

of osteoporosis that far exceeds today's problem, which

already costs billions of dollars a year. Far too many

children have substituted soda, juices and other soft

drinks for the bone-building calcium and vitamin D in milk,

and they rarely make up the deficit by consuming calcium-

rich vegetables or taking calcium supplements. To make

matters worse, millions of teenagers are smoking

cigarettes, another cause of bone loss.

 

Currently, about $10 billion is spent each year to treat

osteoporotic fractures. By the year 2020, experts predict

the cost will exceed $60 billion.

 

But forget cost for a moment. Let's talk about quality of

life, not to mention life itself. Ten million Americans

already have osteoporosis and another 18 million are at

high risk for developing it. Each year, this disease leads

to 1.5 million broken bones, including more than 700,000

vertebral fractures, 300,000 hip fractures, 200,000 wrist

fractures and 300,000 fractures of other bones.

 

Vertebral fractures result in lost height, a bent-over

posture and often, chronic and debilitating pain. Of those

who break their hips, often in minor falls, half will never

walk independently again and a quarter will die of

complications within a year.

 

Bones are constantly being broken down and rebuilt.

Preventing osteoporosis requires that the rebuilding keeps

up with or exceeds the breakdown. Rebuilding is undermined

by smoking, excessive alcohol consumption, insufficient

dietary calcium, a shortage of vitamin D, lack of

weight-bearing or strength-building exercise and, in women,

a lack of estrogen. This last factor accounts for the rapid

loss of bone that occurs in women during the first five

years after menstruation ceases, but it can also affect

young women who diet too strenuously or exercise too

vigorously and lose their periods as a result.

 

According to national nutrition surveys, 90 percent of

adult women, 75 percent of men and teenagers and 70 percent

of younger children do not consume enough calcium to

prevent osteoporosis. The main dietary sources of this

vital mineral are milk and other dairy products. Several

dark-green leafy vegetables, especially collard greens, are

also rich sources, but they are not among the nation's

favorites. Other good sources include sardines and canned

salmon (eaten with the bones). Many juices and cereals are

now available with added calcium.

 

Young people from 9 through 18 should consume 1,300

milligrams of calcium a day, adults 19 to 50 need at least

1,000 milligrams and those over 50 at least 1,200

milligrams (the amount in a quart of low-fat milk), if not

from foods then from supplements, like calcium carbonate or

calcium citrate. For postmenopausal women not taking

estrogen, 1,500 milligrams are recommended.

 

If calcium intake is adequate, moderate amounts of caffeine

and carbonated drinks seem to have no adverse effect on the

body's calcium stores.

 

For calcium to be properly used by the body, adequate

vitamin D is needed; this is mainly obtained from fortified

milk, and it is made in the skin in sunlight. Sun exposure

on the face and hands (without sunscreen) for 10 minutes a

day is needed to foster adequate production of vitamin D,

but that kind of exposure is uncommon in winter and among

the elderly in every season. Recent studies suggest that

people over 65 should consume 800 International Units of

vitamin D daily, and that dosage would require taking a

supplement.

 

Adequate protein - 63 grams a day for men and 50 grams for

women (more if from vegetable sources like soy) - as well

as vitamins C and K are also important to bone health. Keep

in mind, too, that without weight-bearing or

strength-building exercise, relatively little of the

calcium consumed gets used by bones. That inactivity

explains the loss of bone mineral among astronauts while

they are weightless in space. Exercise also improves

balance, flexibility and muscle strength, all of which can

help to prevent falls.

 

If you already have osteoporosis, you may need help in

formulating an appropriate exercise program. Ask your

doctor for a referral to a physical therapist, who can

design an exercise program to increase bone density and

reduce stress on fragile bones.

 

For those seeking written guidance, Margie Bissinger, a

physical therapist, has produced the book " Osteoporosis: An

Exercise Guide, " available for $9.95.

 

Drugs That Help

 

The osteoporosis crisis has spawned a number of medicines

designed to tip the balance in favor of bone building. The

leading one, for women, is estrogen replacement after

menopause, which may have to be maintained indefinitely to

prevent rapid bone loss. Even physically frail older women

can achieve stronger bones by taking hormone replacement,

according to a recent study of 67 women 75 and older,

although there is no evidence yet that this regimen

prevents fractures in older women.

 

Since many women cannot or will not take estrogen, other

effective products have been developed. One is the estrogen

mimic raloxifene (marketed as Evista), which lacks

estrogen's adverse effects on the breast and uterus and may

help prevent breast cancer. Studies thus far have shown

that raloxifene helps to prevent vertebral fractures.

 

Two drugs called biphosphonates - alendronate (Fosamax) and

risedronate (Ac tonel) - are often prescribed for people

who already show signs of serious bone loss. They represent

another alternative for women who do not take estrogen

replacement. Fosamax has been shown to reduce the risk of

fractures of the hip, spine and wrists by as much as 50

percent and Actonel, a newer drug, also reduced the

incidence of new fractures in a two-year study of women

with osteoporosis.

 

These two drugs require adherence to a strict regimen to

avoid damage to the esophagus and to assure absorption.

They must be taken first thing in the morning on an empty

stomach and with a large glass of water, after which you

must stand or sit upright and not eat or drink anything

else for at least 30 minutes.

 

A third option is salmon calcitonin, a hormone that

inhibits bone resorption. But it is less effective than the

other drugs. It is available as a nasal spray and approved

for the treatment of osteoporosis, especially painful

vertebral fractures. A number of other products, including

parathyroid hormone, are now being studied. So stay tuned.

 

http://www.nytimes.com/2001/11/13/health/aging/13BROD.html?ex=1006642361 & ei=

1 & en=8ae683c852941d24

 

 

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