All Osteoporosis

Here is the full list of pages on osteoporosis.phoolish.org

2008-07-18T20:40:00.001-07:00

Here is the full list of pages on osteoporosis.phoolish.org

46. Skater Breaks His Arm
45. Osteoporosis in Men
44. Osteoporosis: The Diagnosis
43. Osteoporosis: Coping With Chronic Pain
42. Osteoporosis: The Bone Thief
41. Osteoporosis and Hispanic Women
40. Osteoporosis and Arthritis: Two Common but Different Conditions
39. Osteoporosis and African American Women
38. Medications to Prevent and Treat Osteoporosis
37. For People With Osteoporosis: How to Find a Doctor
36. Bone Health and Osteoporosis: A Guide for Asian Women Aged 50 and Older
35. A New Way to Build Bone
34. Bear Bones May Provide Key to Osteoporosis
33. The Impact of Osteoporosis on Men's and Women's Health
32. What's Best For Your Bones?
31. Osteoporosis remains undiagnosed in millions of Americans
30. New weapon in battle against osteoporosis
29. What is osteoporosis?
28. Do you know what nutritional supplements you need?
27. Fight Osteoporosis: Bone Up On B12
26. Calcium, Osteoporosis, and the Selling of Dairy Products
25. Excessive Calcium Causes Osteoporosis
24. 4 proven steps to prevent osteoporosis fractures
23. Men With Osteoporosis Often Fall Through the Cracks
22. More on Osteoporosis
21. Osteoporosis - General Information
20. OSTEOPOROSIS - Preventing Bone Loss Without Drugs
19. Caffeine, Sugar and Bone Loss
18. Menopause and Bone Health
17. Brittle Bones? Take an Aggressive Stance
16. Osteoporosis
15. Osteoporosis, Heart Disease, and Breast Cancer
14. Osteoporosis & Other Physical Changes
13. Healthy Bones
12. A Guide to Osteoporosis
11. What is Osteoporosis?
10. Exercise and Osteoporosis: A Primer on Tomorrow's Therapy
09. Women's Health: Osteoporosis
08. Concerning Osteoporosis
07. Osteoporosis - What You Eat Affects Your Bones
06. The Prevention of Post-menopausal Osteoporosis
05. It's Never Too Late to Prevent Osteoporosis
04. Walking Is Not Enough To Prevent Osteoporosis
03. Reversing Osteopenia
02. Osteoporosis and Women
01. Inhaled Steroids Linked to Osteoporosis

Skater Breaks His Arm

2007-06-12T20:21:00.004-07:00

this skater breaks his arm and tries to pop it back in place more sexy videos

Osteoporosis in Men

2007-04-05T00:20:00.044-07:00

Osteoporosis is a disease that causes the skeleton to weaken and the bones to break. It poses a significant threat to more than 2 million men in the United States. After age 50, 6 percent of all men will experience a hip fracture and 5 percent will have a vertebral fracture as a result of osteoporosis.

Despite these compelling figures, a majority of American men view osteoporosis solely as a "woman’s disease," according to a 1996 Gallup Poll. Moreover, among men whose lifestyle habits put them at increased risk, few recognize the disease as a significant threat to their mobility and independence.

Osteoporosis is called a "silent disease" because it progresses without symptoms until a fracture occurs. It develops less often in men than in women because men have larger skeletons, their bone loss starts later and progresses more slowly, and they have no period of rapid hormonal change and bone loss. However, in the last few years the problem of osteoporosis in men has been recognized as an important public health issue, particularly in light of estimates that the number of men above the age of 70 will continue to increase as life expectancy continues to rise.

Clearly, more information is needed about the causes and treatment of osteoporosis in men, and researchers are beginning to turn their attention to this long-neglected group.

For example, in 1999, the National Institutes of Health launched a major research effort that will attempt to answer some of the many remaining questions. The 7-year, multisite study will follow more than 5,000 men ages 65 and older to determine how much the risk of fracture in men is related to bone mass and structure, biochemistry, lifestyle, tendency to fall, and other factors.

The results of such studies will help doctors to better understand how to prevent, manage, and treat osteoporosis in men. This fact sheet describes the highlights of what is already known.

What Causes Osteoporosis?

Bone is constantly changing – that is, old bone is removed and replaced by new bone. During childhood, more bone is produced than removed, so the skeleton grows in both size and strength. For most people, bone mass peaks during the third decade of life. By this age, men typically have accumulated more bone mass than women. After this point, the amount of bone in the skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone.

Men in their 50s do not experience the rapid loss of bone mass that women do in the years following menopause. By age 65 or 70, however, men and women are losing bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes. Excessive bone loss causes bone to become fragile and more likely to fracture.

Fractures resulting from osteoporosis most commonly occur in the hip, spine, and wrist, and can be permanently disabling. Hip fractures are especially dangerous. Perhaps because such fractures tend to occur at older ages in men than in women, men who sustain hip fractures are more likely than women to die from complications.

Primary and Secondary Osteoporosis

There are 2 main types of osteoporosis: primary and secondary. In cases of primary osteoporosis, either the condition is caused by age-related bone loss (sometimes called senile osteoporosis) or the cause is unknown (idiopathic osteoporosis). The term idiopathic osteoporosis is used only for men less than 70 years old; in older men, age-related bone loss is assumed to be the cause.

The majority of men with osteoporosis have at least one (sometimes more than one) secondary cause. In cases of secondary osteoporosis, the loss of bone mass is caused by certain lifestyle behaviors, diseases, or medications. The most common causes of secondary osteoporosis in men include exposure to glucocorticoid medications, hypogonadism (low levels of testosterone), alcohol abuse, smoking, gastrointestinal disease, hypercalciuria, and immobilization.

Causes of Secondary Osteoporosis in Men

* glucocorticoid medications
* other immunosuppressive drugs
* hypogonadism (low testosterone levels)
* excessive alcohol consumption
* smoking
* chronic obstructive pulmonary disease and asthma
* cystic fibrosis
* gastrointestinal disease
* hypercalciuria

* anticonvulsant medications
* thyrotoxicosis
* hyperparathyroidism
* immobilization
* osteogenesis imperfecta
* homocystinuria
* neoplastic disease
* ankylosing spondylitis and rheumatoid arthritis
* systemic mastocytosis

Glucocorticoid medications: Glucocorticoids are steroid medications used to treat diseases such as asthma and rheumatoid arthritis. Bone loss is a very common side effect of these medications. The bone loss these medications cause may be due to their direct effect on bone, muscle weakness or immobility, reduced intestinal absorption of calcium, a decrease in testosterone levels, or, most likely, a combination of these factors.

When glucocorticoid medications are used on an ongoing basis, bone mass often decreases quickly and continuously, with most of the bone loss in the ribs and vertebrae. Therefore, people taking these medications should talk to their doctor about having a bone mineral density (BMD) test. Men should also be tested to monitor testosterone levels, as glucocorticoids often reduce testosterone in the blood.

A treatment plan to minimize loss of bone during long-term glucocorticoid therapy may include using the minimal effective dose, and discontinuing the drug or administering it through the skin, if possible. Adequate calcium and vitamin D intake is important, as these nutrients help reduce the impact of glucocorticoids on the bones. Other possible treatments include testosterone replacement and osteoporosis medication. Alendronate and risedronate are two bisphosphonate medications approved by the U.S. Food and Drug Administration (FDA) for use by men and women with glucocorticoid-induced osteoporosis.

Hypogonadism: Hypogonadism refers to abnormally low levels of sex hormones. It is well known that loss of estrogen causes osteoporosis in women. In men, reduced levels of sex hormones may also cause osteoporosis.

While it is natural for testosterone levels to decrease with age, there should not be a sudden drop in this hormone that is comparable to the drop in estrogen experienced by women at menopause. However, medications like glucocorticoids (discussed above), cancer treatments (especially for prostate cancer), and many other factors can affect testosterone levels. Testosterone replacement therapy may be helpful in preventing or slowing bone loss. Its success depends on factors such as age and how long testosterone levels have been reduced. Also, it is not yet clear how long any beneficial effect of testosterone replacement will last. Therefore, doctors usually treat the osteoporosis directly, using medications approved for this purpose.

Recent research suggests that estrogen deficiency may also be a cause of osteoporosis in men. For example, estrogen levels are low in men with hypogonadism and may play a part in bone loss. Osteoporosis has been found in some men who have rare disorders involving estrogen. Therefore, the role of estrogen in men is under active investigation.

Alcohol abuse: There is a wealth of evidence that alcohol abuse may decrease bone density and lead to an increase in fractures. Low bone mass is common in men who seek medical help for alcohol abuse.

In cases where bone loss is linked to alcohol abuse, the first goal of treatment is to help the patient stop – or at least reduce – his consumption of alcohol. More research is needed to determine whether bone lost to alcohol abuse will rebuild once drinking stops, or even whether further damage will be prevented. It is clear, though, that alcohol abuse causes many other health and social problems, so quitting is ideal. A treatment plan may also include a balanced diet with lots of calcium- and vitamin D-rich foods, a program of physical exercise, and smoking cessation.

Smoking: Bone loss is more rapid, and rates of hip and vertebral fracture are higher, among men who smoke, although more research is needed to determine exactly how smoking damages bone. Tobacco, nicotine, and other chemicals found in cigarettes may be directly toxic to bone, or they may inhibit absorption of calcium and other nutrients needed for bone health. Quitting is the ideal approach, as smoking is harmful in so many ways. As with alcohol, it is not known whether quitting smoking leads to reduced rates of bone loss or to a gain in bone mass.

Gastrointestinal disorders: Several nutrients – including amino acids, calcium, magnesium, phosphorous, and vitamins D and K – are important for bone health. Diseases of the stomach and intestines can lead to bone disease when they impair absorption of these nutrients. In such cases, treatment for bone loss may include taking supplements to replenish these nutrients.

Hypercalciuria: Hypercalciuria is a disorder that causes too much calcium to be lost through the urine, which makes the calcium unavailable for building bone. Patients with hypercalciuria should talk to their doctor about having a BMD test and, if bone density is low, discuss treatment options.

Immobilization: Weight-bearing exercise is essential for maintaining healthy bones. Without it, bone density may decline rapidly. Prolonged bed rest (following fractures, surgery, spinal cord injuries, or illness) or immobilization of some part of the body often result in significant bone loss. It is crucial to resume weight-bearing exercise (such as walking, jogging, dancing, and lifting weights) as soon as possible after a period of prolonged bed rest. If this is not possible, you should work with your doctor to minimize other risk factors for osteoporosis.

How Is Osteoporosis Diagnosed in Men?

Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. A medical workup to diagnose osteoporosis will include a complete medical history, x rays, and urine and blood tests. The doctor may also order a BMD (bone mineral density) test. This test can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized bone mineral density test is called a dual-energy x-ray absorptiometry or DXA test. It is painless: a bit like having an x ray, but with much less exposure to radiation. It can measure bone density at your hip and spine.

It is increasingly common for women to be diagnosed with osteoporosis or low bone mass using a BMD test, often at midlife when doctors begin to watch for signs of bone loss. In men, however, the diagnosis is often not made until a fracture occurs or a man complains of back pain and sees his doctor. This makes it especially important for men to inform their doctors about risk factors for developing osteoporosis, loss of height or change in posture, a fracture, or sudden back pain.

What Are the Risk Factors for Men?

Several risk factors have been linked to osteoporosis in men:

* chronic diseases that affect the kidneys, lungs, stomach, and intestines or alter hormone levels
* regular use of certain medications, such as glucocorticoids
* undiagnosed low levels of the sex hormone testosterone
* unhealthy lifestyle habits: smoking, excessive alcohol use, low calcium intake, inadequate physical exercise
* age. The older you are, the greater your risk.
* race. Caucasian men appear to be at particularly high risk, but all men can develop this disease.

Some doctors may be unsure how to interpret the results of a BMD test in men, because it is not known whether the World Health Organization guidelines used to diagnose osteoporosis or low bone mass in women are also appropriate for men. Although controversial, the International Society for Clinical Densitometry recommends using separate guidelines when interpreting BMD test results in men.

What Treatments Are Available?

Once a man has been diagnosed with osteoporosis, his doctor may prescribe one of the medications approved by the FDA for this disease. Alendronate and residronate have been approved to treat the disease in men, postmenopausal women, and in men and women with glucocorticoid-induced osteoporosis. Teriparatide is approved to treat osteoporosis in men and women who are at increased risk of fracture.

The treatment plan will also likely include the nutrition, exercise, and lifestyle guidelines for preventing bone loss listed at the end of this fact sheet.

If bone loss is due to glucocorticoid use, the doctor may prescribe a bisphosphonate (e.g., alendronate or risedronate), monitor bone density and testosterone levels, and suggest using the minimum effective dose of glucocorticoid. The doctor may also suggest discontinuing the drug when practical, and/or administering it topically (through the skin).

Other possible prevention or treatment approaches include calcium and/or vitamin D supplements and regular physical activity.

If osteoporosis is the result of another condition (such as testosterone deficiency) or exposure to certain other medications, the doctor may design a treatment plan to address the underlying cause.

How Can Osteoporosis Be Prevented?

There have been fewer research studies on osteoporosis in men than in women. However, experts agree that all people should take the following steps to preserve their bone health:

* Avoid smoking, reduce alcohol intake, and increase your level of physical activity.
* Ensure a daily calcium intake that is adequate for your age.
* Ensure an adequate intake of vitamin D. Normally, the body makes enough vitamin D from exposure to as little as 10 minutes of sunlight a day. If exposure to sunlight is inadequate, dietary vitamin D intake should be between 200 and 600 IU (International Units) per day (See Table). 400 IU is the amount found in one quart of fortified milk and most multivitamins.
* Engage in a regular regimen of weight-bearing exercises in which bones and muscles work against gravity. This might include walking, jogging, racquet sports, stair climbing, team sports, lifting weights, and using resistance machines. A doctor should evaluate the exercise program of anyone already diagnosed with osteoporosis to determine if twisting motions and impact activities, such as those used in golf, tennis, or basketball, need to be curtailed.
* Discuss with your doctor the use of medications that are known to cause bone loss, such as glucocorticoids.
* Recognize and seek treatment for any underlying medical conditions that affect bone health.

Osteoporosis: The Diagnosis

2007-04-05T00:20:00.043-07:00

Osteoporosis is a condition of low bone density that can progress silently over a long period of time. If diagnosed early, the fractures associated with the disease can often be prevented. Unfortunately, osteoporosis frequently remains undiagnosed until a fracture occurs.

An examination to diagnose osteoporosis can involve several steps that predict your chances of future fracture, diagnose osteoporosis, or both. It might include:

* an initial physical exam
* various x rays that detect skeletal problems
* laboratory tests that reveal important information about the metabolic process of bone breakdown and formation
* a bone density test to detect low bone density.

Before performing any tests, your doctor will record information about your medical history and lifestyle and will ask questions related to:

* risk factors, including information about any fractures you have had
* your family history of disease, including osteoporosis
* medication history
* general intake of calcium and vitamin D
* exercise pattern
* for women, menstrual history.

In addition, the doctor will note medical problems and medications you may be taking that can contribute to bone loss (including glucocorticoids, such as cortisone). He or she will also check your height for changes and your posture to note any curvature of the spine from vertebral fractures, which is known as kyphosis.

Risk Factors for Osteoporotic Fracture Include:

* personal history of fracture as an adult
* history of fracture in a first-degree relative
* Caucasian or Asian race, although African Americans and Hispanic Americans are at significant risk as well
* advanced age
* being female
* dementia
* poor health, frailty, or both
* current cigarette smoking
* low body weight
* anorexia nervosa
* estrogen deficiency (past menopause, menopause before age 45, having both ovaries removed, or the absence of menstrual periods for a year or more prior to menopause)*
* low testosterone levels in men
* use of certain medications such as corticosteroids and anticonvulsants
* lifelong low calcium intake
* excessive alcohol intake
* impaired eyesight despite adequate correction
* recurrent falls
* inadequate physical activity.

*Women lose bone rapidly in the first 4-8 years following menopause, making them more susceptible to osteoporosis.

X Ray Tests

If you have back pain, your doctor may order an x ray of your spine to determine whether you have had a fracture. An x ray also may be appropriate if you have experienced a loss of height or a change in posture. However, since an x ray can detect bone loss only after 30 percent of the skeleton has been depleted, the presence of osteoporosis may be missed.

Bone Mineral Density Tests

A bone mineral density (BMD) test is the best way to determine your bone health. BMD tests can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized bone mineral density test is called a dual-energy x-ray absorptiometry or DXA test. It is painless: a bit like having an x ray, but with much less exposure to radiation. It can measure bone density at your hip and spine.

During a BMD test, an extremely low energy source is passed over part or all of the body. The information is evaluated by a computer program that allows the doctor to see how much bone mass you have. Since bone mass serves as an approximate measure of bone strength, this information also helps the doctor accurately detect low bone mass, make a definitive diagnosis of osteoporosis, and determine your risk of future fractures.

BMD tests provide doctors with a measurement called a T-score, a number value that results from comparing your bone density to optimal bone density. When a T-score appears as a negative number such as -1, -2 or -2.5, it indicates low bone mass. The more negative the number, the greater the risk of fracture.

Although no bone density test is 100 percent accurate, this type of test is the single most important predictor of whether a person will fracture in the future.

Bone Scans

For some people, a bone scan may be ordered. A bone scan is different from the BMD test just described, although the term “bone scan” often is used incorrectly to describe a bone density test. A bone scan can tell the doctor whether there are changes that may indicate cancer, bone lesions, inflammation, or new fractures. In a bone scan, the person being tested is injected with a dye that allows a scanner to identify differences in the conditions of various areas of bone tissue.

Laboratory Tests

A number of laboratory tests may be performed on blood and urine samples. The results of these tests can help your doctor identify conditions that may be contributing to your bone loss.

The most common blood tests evaluate:

* blood calcium levels
* blood vitamin D levels
* thyroid function
* parathyroid hormone levels
* estradiol levels to measure estrogen (in women)
* follicle stimulating hormone (FSH) test to establish menopause status
* testosterone levels (in men)
* osteocalcin levels to measure bone formation.

The most common urine tests are:

* 24-hour urine collection to measure calcium metabolism
* tests to measure the rate at which a person is breaking down or resorbing bone.

Treatment

In addition to diagnosing osteoporosis, results from BMD tests assist the doctor in deciding whether to begin a prevention or treatment program. Once you and your doctor have definitive information based on your history, physical examination, and diagnostic tests, a specific treatment program can be developed for you.

Recommendations for optimizing bone health include a comprehensive program that consists of a well-balanced diet rich in calcium and vitamin D, physical activity, and a healthy lifestyle (including not smoking, avoiding excessive alcohol use, and recognizing that some prescription medications and chronic diseases can cause bone loss). If you already have experienced a fracture, your doctor may refer you to a specialist in physical therapy or rehabilitation medicine to help you with daily activities, safe movement, and exercises to improve your strength and balance.

Osteoporosis: Coping With Chronic Pain

2007-04-05T00:20:00.042-07:00

Osteoporosis often causes very painful fractures, which can take many months to heal. In many cases, the pain starts to go away as the fracture heals. Most new fractures heal in approximately 3 months. Pain that continues after that is generally considered chronic pain. One cause of chronic pain is vertebral fractures. When a vertebra breaks, some people have no pain, while others have intense pain and muscle spasms that last long after the fracture has healed.

Pain is the body’s way of responding to an injury. When a bone breaks, nerves send pain messages through the spinal cord to the brain, where they are interpreted. Your response to pain is determined by many factors, including your emotional outlook. For example, depression seems to increase a person’s perception of pain and decrease her or his ability to cope with it. Often, treating the depression treats the pain as well.

Chronic pain is pain that lasts beyond the expected time for healing and interferes with normal life. The injury has healed, but the pain continues. The pain message may be triggered by muscle tension, stiffness, weakness, or spasms. Whatever the cause of chronic pain, feelings of frustration, anger, and fear can make the pain more intense. Chronic pain can affect all areas of your life and should be taken seriously.

The following information provides those who have chronic pain with an overview of different options for pain management. If you have chronic pain and need help managing it, you may wish to discuss these options with your doctor.

Coping Strategies: Physical Methods of Pain Management

Heat and ice: Heat, in the form of warm showers or hot packs, can relieve chronic pain or stiff muscles. Cold packs or ice packs provide pain relief by numbing the pain-sensing nerves in the affected area. Cold also helps reduce swelling and inflammation. Depending on which feels better, apply heat or cold for 15 to 20 minutes at a time to the area where you feel the pain. To protect your skin, place a towel between your skin and the source of the cold or heat. Some simple ways to make heat and ice packs are listed below:

* Warm towels or hot packs in the microwave for a quick source of heat. (Handle carefully.)
* Make instant cold packs from frozen juice cans or bags of frozen vegetables.
* Freeze a plastic, resealable bag filled with water to make a good ice bag.

Transcutaneous Electrical Nerve Stimulation (TENS): A TENS machine is a small device that sends electrical impulses to certain parts of the body to block pain signals. Two electrodes are placed on the body where you are experiencing pain. The electrical current that is produced is very mild, but it can prevent pain messages from being transmitted to the brain. Pain relief can last for several hours. Some people may use a small, portable TENS unit that hooks onto a belt for more continuous relief. TENS machines should only be used under the supervision of a physician or physical therapist. They can be purchased or rented from hospital supply or surgical supply houses; however, a prescription is necessary for insurance reimbursement.

Braces and supports: Spinal supports or braces reduce pain and inflammation by restricting movement. Following a vertebral fracture, a back brace or support will relieve pain and allow you to resume normal activities while the fracture heals. However, continuous use of a back support can weaken back muscles. For this reason, exercises to strengthen the muscles in the back should be started as soon as possible.

Exercise and physical therapy: Prolonged inactivity increases weakness and causes loss of muscle mass and strength. A regular exercise program and physical therapy can help you regain strength, energy, and a more positive outlook on life. Because exercise raises the body’s level of endorphins – or natural pain killers produced by the brain – it will relieve pain somewhat. Exercise also relieves tension, increases flexibility, strengthens muscles, and reduces fatigue.

A physical therapist can help you reorganize your home or work environment to avoid further injuries. Physical therapists also teach proper posture and exercises to strengthen the back and abdominal muscles without injuring a weakened spine. Water therapy in a pool, for example, is one of the best exercise techniques for gently improving back muscle strength and reducing pain.

Acupuncture and acupressure: Acupuncture is the use of special needles that are inserted into the body at certain points. These needles stimulate nerve endings and cause the brain to release endorphins. It may take several acupuncture sessions before the pain is relieved. Acupuncture has been used for centuries in China and other parts of Asia to treat many types of pain.

Acupressure is direct pressure applied to areas that trigger pain. This technique can be self-administered after training with an instructor.

Massage therapy: Massage therapy can be a light, slow, circular motion with the fingertips or a deep, kneading motion that moves from the center of the body outward toward the fingers or toes. Massage relieves pain, relaxes stiff muscles, and smoothes out muscle knots by increasing the blood supply to the affected area and warming it. The person doing the massage uses oil or powder so that her or his hands slide smoothly over the skin. Massage can also include gentle pressure over the affected areas or hard pressure over trigger points in muscle knots. Note: Deep muscle massage should not be done near the spine of a person who has spinal osteoporosis. Light, circular massage with fingers or the palm of the hand is best in this case.

Coping Strategies: Psychological Methods of Pain Management

Relaxation training: Relaxation involves concentration and slow, deep breathing to release tension from muscles and relieve pain. Learning to relax takes practice, but relaxation training can focus attention away from pain and release tension from all muscles. Relaxation tapes are widely available to help you learn these skills.

Biofeedback: Biofeedback is taught by a professional who uses special machines to help you learn to control bodily functions, such as heart rate and muscle tension. As you learn to release muscle tension, the machine immediately indicates success. Biofeedback can be used to reinforce relaxation training. Once the technique is mastered, it can be practiced without the use of the machine.

Visual imagery and distraction: Imagery involves concentrating on mental pictures of pleasant scenes or events or mentally repeating positive words or phrases to reduce pain. Tapes are also available to help you learn visual imagery skills.

Distraction techniques focus your attention away from negative or painful images to positive mental thoughts. This may include activities as simple as watching television or a favorite movie, reading a book or listening to a book on tape, listening to music, or talking to a friend.

Hypnosis: Hypnosis can be used in two ways to reduce your perception of pain. Some people are hypnotized by a therapist and given a post-hypnotic suggestion that reduces the pain they feel. Others are taught self-hypnosis and can hypnotize themselves when pain interrupts their ability to function. Self-hypnosis is a form of relaxation training.

Individual, group, or family therapy: These forms of psychotherapy may be useful for those whose pain has not responded to physical methods. People who suffer from chronic pain often experience emotional stress and depression. Therapy can help you cope with these feelings, making it easier to manage your pain.

Coping Strategies: Medication for Pain Management

Medications are the most popular way to manage pain. Commonly used medications include aspirin, acetaminophen, and ibuprofen. Although these are probably the safest pain relievers available, they sometimes cause stomach irritation and bleeding.

Narcotic drugs may be prescribed for short-term acute pain. These drugs should not be used for long periods because they are addictive and can affect your ability to think clearly. They also have other side effects, such as constipation.

Many people with persistent pain that has not responded to other forms of pain relief are treated with antidepressant medication. These drugs may work in a different way when used for treatment of unyielding pain. The body’s internal pain suppression system may depend upon the concentrations of various chemicals in the brain. These concentrations are increased by the use of antidepressants.

The above-mentioned methods of pain management are used in various hospitals and clinics across the country. If you have chronic pain that has not responded to treatment, you should consult your physician for a referral to a physical therapist or a clinic specializing in pain management.

Pain Management Resources

National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
http://www.niams.nih.gov
Phone: 877-22-NIAMS (226-4267) (free of charge) or 301-495-4484
Fax: 301-718-6366
The National Institute of Arthritis and Musculoskeletal and Skin Diseases publishes Pain Research: An Overview. This publication is available at: http://www.niams.nih.gov/hi/topics/pain/pain.htm.

National Institute of Dental and Craniofacial Research
National Institutes of Health
Bethesda, MD 20892-2190
E-mail: nidcrinfo@mail.nih.gov
http://www.nidcr.nih.gov/
Phone: 301-496-4261
The National Institute of Dental and Craniofacial Research is the primary NIH organization for research on pain.

National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
http://www.ninds.nih.gov
Phone: 800-352-9424 (free of charge) or 301-496-5751
The National Institute of Neurological Disorders and Stroke has developed a Chronic Pain Information Page. This resource is available at: http://www.ninds.nih.gov/health_and_medical/disorders/chronic_pain.htm.

American Pain Society
4700 West Lake Avenue
Glenview, IL 60025-1485
E-mail: info@ampainsoc.org
http://www.ampainsoc.org
Phone: 847-375-4715
Fax: 877-734-8758 (free of charge)
This society provides general information to the public and maintains a directory of resources, including referrals to pain centers.

American Chronic Pain Association
P.O. Box 850
Rocklin, CA 95677-0850
E-mail: ACPA@pacbell.net
http://www.theacpa.org
Phone: 800-533-3231 (free of charge) or 919-632-0922
Fax: 919-632-3208
This association provides information on positive ways to deal with chronic pain and can provide guidelines on selecting a pain management center.

NIH Pain Consortium
National Institutes of Health
9000 Rockville Pike
Bethesda, Maryland 20892
E-mail: NIHInfo@od.nih.gov
http://painconsortium.nih.gov
Phone: 301-496-4000
The NIH Pain Consortium was established to enhance pain research and promote collaboration among researchers across the many NIH Institutes and Centers that have programs and activities addressing pain.

For Your Information

This publication contains information about medications used to treat the health condition discussed here. When this fact sheet was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.

For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at 1-888-INFO-FDA (1-888-463-6332, a toll-free call) or visit their Web site at www.fda.gov

Osteoporosis: The Bone Thief

2007-04-05T00:20:00.041-07:00

Helen grew up on a farm in the Midwest. She drank lots of milk as a child. She also walked a lot. After graduating from high school, she got married and found a job. Family and work kept her too busy to exercise. Helen went through menopause at age 47. At age 76, she was enjoying retirement — traveling and working in her garden. But then she slipped on a small rug in her kitchen and broke her hip. After Helen recovered, she needed a cane to walk, and gardening was a lot harder to enjoy.

Helen had osteoporosis, but she didn’t know it before she fell. Osteoporosis is a disease that weakens bones to the point where they break easily—most often bones in the hip, backbone (spine), and wrist. Osteoporosis is called the “silent disease”—you may not notice any changes until a bone breaks. But your bones have been losing strength for many years.

Bone is living tissue. To keep bones strong, your body is always breaking down old bone and replacing it with new bone tissue. As people enter their forties and fifties, more bone is broken down than is replaced. A close look at the inside of bone shows something like a honeycomb. When you have osteoporosis, the spaces in this honeycomb grow larger. And the bone that forms the honeycomb gets smaller. The outer shell of your bones also gets thinner. All this loss makes your bones weaker.
Who Has Osteoporosis?

Millions of Americans have osteoporosis. They are mostly women, but more than 2 million men also have this disease. White and Asian women are most likely to have osteoporosis. Other women at great risk include those who:

* have a family history of the disease,
* have broken a bone while an adult,
* had surgery to remove their ovaries before their periods stopped,
* had early menopause,
* have not gotten enough calcium throughout their lives,
* had extended bed rest,
* used certain medicines for a long time, or
* have a small body frame.

The risk of osteoporosis grows as you get older. At the time of menopause women may lose bone quickly for several years. After that, the loss slows down, but continues. In men the loss of bone mass is slower. But, by age 65 or 70 men and women are losing bone at the same rate.
What Is Osteopenia?

Millions more Americans have osteopenia. Whether your doctor calls it osteopenia or just says you have low bone mass, consider it a warning. Bone loss has started, but you can still take action to keep your bones strong and maybe prevent osteoporosis later in life. That way you will be less likely to break a wrist, hip, or vertebrae (bone in your spine) when you are older.
Can My Bones Be Tested?

For some people the first sign of osteoporosis is to realize they are getting shorter or to break a bone easily, like Helen. Don’t wait until that happens to see if you have osteoporosis. You can have a bone density testto find out how solid your bones are. Your doctor may suggest a type of bone density test called a DEXA-scan (dual-energy x-ray absorptiometry) if you are age 65 or older or if he or she thinks you are at risk for osteoporosis.

The DEXA-scan tells what your risk for a fracture or broken bone is. It could show that you have normal bone density. Or, it could show that you have low bone mass or even osteoporosis.
How Can I Keep My Bones Strong?

There are things you should do at any age to prevent weakened bones. Eating foods that are rich in calcium and vitamin D is important. So is including regular weight-bearing exercise in your lifestyle. These are the best ways to keep your bones strong and healthy.

Calcium. Getting enough calcium all through your life helps to build and keep strong bones. People over age 50 need 1200 mg of calcium every day. Foods that are high in calcium are the best source. For example, eat low-fat dairy foods, canned fish with soft bones such as salmon, dark green leafy vegetables, and calcium-fortified foods like orange juice, breads, and cereals.

If you think you aren’t getting enough calcium in your diet, check with your doctor first. He or she may tell you to try a calcium supplement. Calcium carbonate and calcium citrate are two common forms. You have to be careful though. Too much calcium can cause problems for some people. On most days you should not get more than 2,500 mg of total calcium. That includes calcium from all sources—foods, drinks, and supplements.

Vitamin D. Your body uses vitamin D to absorb calcium. Most people’s bodies are able to make enough vitamin D if they are out in the sun for a total of 20 minutes every day. You can also get vitamin D from eggs, fatty fish, and cereal and milk fortified with vitamin D. If you think you are not getting enough vitamin D, check with your doctor. Each day you should have:

* 400 IU (international unit) if you are age 51 to 70
* 600 IU if you are over age 70.

As with calcium, be careful. More than 2000 IU of vitamin D each day may cause side effects.

Exercise. Your bones and muscles will be stronger if you are physically active. Weight-bearing exercises, done three to four times a week, are best for preventing osteoporosis. Walking, jogging, playing tennis, and dancing are examples of weight-bearing exercises. Try some strengthening and balance exercises, too. They may help you avoid falls which could cause a broken bone.

Medicines. Some common medicines can make bones weaker. These include a type of steroid drug called glucocorticoids used for arthritis and asthma, some antiseizure drugs, certain sleeping pills, treatments for endometriosis, and some cancer drugs. An overactive thyroid gland or using too much thyroid hormone for an underactive thyroid can also be a problem. If you are taking these medicines, talk to your doctor about what you can do to help protect your bones.

Lifestyle. Smoking increases loss of bone mass. For this and many other health reasons, stop smoking. Limit how much alcohol you drink. Too much alcohol can put you at risk for falling and breaking a bone.
What Can I Do for My Osteoporosis?

Treating osteoporosis means stopping the bone loss and rebuilding bone to prevent breaks. Diet and exercise can help make your bones stronger. But they may not be enough if you have lost a lot of bone density. There are also several medicines to think about. Some will slow your bone loss, and others can help rebuild bone. Talk with your doctor to see if one of these might work for you:

* Bisphosphonates. These medicines slow the breakdown of bone and increase bone density. They can make it less likely that you will break a bone, most of all in your spine, hip, or wrist. Side effects may include nausea, heartburn, and stomach pain. A few people have muscle, bone, or joint pain while using these medicines. These drugs must be taken in a certain way—when you first get up, before you have eaten, and with a full glass of water. You should not lie down, eat, or drink for at least one-half hour after taking the drug. Even if you follow the directions closely, these drugs can cause serious digestive problems, so be aware of any side effects. These pills are available in once-daily, once-a-week, and once-a-month versions.
* Raloxifene. This drug is used to prevent and treat osteoporosis. It is a SERM (selective estrogen receptor modulator). It prevents bone loss and spine fractures but may cause hot flashes or increase the risk of blood clots in some women.
* Estrogen. Doctors sometimes prescribe this female hormone around the time of menopause to treat symptoms like hot flashes or vaginal dryness. Estrogen also slows bone loss and increases bone mass in your spine and hip, so women can use it to prevent or treat osteoporosis. But, estrogen use is thought to be risky for some women. Talk to your doctor. Ask about the benefits, risks, and side effects, as well as other possible treatments for you.
* Calcitonin. This hormone increases bone mass in your spine and can lessen the pain of fractures already there. It comes in two forms—a shot or nasal spray. The shot may cause an allergic reaction and has some side effects like nausea, diarrhea, or redness in your face, ears, hands, or feet. The only side effect of the nasal spray is a runny nose in some people. Calcitonin is most useful for women who are 5 years past menopause.
* Parathyroid hormone (PTH). Also called teriparatide, this shot is given daily for up to two years to postmenopausal women and men who are at high risk for broken bones. It improves bone density in the spine and hip. Common side effects include nausea, dizziness, and leg cramps.

Can I Avoid Falling?

When your bones are weak, a simple fall can cause a broken bone. This can mean a trip to the hospital and maybe surgery. It might also mean being laid up for a long time, especially in the case of a hip fracture. So, it is important to prevent falls. Some things you can do are:

* Make sure you can see and hear well. Use your glasses or a hearing aid if needed.
* Ask your doctor if any of the drugs you are taking can make you dizzy or unsteady on your feet.
* Use a cane or walker if your walking is unsteady.
* Wear rubber-soled and low-heeled shoes.
* Make sure all the rugs and carpeting in your house are firmly attached to the floor, or don’t use them.
* Keep your rooms well lit and the floor free of clutter.
* Use nightlights.

You can find more suggestions in the National Institute on Aging’s Preventing Falls and Fractures Age Page, also available from the National Institute on Aging Information Center listed in the resource section.
Do Men Have Osteoporosis?

Osteoporosis is not just a woman’s disease. Not as many men have it as women do, but men need to worry about it as well. This may be because most men start with more bone density than women and lose it more slowly as they grow older.

Experts don’t know as much about this disease in men as they do in women. However, many of the things that put men at risk are the same as those for women:

* family history
* not enough calcium or vitamin D
* too little exercise
* low levels of testosterone
* too much alcohol
* taking certain drugs
* smoking.

Older men who break a bone easily or are at risk for osteoporosis should talk with their doctors about testing and treatment. Men can use bisphsphonates or parathyroid hormone to increase bone density. Testosterone supplements may help some men with low levels of testosterone.
Resources

National Osteoporosis Foundation
1232 22nd Street, NW
Washington, DC 20037-1292
202-223-2226
www.nof.org

National Institutes of Health
Osteoporosis and Related Bone Diseases~NationalResourceCenter
2 AMS Circle
Bethesda, MD 20892-3676
800-624-BONE (800-624-2663)
202-466-4315 (TTY)
www.niams.nih.gov/bone

National Library of Medicine
MedlinePlus
In Health Topics, go to:
“Osteoporosis”
“Falls”
www.medlineplus.gov

The National Institute on Aging has information on health and aging, including a booklet and video about exercise for older people and several helpful Age Pages. Contact:
National Institute on AgingInformationCenter
P.O. Box 8057
Gaithersburg, MD 20898-8057
800-222-2225 (toll-free)
800-222-4225 (TTY, toll-free)
www.nia.nih.gov

To order publications (in English or Spanish) or sign up for regular email alerts, go to www.nia.nih.gov/HealthInformation.

Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This simple-to-use website features popular health topics for older adults. It has large type and a talking function that “reads” the text out loud.

National Institute on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
December 2004
Updated 2006

Osteoporosis and Hispanic Women

2007-04-05T00:20:00.040-07:00

It is a common misconception that osteoporosis only affects white women. But, according to the Surgeon General’s Report on Bone Health and Osteoporosis, in the United States, the prevalence of osteoporosis in Hispanic women is similar to that in white women. Fortunately, osteoporosis is preventable and treatable. As a Hispanic woman, it is important that you understand your risk for osteoporosis, the steps you can take to protect your bones, and, if you have the disease, the options for treating it.

What Is Osteoporosis?

Osteoporosis is a debilitating disease characterized by low bone mass and, thus, bones that are susceptible to fracture. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks, typically in the hip, spine, or wrist. A hip fracture can limit mobility and lead to a loss of independence, while vertebral fractures can result in a loss of height, stooped posture, and chronic pain.

What Are the Risk Factors for Osteoporosis?

Risk factors for developing osteoporosis include:

* a thin, small-boned frame
* previous fracture or family history of osteoporotic fracture
* estrogen deficiency resulting from early menopause (before age 45), either naturally, from surgical removal of the ovaries, or as a result of prolonged amenorrhea (abnormal absence of menstruation) in younger women
* advanced age
* a diet low in calcium
* Caucasian and Asian ancestry (African American and Hispanic women are at lower but significant risk)
* cigarette smoking
* excessive use of alcohol
* prolonged use of certain medications, such as those used to treat diseases like lupus, asthma, thyroid deficiencies, and seizures.

Are There Any Special Issues for Hispanic Women Regarding Bone Health?

Several studies indicate a number of facts that highlight the risk Hispanic women face with regard to developing osteoporosis:

* Ten percent of Hispanic women aged 50 and older are estimated to have osteoporosis, and 49 percent are estimated to have bone mass that is low, but not low enough for them to be diagnosed with osteoporosis.
* The incidence of hip fractures among some Hispanic women appears to be on the rise.
* Studies have shown that Hispanic women consume less calcium than the Recommended Dietary Allowance in all age groups.
* Hispanic women are twice as likely to develop diabetes as white women, which may increase their risk for osteoporosis.

How Can Osteoporosis Be Prevented?

Osteoporosis prevention begins in childhood. The recommendations listed below should be followed throughout life to lower your risk of osteoporosis.

* Eat a well-balanced diet adequate in calcium and vitamin D.
* Exercise regularly, with an emphasis on weight-bearing activities such as walking, jogging, dancing, and lifting weights.
* Live a healthy lifestyle. Avoid smoking, and, if you drink alcohol, do so in moderation.

Talk to your doctor if you have a family history of osteoporosis or other factors that may put you at increased risk for the disease. Your doctor may suggest that you have your bone density measured through a safe and painless test that can determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized bone mineral density test is called a dual-energy x-ray absorptiometry or DXA test. It is painless: a bit like having an x ray, but with much less exposure to radiation. It can measure bone density at your hip and spine.

What Treatments Are Available?

Although there is no cure for osteoporosis, there are treatments available to help stop further bone loss and reduce the risk of fractures:

* bisphosphonate drugs: alendronate (Fosamax1), alendronate plus vitamin D (Fosamax Plus D), risedronate (Actonel), risedronate with calcium (Actonel with Calcium), and ibandronate (Boniva)
* calcitonin (Miacalcin)
* raloxifene (Evista), a Selective Estrogen Receptor Modulator
* teriparatide (Forteo), a form of the hormone known as PTH, which is secreted by the parathyroid glands
* estrogen therapy (also called hormone therapy when estrogen and another hormone, progestin, are combined).

Osteoporosis and Arthritis: Two Common but Different Conditions

2007-04-05T00:20:00.039-07:00

Many people confuse osteoporosis and some types of arthritis. This fact sheet will discuss the similarities and differences between these conditions.

Osteoporosis

Osteoporosis is a major health threat for 44 million Americans, 68 percent of whom are women. In osteoporosis, there is a loss of bone tissue that leaves bones less dense and more prone to fracture. It can result in a loss of height, severe back pain, and a change in one’s posture. Osteoporosis can impair a person’s ability to walk and can cause prolonged or permanent disability.

Risk factors for developing osteoporosis include:

* thinness or small frame
* family history of osteoporosis
* being postmenopausal, and particularly having had early menopause
* abnormal absence of menstrual periods
* prolonged use of certain medications, such as those used to treat diseases like systemic lupus erythematosus, asthma, thyroid deficiencies, and seizures
* low calcium intake
* physical inactivity
* smoking
* excessive alcohol intake.

Osteoporosis is a silent disease that often can be prevented. However, if undetected, it can progress for many years without symptoms until a fracture occurs. Osteoporosis is diagnosed by a bone mineral density (BMD) test, which is a safe and painless way to detect low bone density.

Although there is no cure for the disease, several medications have been approved by the Food and Drug Administration to prevent and treat osteoporosis. In addition, a diet rich in calcium and vitamin D, regular weight-bearing exercise, and a healthy lifestyle can prevent or lessen the effects of the disease.

Arthritis

Arthritis is a general term for conditions that affect the joints and surrounding tissues. Joints are places in the body where bones come together, such as the knees, wrists, fingers, toes, and hips. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

* Osteoarthritis (OA) is a painful, degenerative joint disease that often involves the hips, knees, neck, lower back, or the small joints of the hands. OA usually develops in joints that are injured by repeated overuse from performing a particular task or playing a favorite sport, or from carrying around excess body weight. Eventually this injury or repeated impact thins or wears away the cartilage that cushions the ends of the bones in the joint. As a result, the bones rub together, causing a grating sensation. Joint flexibility is reduced, bony spurs develop, and the joint swells. Usually, the first symptom of OA is pain that worsens following exercise or immobility. Treatment usually includes analgesics, topical creams, or nonsteroidal anti-inflammatory medications (known as NSAIDs); appropriate exercises or physical therapy; joint splinting; or joint replacement surgery for seriously damaged larger joints, such as the knee or hip.

* Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that usually involves various joints in the fingers, thumbs, wrists, elbows, shoulders, knees, feet, and ankles. An autoimmune disease is one in which the body releases enzymes that attack its own healthy tissues. In RA, these enzymes destroy the linings of joints. This causes pain, swelling, stiffness, malformation, and reduced movement and function. People with RA also may have systemic symptoms, such as fatigue, fever, weight loss, eye inflammation, anemia, subcutaneous nodules (bumps under the skin), or pleurisy (a lung inflammation).

While osteoporosis and OA are two very different medical conditions with little in common, the similarity of their names causes great confusion. These conditions develop differently, have different symptoms, are diagnosed differently, and are treated differently. While it is possible to have both osteoporosis and arthritis, studies show that people with OA are less likely to develop osteoporosis. On the other hand, people with RA may be more likely than average to develop osteoporosis. This is especially true because some medications used to treat RA can contribute to osteoporosis.

Osteoporosis and arthritis do share many coping strategies. With either or both of these conditions, many people benefit from exercise programs that may include physical therapy and rehabilitation. In general, exercises that emphasize stretching, strengthening, posture, and range of motion are appropriate. Examples include low-impact aerobics, swimming, tai chi, and low-stress yoga. However, people with osteoporosis must take care to avoid activities that include bending forward from the waist, twisting the spine, or lifting heavy weights. People with arthritis must compensate for limited movement in affected joints. Always check with your doctor to determine if a certain exercise or exercise program is safe for your specific medical situation.

Osteoporosis and African American Women

2007-04-05T00:20:00.038-07:00

While African American women tend to have higher bone mineral density (BMD) than white women throughout life, they are still at significant risk of developing osteoporosis. The misperception that osteoporosis is only a concern for white women can delay prevention and treatment in African American women who do not believe they are at risk for the disease.

What Is Osteoporosis?

Osteoporosis is a metabolic bone disease characterized by low bone mass, which makes bones fragile and susceptible to fracture. Osteoporosis is known as a silent disease because symptoms and pain do not appear until a fracture occurs. Without prevention or treatment, osteoporosis can progress painlessly until a bone breaks, typically in the hip, spine, or wrist. A hip fracture can limit mobility and lead to a loss of independence, while vertebral fractures can result in a loss of height, stooped posture, and chronic pain.

What Are the Risk Factors for Osteoporosis?

Risk factors for developing osteoporosis include:

* a thin, small-boned frame
* previous fracture or family history of osteoporotic fracture
* estrogen deficiency resulting from early menopause (before age 45), either naturally, from surgical removal of the ovaries, or as a result of prolonged amenorrhea (abnormal absence of menstruation) in younger women
* advanced age
* a diet low in calcium
* Caucasian and Asian ancestry (African American and Hispanic women are at lower but significant risk)
* cigarette smoking
* excessive use of alcohol
* prolonged use of certain medications, such as those used to treat diseases like lupus, asthma, thyroid deficiencies, and seizures.

Are There Special Issues for African American Women Regarding Bone Health?

Many scientific studies highlight the risk that African American women face with regard to developing osteoporosis and fracture.

* Osteoporosis is underrecognized and undertreated in African American women.
* As African American women age, their risk for hip fracture doubles approximately every 7 years.
* African American women are more likely than white women to die following a hip fracture.
* Diseases more prevalent in the African American population, such as sickle-cell anemia and lupus, can increase the risk of developing osteoporosis.
* African American women consume 50 percent less calcium than the Recommended Dietary Allowance. Adequate intake of calcium plays a crucial role in building bone mass and preventing bone loss.
* As many as 75 percent of all African Americans are lactose intolerant. Lactose intolerance can hinder optimal calcium intake. People with lactose intolerance often may avoid milk and other dairy products that are excellent sources of calcium because they have trouble digesting lactose, the primary sugar in milk.

How Can Osteoporosis Be Prevented?

Osteoporosis prevention begins in childhood. The recommendations listed below should be followed throughout life to lower your risk of osteoporosis.

* Eat a well-balanced diet adequate in calcium and vitamin D.
* Exercise regularly, with an emphasis on weight-bearing activities such as walking, jogging, dancing, and lifting weights.
* Live a healthy lifestyle. Avoid smoking, and, if your drink alcohol, do so in moderation.

Talk to your doctor if you have a family history of osteoporosis or other risk factors that may put you at increased risk for the disease. Your doctor may suggest that you have your bone density measured through a safe and painless test that can determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized bone mineral density test is called a dual-energy x-ray absorptiometry or DXA test. It is painless: a bit like having an x ray, but with much less exposure to radiation. It can measure bone density at your hip and spine.

What Treatments Are Available?

Although there is no cure for osteoporosis, there are treatments available to help stop further bone loss and reduce the risk of fractures:

* bisphosphonate drugs: alendronate (Fosamax1), alendronate plus vitamin D (Fosamax Plus D), risedronate (Actonel), risedronate with calcium (Actonel with Calcium), and ibandronate (Boniva)
* calcitonin (Miacalcin)
* raloxifene (Evista), a Selective Estrogen Receptor Modulator
* teriparatide (Forteo), a form of the hormone known as PTH, which is secreted by the parathyroid glands
* estrogen therapy (also called hormone therapy when estrogen and another hormone, progestin, are combined).

1 Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Medications to Prevent and Treat Osteoporosis

2007-04-05T00:20:00.037-07:00

Although there is no cure for osteoporosis, several medications approved by the U.S. Food and Drug Administration (FDA) can help stop or slow bone loss, or help form new bone, and reduce the risk of fractures. Currently, alendronate, raloxifene, risedronate, and ibandronate are approved for preventing and treating postmenopausal osteoporosis. Teriparatide is approved for treating the disease in postmenopausal women and men at high risk for fracture. Estrogen/hormone therapy (ET/HT) is approved for preventing postmenopausal osteoporosis, and calcitonin is approved for treatment. In addition, alendronate is approved to treat bone loss that results from glucocorticoid medications like prednisone or cortisone. It is also approved for treating osteoporosis in men. Risedronate is approved to prevent and treat glucocorticoid-induced osteoporosis and to treat ostoeporosis in men.

Bisphosphonates

Alendronate (Fosamax¹), risedronate (Actonel), and ibandronate (Boniva) are medications from the class of drugs called bisphosphonates.

Alendronate and risedronate have been shown to increase bone mass and reduce the incidence of spine, hip, and other fractures. Ibandronate has been shown to reduce the incidence of spine fractures.

Alendronate is available in daily and weekly doses. Risedronate is available in daily and weekly doses. Ibandronate is available in a monthly dose and as an intravenous injection administered once every three months.

Oral bisphosphonates should be taken on an empty stomach and with a full glass of water first thing in the morning. It is important to remain in an upright position and refrain from eating or drinking for at least 30 minutes after taking a bisphosphonate.

Side effects for bisphosphonates include gastrointestinal problems such as difficulty swallowing, inflammation of the esophagus, and gastric ulcer. There have been rare reports of osteonecrosis of the jaw and of visual disturbances in people taking bisphosphonates.

Some bisphosphonates are fortified with calcium and vitamin D. These nutrients are important for everyone, and people should include adequate amounts of them in their diets.

¹Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Raloxifene

Raloxifene (Evista) is approved for the prevention and treatment of postmenopausal osteoporosis. It is from a class of drugs called Selective Estrogen Receptor Modulators (SERMs) that appear to prevent bone loss in the spine, hip, and total body. Raloxifene has beneficial effects on bone mass and bone turnover and can reduce the risk of vertebral fractures. While side effects are not common with raloxifene, those reported include hot flashes and blood clots in the veins, the latter of which is also associated with estrogen therapy. Additional research studies on raloxifene will continue for several more years.

Calcitonin

Calcitonin (Miacalcin, Fortical) is a naturally occurring hormone involved in calcium regulation and bone metabolism. In women who are at least 5 years past menopause, calcitonin slows bone loss, increases spinal bone density, and according to anecdotal reports, relieves the pain associated with bone fractures. Calcitonin reduces the risk of spinal fractures and may reduce hip fracture risk as well. Studies on fracture reduction are ongoing. Calcitonin is currently available as an injection or nasal spray. While it does not affect other organs or systems in the body, injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, frequent urination, nausea, and skin rash. The only side effect reported with nasal calcitonin is a runny nose.

Teriparatide

Teriparatide (Forteo) is an injectable form of human parathyroid hormone. It is approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. Teriparatide stimulates new bone formation in both the spine and the hip. It also reduces the risk of vertebral and nonvertebral fractures in postmenopausal women. In men, teriparatide reduces the risk of vertebral fractures. However, it is not known whether teriparatide reduces the risk of nonvertebral fractures. Side effects include nausea, dizziness, and leg cramps. Teriparatide is approved for use for up to 24 months.

Estrogen/Hormone Therapy

Estrogen/hormone therapy (ET/HT) has been shown to reduce bone loss, increase bone density in both the spine and hip, and reduce the risk of hip and spine fractures in postmenopausal women. ET/HT is approved for preventing postmenopausal osteoporosis and is most commonly administered in the form of a pill or skin patch. When estrogen – also known as estrogen therapy or ET – is taken alone, it can increase a woman’s risk of developing cancer of the uterine lining (endometrial cancer). To eliminate this risk, physicians prescribe the hormone progestin – also known as hormone therapy or HT – in combination with estrogen for those women who have not had a hysterectomy. Side effects of ET/HT include vaginal bleeding, breast tenderness, mood disturbances, blood clots in the veins, and gallbladder disease.

The Women’s Health Initiative (WHI), a large Government-funded research study, recently demonstrated that the drug Prempro, which is used in hormone therapy, is associated with a modest increase in the risk of breast cancer, stroke, and heart attack. The WHI also demonstrated that estrogen therapy is associated with an increase in the risk of stroke. It is unclear whether estrogen therapy is associated with an increased risk of breast cancer or cardiovascular events. A large study from the National Cancer Institute indicated that long-term use of estrogen therapy may be associated with an increased risk of ovarian cancer. It is unclear whether hormone therapy carries a similar risk.

Any estrogen therapy should be prescribed for the shortest period of time possible. When used solely for the prevention of postmenopausal osteoporosis, any ET/HT regimen should only be considered for women at significant risk of osteoporosis, and nonestrogen medications should be carefully considered first.

Medications for Osteoporosis Prevention and Treatment

Types

Brand
Names

Therapy Options

FDA Approval

Forms of
Administration

Other Considerations

Possible Side Effects

alendronate

Fosamax¹

Bisphosphonates

Fosamax approved for preventing and treating osteoporosis in postmenopausal women. Fosamax approved for treating glucocorticoid-induced osteoporosis in women and men and for treating osteoporosis in men.

Fosamax available as pill in daily and weekly doses.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

ibandronate

Boniva

Bisphosphonates

Boniva approved for preventing and treating osteoporosis in postmenopausal women.

Boniva available as pill in monthly dose and as an intravenous injection administered once every 3 months.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

risedronate

Actonel

Bisphosphonates

Actonel approved for preventing and treating osteoporosis in postmenopausal women and for treating osteoporosis in men. Actonel approved for preventing and treating glucocorticoid-induced osteoporosis in women and men.

Actonel available as pill in daily and weekly doses.

Oral medication should be taken on an empty stomach with a full glass of water first thing in the morning. After taking the medication, remain in an upright position and do not eat or drink for at least 30 minutes.

May include abdominal or musculoskeletal pain, nausea, heartburn, irritation of the esophagus, and rarely osteonecrosis of the jaw.

salmon calcitonin

Miacalcin
Fortical

Calcitonin

Approved for treating osteoporosis in postmenopausal women

Daily nasal spray or injection

Approved for use in women at least 5 years beyond menopause

Use of nasal spray may result in runny, irritated nose. Injectable form may cause flushing of the face and hands, frequent urination, nausea, and skin rash.

estrogen therapy

Including:
Climara
Estrace
Estraderm
Estratab
Ogen
Ortho-Est
Premarin
Vivelle

Estrogen/ Hormone Therapy (ET/HT)

Approved for preventing osteoporosis in postmenopausal women

Pill and skin patch forms

Estrogen taken without progesterone increases the risk of uterine cancer. ET should be considered only for women at significant risk of postmenopausal osteoporosis and only after nonestrogen medications have been considered.

May increase risk of blood clots in the veins, stroke, heart attack, and breast and ovarian cancer. Also, vaginal bleeding, breast tenderness, mood disturbances, and gallbladder disease.

hormone therapy

Including:
Activella
Femhrt
Ortho-
Prefest
Premphase
Prempro

Estrogen/ Hormone Therapy (ET/HT)

Approved for preventing osteoporosis in postmenopausal women

Pill and skin patch forms

HT should be considered only for women at significant risk of postmenopausal osteoporosis and only after nonestrogen medications have been considered.

May increase risk of blood clots in the veins, stroke, heart attack, and breast and ovarian cancer. Also, vaginal bleeding, breast tenderness, mood disturbances, and gallbladder disease.

teriparatide

Forteo

Parathyroid Hormone

Approved for treating osteoporosis in postmenopausal women and men at high risk for fracture

Daily injection

Approved for use for up to 24 months

May include nausea, dizziness, and cramps

raloxifene

Evista

Selective Estrogen Receptor Modulators (SERMs)

Approved for preventing and treating osteoporosis in postmenopausal women

Pill in daily dose

May have a protective effect against breast cancer

May include hot flashes and blood clots in the veins

¹ Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

For People With Osteoporosis: How to Find a Doctor

2007-04-05T00:20:00.036-07:00

Isabel Johnson, age 64 years old, picked up a brochure on osteoporosis at her local pharmacy. What she read about the “silent disease” concerned her. She learned that she had several of the risk factors: she had gone through menopause at an early age, and her mother had suffered several fractures in her seventies and eighties.

Isabel called her neighbor, a registered nurse, who suggested that she discuss her concerns with a doctor. Isabel wondered how to find a doctor with expertise in osteoporosis.

For many people, finding a doctor who is knowledgeable about osteoporosis can be difficult. There is no physician specialty dedicated solely to osteoporosis, nor is there a certification program for health professionals who treat the disease. A variety of medical specialists treat people with osteoporosis, including internists, gynecologists, family physicians, endocrinologists, rheumatologists, physiatrists, orthopaedists, and geriatricians.

There are a number of ways to find a doctor who treats osteoporosis patients. If you have a primary care physician or a family doctor, discuss your concerns with him or her. Your doctor may treat the disease or be able to refer you to an osteoporosis specialist.

If you are enrolled in an HMO or managed care health plan, consult your assigned physician about osteoporosis. This doctor should be able to give you an appropriate referral.

If you do not have a personal physician or your doctor cannot help, you should contact your nearest university hospital or academic health center and ask for the department that cares for patients with osteoporosis. The department will vary from institution to institution. For example, in some facilities, the department of endocrinology or metabolic bone disease treats osteoporosis patients. In other medical centers, the appropriate department may be rheumatology, orthopedics, or gynecology. Some hospitals have a separate osteoporosis program or women’s clinic that treats osteoporosis patients.

Once you have identified a doctor, you may wish to ask whether the physician has specialized training in osteoporosis, how much of the practice is dedicated to osteoporosis, and whether he or she uses bone mass measurement.

Your own primary care doctor – whether an internist, orthopaedist, or gynecologist – is often the best person to treat you because she or he knows your medical history, your lifestyle, and your special needs.

Medical Specialists Who Treat Osteoporosis

After an initial assessment, it may be necessary to see an endocrinologist, a rheumatologist, or another specialist to exclude the possibility of an underlying disease that may contribute to osteoporosis:

Endocrinologists treat the endocrine system, which comprises the glands and hormones that help control the body’s metabolic activity. In addition to osteoporosis, endocrinologists also treat diabetes and diseases of the thyroid and pituitary glands.

Rheumatologists diagnose and treat diseases of the joints, muscles, bones, and tendons, including arthritis and collagen diseases.

Family physicians have a broad range of training that includes internal medicine, gynecology, and pediatrics. They place special emphasis on caring for an individual or family on a long-term, continuing basis.

Geriatricians are family physicians or internists who have received additional training on the aging process and the conditions and diseases that often occur among the elderly, including incontinence, falls, and dementia. Geriatricians often care for patients in nursing homes, the patient’s home, or in office or hospital settings.

Gynecologists diagnose and treat conditions of the female reproductive system and associated disorders. They often serve as primary care physicians for women and follow their patients’ reproductive health over time.

Internists are trained in general internal medicine. Internists diagnose and treat many diseases of the body. They provide long-term comprehensive care in the hospital and office, have expertise in many areas, and often act as consultants to other specialists.

Orthopaedic surgeons are physicians trained in the care of patients with musculoskeletal problems. Congenital skeletal malformations, bone fractures and infections, and metabolic problems are some of the conditions addressed by orthopaedists.

Physiatrists are physicians who specialize in physical medicine and rehabilitation. Physiatrists evaluate and treat patients with impairments, disabilities, or pain arising from various medical problems, including bone fractures. Physiatrists focus on restoring the physical, psychological, social, and vocational functioning of the individual.

Bone Health and Osteoporosis: A Guide for Asian Women Aged 50 and Older

2007-04-05T00:20:00.035-07:00

When you think about your health, you probably do not think about your bones. But keeping your bones healthy and reducing your risk of fractures by preventing osteoporosis is very important throughout life and especially as you get older. Here is some important information to help you.

Risk Factors

Factors that increase your chances of having osteoporosis and fractures include:

* being Asian
* being female
* being older (50+ years)
* low body weight
* menopause or surgery to remove both ovaries prior to menopause (resulting in lower levels of the hormone estrogen)
* history of fracture as an adult
* close relative with history of fracture as an adult
* long-term low calcium intake
* inadequate physical activity
* current cigarette smoking
* alcoholism
* use of certain medications such as corticosteroids and anticonvulsants
* history of anorexia nervosa.

What Is Osteoporosis?

Osteoporosis is a disease that makes bones fragile and more likely to break. There are no symptoms to warn you. The first sign is usually a fracture that occurs after your bones have already become fragile. Fractures occur most often in the hip, spine, and wrist. Spinal fractures cause stooped posture, loss of height, and chronic back pain. Hip fractures, the most serious consequence of osteoporosis, can result in permanent disability and even death.

You can take steps to protect your bones in your older years. These include a good diet with plenty of calcium and vitamin D, a regular exercise program, a healthy lifestyle, and, sometimes, medication.

Calcium and Vitamin D

You need calcium to help maintain healthy, strong bones throughout your life. Adult women under age 50 need 1,000 mg (milligrams) of calcium every day. Over age 50, they need 1,200 mg of calcium every day.

Many Asian diets are low in calcium. Examples of foods that contain calcium in different amounts include:

* almonds
* bok choy
* broccoli
* calcium-fortified orange juice
* calcium-fortified soy milk
* calcium-fortified rice
* canned sardines with bones
* canned salmon with bones
* milk, yogurt, cheese, ice cream
* napa cabbage
* oysters
* sesame seeds
* soybeans
* tofu
* turnip leaves.

Many Asian Americans have trouble digesting milk products. This is called lactose intolerance. If you are lactose intolerant, here are some things you can do:

* eat dairy foods in small amounts spread out over the day
* eat more nondairy, calcium-rich foods
* take calcium supplements
* use lactase pills, which make milk products more digestible.

Vitamin D helps your body absorb calcium. You need 400 to 800 IU (International Units) of vitamin D every day. Most people get enough vitamin D from such sources as:

* 15 minutes of exposure to sunlight
* egg yolks
* saltwater fish
* fortified dairy products
* vitamin and mineral supplements.

Exercise

Physical activity is also important to prevent osteoporosis and reduce falls that can result in fractures. Weight-bearing activities can help you maintain strong bones. Examples include:

* walking
* climbing stairs
* dancing
* lifting weights.

Other kinds of exercise will help you increase your flexibility and improve your balance to prevent falls. Examples include:

* tai chi
* bike riding
* swimming.

Talk to your doctor about an exercise program that is safe for you. If you have low bone density or osteoporosis, you should protect your spine by avoiding exercises and activities that flex, bend, or twist your spine.

A Healthy Lifestyle

Smoking and drinking too much alcohol are bad for bones. To protect your bones, do not smoke, and if you drink alcoholic beverages, do so in moderation.

Bone Density Testing

If you are at high risk for osteoporosis, you may want to ask your doctor if a bone density test is right for you. This test will help your doctor decide if you need medication to reduce your risk of fractures.

Bone density tests are quick and painless. You usually do not need to get undressed. The most widely recognized test is called a dual-energy x-ray absorptiometry or DXA test, which measures bone density at the hip and spine. If you are 65 years old or older, Medicare may pay for your test. Ask your doctor for more information.

Treatment of Osteoporosis

If bone density testing indicates that you have low bone density or osteoporosis, your doctor may prescribe treatment that includes calcium and vitamin D, exercise, and medication. Medications approved by the U.S. Food and Drug Administration (FDA) include:

* bisphosphonate drugs: alendronate (Fosamax¹), risedronate (Actonel), and ibandronate (Boniva)
* calcitonin (Miacalcin)
* raloxifene (Evista), a Selective Estrogen Receptor Modulator
* teriparatide (Forteo), a form of the hormone known as PTH, which is secreted by the parathyroid glands
* estrogen therapy (also called hormone therapy when estrogen and another hormone, progestin, are combined).

These medications provide a variety of choices. Your doctor can help you find the one that is best for you.
¹ Brand names included in this fact sheet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

A New Way to Build Bone

2007-04-05T00:20:00.034-07:00

The osteoblast cytoplasm is colored red in this transmission electron micrograph of a mature osteoblast on the bone surface.

Howard Hughes Medical Institute (HHMI) researchers at Stanford University have found that they can increase bone mass in mice by tweaking the shape of a regulatory protein.

HHMI investigator Gerald Crabtree and HHMI predoctoral fellow Monte Winslow report that slightly increasing the activity of a protein called NFATc1 causes massive bone accumulation, suggesting that NFATc1 or other proteins that regulate its activity will make good targets for drugs to treat osteoporosis. They report their findings in a study published in the June 6, 2006, issue of Developmental Cell.

“If you could find a small molecule that would flip 10 percent of the existing NFATc into the active form, you could favor the formation of osteoblasts and make stronger bones.”
Gerald R. Crabtree

In vertebrates, bone is constantly being formed and being broken down throughout life. Cells called osteoclasts continuously degrade bone, while cells called osteoblasts replenish it.

“Ideally, they are perfectly balanced,” said Crabtree, the senior author of the study. “Over the course of a lifetime, if everything goes well, we'll maintain almost exactly identical bone mass.” However, if the balance is upset, and more bone is destroyed than formed, osteoporosis results, increasing the risk of fractures.

The new study arose from the researchers' curiosity about reports that patients who were treated with the drug cyclosporine—often given to suppress the immune system before organ transplants—tend to lose bone mass. Those patients were also at increased risk of bone fractures, said first author Winslow, who led the study as an HHMI predoctoral fellow in Crabtree's lab. Winslow is now working as a postdoctoral fellow in the lab of HHMI investigator Tyler Jacks at the Massachusetts Institute of Technology.

Cyclosporine inhibits a signaling protein complex known as calcineurin, which chemically modifies the NFATc family of proteins. This modification changes its shape. With its new shape, NFATc can move into the nucleus of the cell, where it can trigger the activation of many genes. Although initially shown to regulate immune cell function, NFATc also functions in other cells to regulate heart development, blood vessel formation, neural development and function, and muscle development. Its function seems to depend on the time and place of its activation, like a context-sensitive key on a computer. In bone, it is NFATc1 that seems particularly important.

Since people with suppressed calcineurin/NFATc activity experience bone loss, Winslow, Crabtree, and their colleagues wanted to see whether this pathway would be important in bone development and function as well. They studied mutant mice in which the NFATc1 in osteoblasts had been modified so that it could move more easily to the nucleus and become a little more active than usual.

Mice with the hyperactive NFATc in their osteoblasts had an immense increase in bone mass compared to normal mice, suggesting that the balance between bone formation and breakdown had tipped.

When the researchers examined the cells in these mice, they found that up-regulating NFATc signaling in osteoblasts increased the numbers of both types of bone cells. “It was clear that increased NFATc activity in osteoblasts influenced both osteoblasts and osteoclasts,” Winslow said.

The researchers found that mice with enhanced NFATc activity in their osteoblasts had many more of these bone-forming cells, which explained the increase in bone mass. They also found a possible explanation for why there were more bone-destroying osteoclasts. Osteoblasts with hyperactive NFATc expressed higher levels of inflammatory proteins called chemokines, which promote osteoclast development.

“Osteoblasts produce factors that recruit the progenitors of osteoclasts, and so when osteoblast numbers go up, osteoclast numbers go up,” Crabtree said. This link between osteoblast and osteoclast numbers explains in part how the two types of cells normally stay balanced in animals, he added.

Mice with abnormally active NFATc probably develop so much bone mass because this delicate balance between osteoblasts and osteoclasts has been altered, Crabtree suggested. In the mutant mice, “there's also a huge increase in osteoclasts, but they never catch up,” he said. “The balance has been tipped.”

This imbalance between bone formation and degradation could potentially be recreated by drug treatments for osteoporosis, Crabtree said. Very little NFATc1 must be activated to build extra bone, Winslow noted, which means that it may be possible to up-regulate the calcineurin/NFATc pathway to promote bone formation without disturbing other organ systems that use this same pathway.

“The results were dramatic, yet the molecular alteration is very, very minimal,” Crabtree said. NFATc1 in the mice that developed extra bone mass was only 10 percent more active than it is in normal mice.

The researchers are now screening chemical libraries for small molecules that could increase NFATc just enough to promote bone formation in people with osteoporosis, without causing undesirable side effects. “If you could find a small molecule that would flip 10 percent of the existing NFATc into the active form,” Crabtree said, “you could favor the formation of osteoblasts and make stronger bones."

Bear Bones May Provide Key to Osteoporosis

2007-04-05T00:20:00.033-07:00

Bears don’t go to Florida when the snow flies, but they get to do the next best thing: curl up in a den and sleep away the winter.

If people did this, according to the prevailing medical wisdom, we’d wake up in the spring with a colossal appetite and bones the texture of sugar cookies. Bears, however, seem to have a special mechanism that protects them from developing weak bones, even though they sometimes lay around for months at a time.

Dr. Seth Donahue, an assistant professor in Michigan Tech’s Department of Biomedical Engineering, has been trying to figure out how bears manage to avoid osteoporosis, despite their sedentary ways.

The answer may lie in their hormones.

As in humans, bear bone tissue does break down during inactivity. However, while human bones don't rebuild while their owners are inactive, bears seem to be able to recycle their calcium with almost total efficiency. Even mother bears, who give birth and nurse their cubs during winter hibernation, don't lose bone density.

Donahue made this discovery while a doctoral student at Pennsylvania State University, analyzing blood serum from radio-collared bears. The results were published in the journal “Clinical Orthopaedics and Related Research.”

He’s continuing his work at Michigan Tech, trying to determine which hormones—or other molecules—help bears resist osteoporosis. He is also studying the bones of black bears donated by Upper Peninsula hunters.

Donahue and graduate student Kristin Harvey have been taking small sections from bear leg bones and observing them under a microscope to see if, as bears age, the bones are becoming more porous, a sign of osteoporosis. They aren’t. Chemical analysis of the bones also shows that they aren’t losing minerals, which are essential for strength.

Lastly, they have also been subjecting small pieces of bone to varying degrees of mechanical pressure, to determine how much stress is required to cause a breakage. No matter what the bears’ age, their bones are remarkably strong.

“Their teeth have rings, like trees, so we know exactly how old they are,” Donahue said. “Our preliminary results suggest that their bone density and fracture strength remains high, even as they age.”

“Bears aren’t affected by these annual periods of disuse, while other species have negative consequences,” he said.

Donahue thinks the key to bone health in bears may be a hormone that regulates calcium uptake. “It’s possible that the bears’ hormone has just a couple of amino acids out of sequence,” he said. If that’s the case, then maybe it would be possible to produce that hormone synthetically and prescribe it to people suffering from osteoporosis.

“Now, we don't have a treatment that works,” he said. “A few therapies slow down bone loss, but nothing can recover bone that's already been lost.”

One hundred years ago, osteoporosis was rare. But now, as people routinely live into their 70s, 80s and longer, it can degrade the quality of life.

As we get older, broken bones can be slow to heal and can cause chronic pain. Plus, most elderly patients are ill equipped to handle the stress of surgical treatment, and as a result their lives can be shortened. Approximately 24 percent of individuals over age 50 die within a year following a hip fracture.

Plus, the cost of treating and caring for the victims of osteoporosis runs into the billions of dollars.

According to the National Osteoporosis Foundation, osteoporosis is responsible for more than 1.5 million fractures annually (300,000 hip fractures, 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other sites).

In 2001, an estimated $17 billion was spent on the care of patients with osteoporotic and associated fractures in hospitals and nursing homes. Public health officials expect all these figures to climb as the numbers of frail elderly rise.

Donahue plans to publish the results of his most-recent research soon. He’s hoping to garner funding to begin studying the calcium-regulating hormone in bears. The calcium-regulating hormones are proteins, and determining their structure is a complicated and expensive process.

But the study of bears’ unique resistance to osteoporosis shows unusual promise, he believes. “It’s a model that shows a lot of potential,” Donahue said. “It’s naturally occurring, so we already know it works.”

Ultimately, all we need to know is whether it could work as well in people as it does in bears.

The Impact of Osteoporosis on Men's and Women's Health

2007-04-05T00:20:00.032-07:00

Osteoporosis is the medical term for a condition characterized by bone fragility, pain, fracture, disability, and death associated with fracture complications.

People tend to think of osteoporosis as an issue of women's health; however, it is not an exclusively female condition. Although the condition is more frequent among women, with one in three women over the age of fifty developing osteoporosis, up to one in twelve men will also be affected.

Osteoporosis is one of the most preventable bone diseases. Thanks to years of research, scientists have discovered many of the underlying causes of osteoporosis and some of the steps that can be taken to prevent the disease and avoid its potentially serious complications, such as bone fractures.

The search for a definitive osteoporosis cure is still underway. Meanwhile, awareness of risk factors and adopting proactive lifestyle changes, including proper nutrition, exercise, and possibly hormone supplementation can help prevent the onset of osteoporosis.

What's Best For Your Bones?

2007-04-05T00:20:00.031-07:00

Those advertisements pushing milk as the answer to strong bones are almost inescapable. But does "got milk" really translate into "got strong bones?"

The pro-milk faction believes that increased calcium intake - particularly in the form of the currently recommended three glasses of milk per day - will help prevent osteoporosis, the weakening of bones. Each year, osteoporosis leads to more than 1.5 million fractures, including 300,000 broken hips.

On the other side are those who believe that consuming a lot of milk and other dairy products will have little effect on the rate of fractures but may contribute to problems such as heart disease or prostate cancer.

Which view is right? The final answers aren't in. But here is a summary of what's currently known about calcium and its effects on the body.

What is calcium?

Calcium is a mineral that the body needs for numerous functions, including building and maintaining bones and teeth, blood clotting, the transmission of nerve impulses, and the regulation of the heart's rhythm. Ninety-nine percent of the calcium in the human body is stored in the bones and teeth. The remaining 1 percent is found in the blood and other tissues.

Where do we get calcium?

The body gets the calcium it needs in two ways. One is by eating foods that contain calcium. good sources include dairy products, which have the highest concentration per serving of highly absorbable calcium, and dark leafy greens or dried beans, which have varying amounts of absorbable calcium.

The other way the body gets calcium is by pulling it from bones. This happens when blood levels of calcium drop too low, usually when it's been a while since having eaten a meal containing calcium. Ideally, the calcium that is "borrowed" from the bones will be replaced at a later point. But, this doesn't always happen. Most important, this payback can't be accomplished simply by eating more calcium.

Growing healthy bones

Bone is living tissue that is always in flux. Throughout the lifespan, bones are constantly being broken down and built up in a process known as remodeling. Bone cells called osteoblasts build bone, while other bone cells called osteoclasts break down bone.

In healthy individuals who get enough calcium and physical activity, bone production exceeds bone destruction up to about age 30. After that, destruction typically exceeds production.

What is osteoporosis?

Osteoporosis, or "porous bones," is the weakening of bones caused by an imbalance between bone building and bone destruction. People typically lose bone as they age, despite consuming the recommended intake of calcium necessary to maintain optimal bone health. An estimated 10 million Americans - 8 million women and 2 million men - have osteoporosis. Another 34 million have low bone mass, placing them at increased risk for osteoporosis.(1)

Achieving adequate calcium intake and maximizing bone stores during the time when bone is rapidly deposited (up to age 30) provides an important foundation for the future. But it will not prevent bone loss later in life. The loss of bone with aging is due to several reasons, including genetic factors, physical inactivity, and lower levels of circulating hormones (estrogen in women and testosterone in men).

Postmenopausal women account for 80 percent of all cases of osteoporosis because estrogen production declines rapidly at menopause. Of course, men are also at risk of developing osteoporosis, but they tend to do so 5-10 years later than women, since testosterone levels do not fall abruptly the way estrogen does in women. It is estimated that osteoporosis will cause half of all women over age 50 to suffer a fracture of the hip, wrist, or vertebra.

How can osteoporosis be slowed down?

Preventing osteoporosis depends on two things: making the strongest, densest bones possible during the first 30 years of life and limiting the amount of bone loss in adulthood.

There are a number of lifestyle factors that can help with the latter:

* Getting regular exercise, especially weight-bearing and muscle strengthening exercise.
* Getting adequate vitamin D, whether through diet, exposure to sunshine, or supplements.
* Consuming enough calcium to reduce the amount the body has to borrow from bone.
* Consuming adequate vitamin K, found in green-leafy vegetables.
* Not getting too much preformed vitamin A.

Preventing bone loss in adulthood

Several complementary strategies can help prevent or minimize bone loss during adulthood and old age. These include:

Getting regular exercise

Physical activity that puts some strain or stress on bones causes the bones to retain and possibly even gain density throughout life. Cells within the bone sense this stress and respond by making the bone stronger and denser. Such "weight-bearing" exercises include walking, dancing, jogging, weightlifting, stair-climbing, racquet sports, and hiking.

Swimming is a useful form of exercise for the heart and cardiovascular system. But because water supports the bones, rather than putting stress on them, it's not considered a good "weight-bearing" exercise for bone strength. In addition, physical activity doesn't strengthen all bones, just those that are stressed, so you need a variety of exercises or activities to keep all your bones healthy.

Another function of physical activity, probably at least as important as its direct effect on bone mass, is its role in increasing muscle strength and coordination. With greater muscle strength, one can often avoid falls and situations that cause fractures. Making physical activity a habit can help maintain balance and avoid falls.

Getting enough calcium

Despite the debates surrounding milk and calcium, one thing is clear: adequate calcium - both for bone development and for non-bone functions - is key to reducing the risk of osteoporosis. However, the healthiest or safest amount of dietary calcium hasn't yet been established. Different scientific approaches have yielded different estimates, so it's important to consider all the evidence.

Balance studies - which examine the point at which the amount of calcium consumed equals the amount of calcium excreted - suggest that an adequate intake is 550 mg/day. To ensure that 95 percent of the population gets this much calcium, the National Academy of Sciences established the following recommended intake levels:

* 1,000 mg/day for those age 19-50
* 1,200 mg/day for those age 50 or over
* 1,000 mg/day for pregnant or lactating adult women

But most balance studies are short-term and therefore have important limitations. To detect how the body adapts to different calcium intakes over a long period of time - and to get the big picture of overall bone strength - requires studies of longer duration.

The results from such long-term studies may be surprising to some. While they do not question the importance of calcium in maximizing bone strength, they cast doubt on the value of consuming the large amounts currently recommended for adults.

In particular, these studies suggest that high calcium intake doesn't actually appear to lower a person's risk for osteoporosis. For example, in the large Harvard studies of male health professionals and female nurses, individuals who drank one glass of milk (or less) per week were at no greater risk of breaking a hip or forearm than were those who drank two or more glasses per week.(2, 3) Other studies have found similar results.

Additional evidence also supports the idea that American adults may not need as much calcium as is currently recommended. For example, in countries such as India, Japan, and Peru where average daily calcium intake is as low as 300 mg/day (less than a third of the US recommendation for adults, ages 19-50), the incidence of bone fractures is quite low. Of course, these countries differ in other important bone-health factors as well - such as level of physical activity and amount of sunlight - which could account for their low fracture rates.

Ideally, these issues might be resolved by randomizing a large group of adults to get different amounts of calcium and following them to see how many would eventually break a bone. In fact, a few such studies have been conducted, but they have not provided clear results because they were small or of short duration, or they provided calcium in combination with vitamins, which could obscure the true effects of calcium.

To illustrate the different conclusions drawn from examining the same body of data, a British committee that is comparable to the U.S. group that established calcium requirements here concluded that 700 mg/day was enough for individuals aged 19 and older.

Getting enough vitamin D

Vitamin D plays a critical role in maintaining bone health. When blood levels of calcium begin to drop, the body responds in several ways. It promotes the conversion of vitamin D into its active form, which then travels to the intestines (to encourage greater calcium absorption into the blood) and to the kidneys (to minimize calcium loss in the urine).

For bone health, an adequate intake of vitamin D is no less important than calcium. Vitamin D is found in milk and vitamin supplements, and it can be made by the skin when it is exposed to sunlight in the summertime. But not all sunlight is created equal. Above 40 degrees latitude (north of San Francisco, Denver, Indianapolis, and Philadelphia), the winter sunlight isn't strong enough to promote vitamin D formation. Sunscreens also prevent the formation of vitamin D, although they are still recommended to reduce risk of sun-induced skin cancer and skin damage.

An examination of clinical trials of vitamin D for the prevention of osteoporosis found that the vitamin decreases vertebral fractures and may decrease nonvertebral fractures.(4) A similar analysis of the effect of vitamin D on falls indicated that supplementation with vitamin D reduces the risk of falls among ambulatory or institutionalized older individuals with stable health by more than 20%.(5) (For more information on Vitamin D and chronic disease prevention, see Ask the Expert - Vitamin D.)

Getting enough vitamin K

Vitamin K, which is found mainly in green, leafy vegetables, likely plays one or more important roles in calcium regulation and bone formation.(6) Low intake of the vitamin has been associated with low bone mineral density in women, but not men.(7) Getting one or more servings per day of broccoli, Brussels spouts, dark green lettuce, collard greens, or kale should be enough to meet the daily recommended target of 120 micrograms/day for men and 90 micrograms/day for women.

Some other factors may also help lower the risk of osteoporosis:

* Take care with caffeine. Although the votes aren't all in, there is some evidence that drinking a lot of coffee - about four or more cups per day - can increase the risk of fracture. Caffeine tends to promote calcium excretion in urine.
* Avoid too much protein. Getting too much protein can leach calcium from your bones. As your body digests protein, it releases acids into the bloodstream, which the body neutralizes by drawing calcium from the bones. Animal protein seems to cause more of this calcium leaching than vegetable protein does.(3) Just how important protein is as a risk factor for osteoporosis is still up in the air.
* Get enough vitamin A, but not too much. Long-associated with good vision, vitamin A has also been found to direct the process of borrowing and redepositing calcium in bone. However, too much preformed vitamin A can promote fractures. Avoid vitamin supplements that have a full RDA (5,000 IU) of vitamin A as preformed vitamin A, unless prescribed by your doctor. Vitamin A in the form of beta-carotene does not increase one's fracture risk.

Postmenopausal women may also want to talk to a health care provider about taking a medication that can strengthen bones. The estrogen in postmenopausal hormones can compensate for the drop in estrogen levels after menopause, helping to prevent - and perhaps even partially reverse - bone loss. However, hormone replacement therapy has fallen from grace as the mainstay for preventing osteoporosis after results from several studies showed that it increased the risk of heart disease, stroke, and blood clots.(8) Other medications such as alendronate (Fosamax), risedronate (Actonel), calcitonin (Miacalcin), raloxifene (Evista), and parathyroid hormone (Fortéo) have been approved for the prevention or treatment of osteoporosis.

Should you get calcium from milk?

When most people in the United States think of calcium, they immediately think of milk. But should this be so? Milk is actually only one of many sources of calcium, and there are some important reasons why milk may not be the best source for everyone. These include:

* Lactose intolerance
Many people have some degree of lactose intolerance. For them, eating or drinking dairy products causes problems like cramping, bloating, gas, and diarrhea. These symptoms can range from mild to severe. Certain groups are much more likely to have lactose intolerance. For example, 90 percent of Asians, 70 percent of blacks and Native Americans, and 50 percent of Hispanics are lactose-intolerant, compared to only about 15 percent of people of Northern European descent.

One alternative for those who are lactose intolerant but who still enjoy consuming dairy products is to take a pill containing enzymes that digest milk sugar along with the dairy product, or to consume milk that has the lactase enzyme added to it.
* High saturated fat content
Many dairy products are high in saturated fats, and a high saturated fat intake is a risk factor for heart disease. And while it's true that most dairy products are now available in fat-reduced or nonfat options, the saturated fat that's removed from dairy products is inevitably consumed by someone, often in the form of premium ice cream, butter, or baked goods.

Strangely, it's often the same people who purchase these higher-fat products who also purchase the low-fat dairy products, so it's not clear that they're making great strides in cutting back on their saturated fat consumption. For more information on dietary fats, click here.
* Possible increased risk of ovarian cancer
High levels of galactose, a sugar released by the digestion of lactose in milk, have been studied as possibly damaging to the ovaries and leading to ovarian cancer. Although such associations have not been reported in all studies, there may be potential harm in consuming high amounts of dairy products.(9, 10)

* Possible increased risk of prostate cancer
A diet high in calcium has been implicated as a potential risk factor for prostate cancer. In a Harvard study of male health professionals, men who drank two or more glasses of milk a day were almost twice as likely to develop advanced prostate cancer as those who didn't drink milk at all.(11) Moreover, the association appears to be with calcium itself, rather than with dairy products in general.
Clearly, although more research is needed, we cannot be confident that high milk intake is safe.

The bottom line-recommendations for calcium intake and bone health

Adequate, lifelong dietary calcium intake is necessary to reduce the risk of osteoporosis. Consuming adequate calcium and vitamin D and performing regular, weight-bearing exercise are also important to build maximum bone density and strength. After age 30, these factors help slow bone loss, although they cannot completely prevent bone loss due to aging.

Milk and dairy products are a convenient source of calcium for many people. They are also a good source of protein and are fortified with vitamins D and A. At this time, however, the optimal intake of calcium as well as the optimal sources of calcium, are not clear. As noted earlier, the National Academy of Sciences currently recommends that people ages 19-50 consume 1,000 mg of calcium per day, and that those age 50 or over get 1,200 mg per day. Reaching 1200 mg per day would usually require drinking two to three glasses of milk per day over and above an overall healthy diet.

However, these recommendations are based on very short-term studies, and are likely to be higher than what people really need. Currently, there's no good evidence that consuming more than one serving of milk per day in addition to a reasonable diet (which typically provides about 300 milligrams of calcium per day from nondairy sources) will reduce fracture risk. Because of unresolved concerns about the risk of ovarian and prostate cancer, it may be prudent to avoid higher intakes of dairy products.

At moderate levels, though, consumption of calcium and dairy products has benefits beyond bone health, including possibly lowering the risk of high blood pressure and colon cancer.(12-14) While the blood pressure benefits appear fairly small, the protection against colon cancer seems somewhat larger, and most of the latter benefit comes from having just one glass of milk per day. Getting more than this doesn't seem to lower risk any further.

For individuals who are unable to digest - or who dislike - dairy products and for those who simply prefer not to consume large amounts of such foods, other options are available. Calcium can also be found in dark green leafy vegetables, such as kale and collard greens, and in dried beans and legumes.

Calcium is also found in spinach and chard, but these vegetables contain oxalic acid, which combines with the calcium to form calcium oxalate, a chemical salt that makes the calcium less available to the body. A variety of calcium-fortified foods, such as orange juice, are now on the market.

Calcium (and vitamin D) can also be ingested as a supplement. Antacids contain calcium as well. However, men may want to avoid calcium supplements for men because of questions about possible risks of prostate cancer.

An extensive list of the calcium content of foods is available online from the U.S. Department of Agriculture. These foods are good sources of calcium:
Food Amount Calcium
Yogurt, plain, low fat 8 oz
415
Collards, frozen, boiled 1 cup
357
Skim milk 1 cup
306
Spinach, frozen, boiled 1 cup
291
Yogurt, plain, whole milk 8 oz
275
Cheese food, pasteurized American 1 oz
162
Cottage cheese, 1% milk fat 1 cup
138
Baked beans, canned 1 cup
154
Iceberg lettuce 1 head
97
Canned salmon 3 oz
181
Oranges 1 cup
72
Trail mix (nuts, seeds, chocolate chips) 1 cup
159
Almonds 1 oz (24 nuts)
70
Blackeye peas, boiled 1 cup
211
Green peas, boiled 1 cup
94

References

1. Osteoporosis facts. National Osteoporosis Foundation.
2. Owusu W, Willett WC, Feskanich D, Ascherio A, Spiegelman D, Colditz GA. Calcium intake and the incidence of forearm and hip fractures among men. J Nutr 1997; 127:1782-7.
3. Feskanich D, Willett WC, Stampfer MJ, Colditz GA. Milk, dietary calcium, and bone fractures in women: a 12-year prospective study. Am J Public Health 1997; 87:992-7.
4. Papadimitropoulos E, Wells G, Shea B, et al. Meta-analyses of therapies for postmenopausal osteoporosis. VIII: Meta-analysis of the efficacy of vitamin D treatment in preventing osteoporosis in postmenopausal women. Endocr Rev 2002; 23:560-9.
5. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA 2004; 291:1999-2006.
6. Weber P. Vitamin K and bone health. Nutrition 2001; 17:880-7.
7. Booth SL, Broe KE, Gagnon DR, et al. Vitamin K intake and bone mineral density in women and men. Am J Clin Nutr 2003; 77:512-6.
8. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003; 349:523-34.
9. Cramer DW. Lactase persistence and milk consumption as determinants of ovarian cancer risk. Am J Epidemiol 1989; 130:904-10.
10. Cramer DW, Harlow BL, Willett WC, et al. Galactose consumption and metabolism in relation to the risk of ovarian cancer. Lancet 1989; 2:66-71.
11. Giovannucci E, Rimm EB, Wolk A, et al. Calcium and fructose intake in relation to risk of prostate cancer. Cancer Res 1998; 58:442-447.
12. Martinez ME, Willett WC. Calcium, vitamin D, and colorectal cancer: a review of the epidemiologic evidence. Cancer Epidemiol Biomarkers Prev 1998; 7:163-8.
13. Hyman J, Baron JA, Dain BJ, et al. Dietary and supplemental calcium and the recurrence of colorectal adenomas. Cancer Epidemiol Biomarkers Prev 1998; 7:291-5.
14. Cappuccio FP, Elliott P, Allender PS, Pryer J, Follman DA, Cutler JA. Epidemiologic association between dietary calcium intake and blood pressure: a meta-analysis of published data. Am J Epidemiol 1995; 142:935-45.

Osteoporosis remains undiagnosed in millions of Americans

2007-04-05T00:20:00.030-07:00

Osteoporosis remains undiagnosed in millions of Americans; here's how to beat the disease with nutrition, exercise and sunlight

Millions of Americans have osteoporosis but don't know it, according to a new study authored by Stanford University School of Medicine. It says that 10 million Americans have osteoporosis right now, and 4 million more are at risk, but many people don't notice that they have the condition until they receive a bone fracture -- usually in the hip, the spine, or the wrist.

There's a great deal of misinformation about osteoporosis in organized medicine. It's a highly lucrative disease -- more than 17 billion dollars were spent treating osteoporosis in 2001 alone, and I'm sure that number is much higher today. Osteoporosis sounds like a complex disease, but it really isn't. In Western medicine, doctors and researchers like to make things sound far more complicated than they really are, which is why this disease has such a complex-sounding name. But osteoporosis should really be named "brittle bones disease." It's nothing more than brittle bones, or a loss of bone mass or bone density. There's really nothing complicated about it.

The primary sources of this loss of bone mass are quiet simple -- they are diet and physical exercise. And it's not what you necessarily think about diet and physical exercise, so let's take a look at this in detail, and I'm confident you will learn some new information here about osteoporosis.

Osteoporosis is really caused by only three things. They are: 1) diet, 2) physical exercise, and 3) lack of exposure to natural sunlight. It's really not that complex, so let's take a closer look at these three things, and explore their correlation with osteoporosis and loss of bone density.

First, we have diet. When it comes to diet and osteoporosis, most people think that a lack of calcium is the number one dietary concern. But this isn't true -- calcium is only a minor factor when it comes to preventing and treating osteoporosis. Certainly calcium supplements can help, especially if they provide calcium derived from plant sources, but they alone cannot reverse osteoporosis.

The primary dietary cause of osteoporosis is the consumption of highly acidic foods and food ingredients, such as refined white sugar, refined white flour, high-fructose corn syrup, soft drinks, cookies, candies, sweets, desserts, and anything containing sweeteners. Something rather destructive happens in your body when you consume acidic ingredients. Your blood must maintain a specific pH level in order to support human health. If your pH varies from a level of about 7.1, you start to suffer rather destructive side effects, and if it strays extremely far from 7.1, you will die within a matter of minutes. So the body does everything possible to make sure that your blood maintains a healthy pH level. When you consume highly acidic foods, your body has to come up with a strategy for buffering the acidity of those foods with alkaline minerals, and the way it does that is by reaching into your skeletal system to find those alkaline minerals such as calcium and magnesium, then releasing those into your bloodstream to buffer the acidity of the food ingredients you have absorbed. In this way, your body can balance the pH of its blood and keep you alive.

So every time you drink a soft drink, or drink a product containing corn syrup or sugar, you are effectively taking a few grams of bone density right out of your skeletal system. This gets passed through your kidneys, where it can also contribute to kidney stones, by the way, and then leaves your body in your urine. In a very real sense then, you are pissing away your bones when you consume refined sugars and refined white flour. Anything that's highly acidic will cause this effect in your body.

This is the number one dietary cause of osteoporosis -- not a lack of calcium. And for many women, especially older women, it comes in the form of the sugar in their morning cup of coffee. They start their day with a drink that depletes their bone mass. And then they continue on with the day engaging in other lifestyle habits that deplete their bones even further. A couple of calcium supplements cannot undo all this damage.

To prevent losing your bone mass to dietary causes, simply avoid consuming any white flour, processed sugars, added sugars, soft drinks, sweets, candies, breads, or any other ingredients that are made with refined carbohydrates. Essentially, if you follow the low-carb diet, you will be well on your way to avoiding refined carbohydrates -- but beware -- red meat is also highly acidic. In fact, meat products are acidic in nature and will contribute to the acidity of your diet. If you want to have an alkaline diet, you need to be eating superfoods like chlorella and spirulina. You need to eat fresh vegetables like broccoli, cabbage, onions, celery, and other green, leafy vegetables. You need to get plenty of calcium and magnesium from healthy sources such as organic, plant-based vitamins. You also need to supplement your diet with various sea vegetables, which are naturally alkaline. Those include seaweed, kelp, and many others. And one of my favorite foods for supporting an alkaline diet is, of course, sprouts. I love sunflower sprouts, broccoli sprouts, clover sprouts, and other varieties. These are all considered superfoods because they have extremely high nutrient density.

The second cause of osteoporosis, or loss of bone mass, is lack of physical activity, and to understand this, you have to look at the miracle of the human body and understand how the human body knows to build bone mass in the first place. Bones are piezo-electric devices. As such devices, they give off an electric current when they are physically stressed. In other words, if you take a bone, and put it on a lab table and apply pressure to it, it will actually produce an electric charge. In your body, this electric charge attracts a matrix of minerals to the location that's being stressed where they add to the bone mass density and essentially build bigger and stronger bones.

In other words, by simply getting up and standing on your legs, you are telling your body you need to build stronger leg bones. If you walk on a regular basis, you're telling your body you need stronger hips. And the more you engage in these frequent stresses of your bones, the stronger your bones get. Your body has a very strong adaptation response to the activities that you choose to pursue, and this is one of those adaptation responses. In my book, it's a rather miraculous response because it allows the human body to adapt over time to almost any level of physical activity you choose to pursue.

Now, this is all basic stuff. This is really Anatomy and Physiology 101. These are the basics, right here, and yet I'm amazed at how many doctors neglect to tell their patients about the importance of physical exercise. Instead, they tend to treat osteoporosis with nothing but drugs. They imagine that osteoporosis is caused by a lack of prescription drugs, and therefore drugs are the only thing that can treat it. In fact, drugs are only marginally effective. The body has a much stronger, built-in system for reversing brittle bones disease, or osteoporosis if you want to call it that, and that mechanism is to simply stress your bones and then let your body build up higher bone density on its own. You don't even have to think about it -- all you have to do is stress your bones. Your body builds stronger bones automatically.

Now, to see some examples of why what I'm telling you is true, take a look at what happens to astronauts when they orbit the planet in zero gravity environments. The longer they stay in zero gravity, the more bone mass they start to lose. If they stay in zero gravity for several months, the bones literally become mushy (this is one of the major problems with long-term space travel). Their heads get spherical like a balloon and start to lose their earthly shape. When they eventually come back to earth, some astronauts can hardly walk at all -- their bodies have lost the ability to support their own weight, and they have to undergo physical rehab (gravity training, basically) in the earth's gravity in order for their body to readapt to an environment that has to support their body weight.

It can happen that fast, and if you sit on the couch most of the day, or lay in bed most of the day, and don't expose your body to earth's gravity by standing or walking, you are essentially giving yourself a sort of zero gravity treatment -- you're telling your body that you don't need your bones, and therefore your body will get rid its "extra" bone mass. See, the body is a highly efficient machine. The body lets go of things that you don't absolutely need. That's because during human evolution, calories were scarce, and it didn't make strategic sense for an organism to invest caloric energy in muscle mass or bone mass that wasn't needed. That's why if you stop working out you'll lose muscle mass, and if you stop walking and stressing your bones, you will lose bone mass. Once again, this is really basic stuff -- there's nothing complex in this at all. Osteoporosis is simply a name given to a set of symptoms that will appear when a person stops exercising their body and stops stressing their bones. Physicians never describe it in these terms, of course. They want to make it sound complicated, technical, and out of your intellectual range. But if you can understand the effects of gravity and the acidity of unhealthful foods, you already know all you need to know about preventing osteoporosis.

With all of that in mind, it's very easy to see how you can prevent and even reverse osteoporosis regardless of your current age. The first thing is, of course, to shift to a highly alkaline diet and avoid all acidic food and drinks. The second thing is to engage in regular physical exercise, such as walking, jogging, swimming, cycling and so on. Of course, you should always be working with a health professional before undergoing any new exercise program to make sure that you're capable of handling it, but even if you can't engage in something like jogging, there's always something you can do -- there's some way you can move your body, even if it means sitting in a chair and pumping some dumbbells a few times a day.

In all of this, I must also stress the importance of undergoing strength training. Nothing increases your bone density like strength training. And I'm talking about going to the gym and pushing weights on weight machines. This will increase your bone mass density so rapidly that it will absolutely stun you and your doctors. No prescription drug can come close to duplicating the effectiveness of strength training on your bone mass.

See, when you lift your own body, you're stressing your bones to a certain degree, and that's helping build bone mass to a limit. But when you start adding weight to your body and lifting that as well as your body weight, you're telling your body that you need even more density in your bones. So, if you put 100 pounds on your shoulders and squat that weight using your leg muscles and your pelvis for support, you are essentially telling your body that you need stronger leg muscles and a stronger skeletal system to support that weight. This gives you a higher degree of adaptive response than you could possibly achieve from lifting only your body weight. So strength training is absolutely essential, especially for elderly people who wish to prevent or reverse osteoporosis, and yet it is precisely elderly people who tend to avoid strength training because they carry the misconception that it's an activity for young people only. But in reality, it is older people who need it far more than younger people.

Moving onto the third part of osteoporosis, let's talk about natural sunlight. When you don't get natural sunlight, your body thinks that you're in hibernation, in a sense. And a lot of things start to go wrong with your body and your mind when you lack natural sunlight on your skin. Osteoporosis is one of those things. That's because when you expose your skin to sunlight, your body automatically generates vitamin D, and vitamin D is essential for using calcium to build increased bone mass. Without vitamin D in your body, your body cannot use the calcium that you're eating in your diet. So you could be eating all the calcium in the world, and you could be exercising every day, but if you're not getting sunlight on your skin, and you're not getting vitamin D into your body, and you don't have the fundamental building blocks that your body needs to add to its own bone mass. This will inevitably result in a great loss of bone mass or an inability to add any new bone mass.

Natural sunlight is absolutely essential to this process. You have to get it on your skin, on a frequent basis, without sunscreen. The next best thing if you can't get natural sunlight is to take vitamin D supplements such as cod liver oil. You can also get vitamin D in other forms, but cod liver oil is the best form available. You can find it any health food store. But remember you can make vitamin D yourself simply by getting some sunlight on your skin (your body is a living, breathing vitamin D factory...).

How much sunlight do you need? I say 30 minutes a day, but it depends on where you live on the planet. The closer you are to the equator, the less time you need in the sun. But the darker your skin, the more time you need, so a person who lives close to the equator but has dark skin pigmentation needs far more sunlight exposure than, say, a person living close to the equator with pale skin. At the same time, a person with dark skin living in northern climates, such as Canada or the UK, needs a very large amount of time in the sun in order to maintain optimum health.

That's because people with dark sun pigmentation did not evolve in such northern climates. They actually evolved in more equatorial regions where sunlight was far more intense. It's also important to note that you should avoid using sunscreens during the time that you're attempting to get sunlight nutrition. That's because sunscreen will block the sun from being absorbed by your skin, and of course it's pointless to pursue nutrition from the sun if you're using sunscreen to block it in the first place. You have to get natural sunlight on your skin without any interference.

Of course, use common sense here. If you're pale and not used to getting sun on your skin, you may be easily burned at first. So watch your time in the sun, especially when you're not using sunscreen. Over time, of course, your skin will adapt and you will be able to handle far longer times in the sun.

The bottom line is that if you put all these three together -- diet, physical exercise, and exposure to natural sunlight -- you can quite easily prevent and even reverse osteoporosis. This is a very simple disease. It has a few simple causes, and it's incredibly easy to reverse. You do not need prescription drugs to treat this disease. You do not need surgical procedures or other radical medical therapies. Osteoporosis is a natural result of poor dietary and lifestyle habits, and it can be easily reversed in a matter of months by changing what you do on a daily basis.

The fact that it goes undiagnosed in so many millions of Americans simply speaks to the fact that American society is an extremely unhealthful society that consumes vast quantities of sugars and processed foods, avoids physical exercise, and flees from the sunlight as if were some kind of raging demon in the sky. But you, I think, know better, and now you know how to prevent and reverse osteoporosis without using prescription drugs, no matter what your age.

New weapon in battle against osteoporosis

2007-04-05T00:20:00.029-07:00

Substance reduces bone loss in mice
Medical researchers at the University of Bonn, working in collaboration with scientists from Israel, the USA and Britain, have identified a previously unknown regulatory mechanism in the process of bone loss. Their findings could open up new approaches to the treatment of osteoporosis. More than four million people, predominantly women, are estimated to suffer from this distressing illness in Germany alone. In recognition of the importance of her results, Dr. Meliha Karsak from the Bonn-based Life & Brain Center has recently been awarded the Osteology Prize of the German Society for Endocrinology, which entails a cash award of 8,000 euros. Her study will now be published in the renowned "Proceedings of the National Academy of Sciences" (PNAS).

Working together with colleagues from the University of Jeruslam, Dr. Meliha Karsak found that mice with a particular gene defect have a lower bone density. This breakthrough is making "cannabinoidreceptors" a key focus of osteoporosis research.

"We know two types of cannabinoidreceptors, CB1 and CB2," explains Dr. Karsak. "The CB1 receptor is formed by nerve cells in the brain and is responsible for, among other things, the mental effect of cannabis. The CB2 receptor, on the other hand, does not occur in nerve cells; its function was previously unknown." To explore this function the scientists working with Bonn's senior brain expert Professor Dr. Andreas Zimmer have made genetic modifications in mice in order to switch off their CB2 receptor. Dr. Karsak summarises what happened: "The animals gradually lost their stabilising trabeculae. We found in these mice that the number of osteoclasts � special cells that can break down the bone tissue �increases by almost 50 per cent."

Signal molecules regulate bone density

Together with a research group from Israel and England, Dr. Karsak was able to demonstrate that osteoclasts, as well as their opposite number, the osteoblasts, which are responsible for building bone, carry CB2 receptors on their surface. In this way it appears that signal molecules like the endocannabinoids being formed by the body are able to regulate bone growth.

This thesis has been supported by experiments on mice whose ovaries were removed. The resulting oestrogen deficiency would normally lead to a depletion of bone material and finally to "mouse osteoporosis". "We treated these mice with an active substance that bonds specifically to the CB2 receptor. In this way we were able to diminish the bone loss caused by ovary removal," explains the molecular biologist.

Many patients carry a particular variant of the CB2 gene

But how far can these results be applied to human beings? To answer this question, Dr. Karsak turned to a team of scientists working in France who had access to genetic samples from more than 160 female osteoporosis patients and 240 healthy women. This line of enquiry proved a complete success: "We found that a specific variant of the CB2 gene occurs more frequently among the patients than among the healthy control group," says Dr. Karsak. Individuals who carry this defect in their genetic make-up are not destined to have problems. However, as she points out, "Women with this mutation have a three-fold higher risk of osteoporosis."

The results show not only that the CB2 receptor is essential for the maintenance of a normal bone mass; they also open up completely new possibilities for therapy: "In many women with osteoporosis the CB2 receptor functions, so in their cases the disease has other causes. For them we could consider stimulating the receptor through medication and in this way slow down their bone loss." The possibility that this approach can work has been demonstrated by the experiments on mice without ovaries.

The findings hold out hope for women with a CB2 defect, too. First, it is easy to identify whether a woman is carrying the relevant mutation, so the results promise improved and faster diagnosis. Second, they have drawn attention to a previously unknown regulatory mechanism, making it a focus of osteoporosis research. Here lies the chance of developing new medicines in the long-term.

What is osteoporosis?

2007-04-05T00:20:00.028-07:00

Osteoporosis, which literally means "porous bone", is a disease in which the density and quality of bone are reduced. As the bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs "silently" and progressively. Often there are no symptoms until the first fracture occurs.

The most common fractures associated with osteoporosis occur at the hip, spine and wrist. The incidence of these fractures, particularly at the hip and spine, increases with age in both women and men.

Of notable concern are vertebral (spinal) and hip fractures. Vertebral fractures can result in serious consequences, including loss of height, intense back pain and deformity. A hip fracture often requires surgery and may result in loss of independent living.

The good news is that osteoporosis is now a largely treatable condition and, with a combination of lifestyle changes and appropriate medical treatment, many fractures can be avoided.

Do you know what nutritional supplements you need?

2007-04-05T00:20:00.027-07:00

Dozens of studies published in peer-reviewed medical journals have reported that people who either take vitamin supplements or have higher blood levels of certain vitamins, especially the antioxidant vitamins C and E and the carotene family (precursors of vitamin A), are in better health than those who don't.

For instance, various studies indicate that folate and vitamin B6 can reduce the risk of heart attack, and that vitamin C exerts a protective effect on the arteries of diabetics. Medium to high doses of vitamin C and betacarotene, as well as elevated doses of vitamin D, have been linked to a reduced risk of osteoarthritis and less pain should the osteoarthritis strike.

In a Finnish study, male smokers who took small doses of vitamin E lowered their chances of getting prostate cancer by 30 percent and lowered their risk of dying from prostate cancer by over 40 percent. What's more, American and European studies have found that lycopene, a member of the carotene family that is found in tomatoes and other vegetables, seems to help prevent prostate and colorectal cancer and possibly coronary heart disease.

While Americans spend millions of dollars annually on vitamins, minerals, herbs and other nutritional supplements, the supplement industry is unregulated by the FDA and thus does not have to adhere to strict government standards. This means that consumers may not always be buying what they think they're buying. In the worst-case scenario, tainted supplements (such as melatonin) have been known to cause illness and death.

Nevertheless, many people take their nutritional supplements every day without fail because they believe they can cure and prevent illness, raise energy levels and increase longevity. But how many of us actually understand what kind of vitamins and other supplements we need, along with knowing the unique capabilities and differences between various supplements?

"It can be difficult for individuals to correctly assess which supplements they need," says Dale Prokupek, M.D., a board-certified gastroenterologist and director of the Educational Subcommittee of the Division of Nutrition and Gastroenterology at Cedars-Sinai Hospital in Los Angeles. "Generally, it doesn't hurt to take vitamin supplements as long as you don't overconsume them," says Dr. Prokupek. "Eating a balanced diet meets the standard vitamin requirements for most people over 40," he adds, "but there are reasons to supplement certain vitamins at certain times -- for instance, supplements to help promote cognitive functions in older adults, iron supplements during exercise or as an adjunct to a strict vegetarian diet."

Some people, however, can benefit from taking vitamin/mineral supplements because they fail to consume enough crucial minerals, such as calcium, iron or selenium, in their daily diets. And how do you know if you're mineral-deficient? "Go to your primary care doctor for a serum mineral level blood test," advises Dr. Prokupek. "This is the only way to find out what an individual's mineral levels are." Whatever you do, don't design your own vitamin program without consulting your doctor.

There are two types of vitamins. The fat-soluble ones, such as A, D, E and K, are stored in the body. Then there are the water-soluble ones, such as C, thiamine, riboflavin, B6, niacin, folacin, B12, biotin and pantothenic acid.

Dr. Prokupek, who designs and personally mixes his own vitamin formulas for his patients, says that the ideal way to take vitamins is to "customize vitamin and mineral intake according to family history." For example, if an individual's family history includes a predisposition toward heart disease, high blood pressure and high cholesterol, supplementation with a heart-healthy formula including flax seed, fiber, folic acid, vitamins A, C and E, selenium and grapeseed oil might be recommended.

For individuals who want to prevent or slow the progression of Alzheimer's disease and senile dementia, a vitamin formula including B6, pyridoxine, vitamin E, phosphatidyl serine, ginkgo and other elements might be a worthwhile supplement. Besides being linked to a slower risk of colon cancer and coronary heart disease and a slower progression of Alzheimer's disease, vitamin E has also been shown to boost immunity in elderly people.

The main thing to remember when choosing supplements, says Dr. Prokupek, is to "ensure you understand your health condition and then define your goals. Your health condition," says Dr. Prokupek, "should determine which supplements you take." Another good idea, he adds, is to re-evaluate your diet. "Try and see how you might be consuming more vitamins, minerals and fiber through your food," he says. "Snacking on an apple or carrots once or twice a day is a healthy and natural way to get more vitamins and fiber."

Fight Osteoporosis: Bone Up On B12

2007-04-05T00:20:00.026-07:00

Women are about four times more likely than men to develop osteoporosis, or weak, porous bones. But a new study links vitamin B12 deficiency with low bone mineral density in men, and confirms similar, previously reported findings in women.

Researchers funded by the Agricultural Research Service (ARS) reported the findings in the Journal of Bone and Mineral Research. The study was led by epidemiologist Katherine Tucker with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, Mass. Tucker directs the HNRCA's Dietary Assessment and Epidemiology Research Program.

While vitamin B12 deficiency has been linked with low levels of markers of bone formation, the mechanism behind the relationship is not known.

The scientists examined the relationship between vitamin B12 blood levels and indicators of bone health measured in 2,576 men and women, aged 30 to 87, participating in the Framingham Osteoporosis Study. They found that those with vitamin B12 levels lower than 148 picomoles per liter (pM/L) were at greater risk of osteoporosis than those with higher levels. Plasma B12 levels below 185 pM/L are considered "very low," according to some experts.

The study found that those with vitamin B12 concentrations below 148 pM/L had significantly lower average bone mineral density--at the hip in men, and at the spine in women--than those with concentrations above.

The range of symptoms of B-12 deficiency includes anemia, balance disturbances and cognitive decline. Osteoporosis usually progresses with no outward effect until a fracture occurs.

The recommended dietary allowance for vitamin B12 is 2.4 micrograms per day for both men and women. Low stomach acid and aging can lower the ability to absorb the vitamin. Those over age 50 are encouraged to consume fortified foods or supplements containing B12.

This study suggests adequate vitamin B12 intake is important for maintaining bone mineral density. Animal protein foods, such as fish, liver, beef, pork, milk and cheese are good sources of vitamin B12.

ARS is the U.S. Department of Agriculture's chief scientific research agency.

Note: This story has been adapted from a news release issued by USDA/Agricultural Research Service.

Calcium, Osteoporosis, and the Selling of Dairy Products

2007-04-05T00:20:00.025-07:00

The National Dairy Council wants you to drink your milk. The Physicians Committee for Responsible Medicine (PCRM) doesn't. At issue is your risk of developing osteoporosis and a few billion dollars in profits for the dairy industry.
1. Preventing and Reversing Osteoporosis

Excerpt: While patients tend to assume that boosting their calcium intake will ensure strong bones, research clearly shows that calcium intake is only part of the issue and that simply increasing calcium intake is an inadequate strategy. No less important is reducing calcium losses. The loss of bone mineral probably results from a combination of genetics and dietary and lifestyle factors, particularly the intake of animal protein, salt, and possibly caffeine, along with tobacco use, physical inactivity, and lack of sun exposure.

Would it surprise you that huge, multi-billion-dollar companies who profit from the sale of dairy products and calcium supplements think you need more calcium?

Animal protein tends to leach calcium from the bones, leading to its excretion in the urine. Animal proteins are high in sulfur-containing amino acids, especially cystine and methionine. Sulfur is converted to sulfate, which tends to acidify the blood. During the process of neutralizing this acid, bone dissolves into the bloodstream and filters through the kidneys into the urine. Meats and eggs contain two to five times more of these sulfur-containing amino acids than are found in plant foods. More click for more

But is milk really effective in helping adults prevent osteoporosis? The segment then turned to Harvard Professor Walter Willett, one of the top health researchers in the country. According to Willett, "There's really no good evidence that increasing milk consumption by adults will reduce their risk of fractures." More click for more

Two studies have revealed that soy may play an important role in the prevention and treatment of osteoporosis, a disease that can affect 24 million Americans. [...] A study by the Division of Nutritional Science, University of Illinois at Champaign-Urbana found that post-menopausal women with high concentrations of soy in their diet had stronger bone health. More click for more
2. What's Wrong With Dairy Products?

Excerpt: Insulin-dependent diabetes (Type I or childhood-onset) is linked to consumption of dairy products. Epidemiological studies of various countries show a strong correlation between the use of dairy products and the incidence of insulin-dependent diabetes. Researchers in 1992 found that a specific dairy protein sparks an auto-immune reaction, which is believed to be what destroys the insulin-producing cells of the pancreas. More click for more
3. Protecting Your Bones

BroccoliContrary to popular belief, calcium does not protect bones. Not by itself, anyway. But since the body compensates for a calcium deficiency by leaching calcium from bones, it is important to get anough. So what are the best sources? Surprisingly -- at least for people who get their nutritional guidance from dairy council advertising -- milk is not a very good source. Sure, it's loaded with calcium, but it's not as easy for the body to absorb it as the calcium in kale or swiss chard, and the presence of protein, fats, and other products can cause the body to lose calcium from bones.

That's why the largest study of its kind found that eating dairy products provided no protection at all against bone fractures!

The most healthful calcium sources are green leafy vegetables and legumes, or "greens and beans" for short. Broccoli, Brussels sprouts, collards, kale, mustard greens, Swiss chard, and other greens are loaded with highly absorbable calcium and a host of other healthful nutrients. More click for more
American Fitness Professionals & Associates (AFPA)

The medical profession and the media encourage the public to drink milk and eat dairy products because "it does the body good". Nothing could be further from the truth! Higher calcium and protein intake is purported to lower the incidence of osteoporosis according to the Dairy Council [but] the largest study of diet and disease in medical history [shows that] higher animal calcium and animal protein intake is the primary cause of degenerative disease. More click for more

Organic calcium is found within the body in the matrix, spongy living core of the bones. Animal dairy products contain inorganic calcium. Which is not recognized, nor utilized by the body. Dr. Stanley Kaplan, MD has found that organic calcium losses were elevated markedly in individuals for 3-4 hours after a meal rich in calcium from dairy and high in protein. Independent medical studies, those not funded by the Dairy Council, have concluded that excessive calcium found in the body (in the blood stream ) will not be recognized. Instead, this inorganic calcium from animal sources are removed from the blood and collected in the kidneys. This can lead to the development of kidney stones. The body requires calcium for life and daily bodily repair. Since there is no usable calcium available the brain instructs the bone matrix to release organic calcium into the blood stream. The net result is a loss of calcium from the bone matrix. This loss causes a weakening of the bone resulting in osteoporosis according to Dr. John McDougall, M.D. More click for more
The Big Business Connection: Who Really Profits?

Would it surprise you that huge, multi-billion-dollar companies who profit from the sale of dairy products and calcium supplements think you need more calcium?

From Endocrineweb: Recent studies have shown that many American girls do not get enough calcium in their diet after the age of 11. Much of this is blamed upon the substitution of sodas in the diet for milk [....] The vast majority of endocrinologists encourage their female patients to take supplemental calcium daily. One of the easiest and most effective methods of increasing your calcium intake is to take an oral calcium supplement [...] such as Citracal [...].

Surprise, surprise ... there was an ad for Citracal on the page!

From the National Dairy Council: CASE STUDY OF "JUNK SCIENCE": "Further fueling misinformation [...] are activists like the Physicians Committee for Responsible Medicine (PCRM) and People for the Ethical Treatment of Animals (PETA). The PCRM and PETA have been conducting a systematic and misleading anti-milk campaign to further their own animal rights and vegan agendas. These groups inappropriately interpret observational research to make bogus food and health claims promoted on the Internet to unnecessarily scare millions of consumers."

Notice the derogatory use of "activist" to mean "fanatic." Of course, the National Dairy Council isn't an activist organization at all! They have no agenda! Their idea of plain talk is to use loaded words like "misleading," "inappropriate," "bogus," and "scare."

Why the Dairy People would Rather Sling Mud than Talk Science

Perhaps because it could not substantiate its claim that PCRM used junk science, the thrust of the Dairy Council's press release was to attack PCRM by dismissing the organization as, "a fringe anti-meat, anti-dairy, animal rights group." The Dairy Council went on to deride PCRM's milk warnings as, "ridiculous and irresponsible," and attacked PCRM for trying to push a "hidden agenda." It's true PCRM has an agenda, as does any group that seeks to modify a population's eating patterns, but this agenda is certainly not hidden. PCRM has never tried to hide its position that a vegan lifestyle offers numerous health, environmental, and ethical advantages. In fact, it's fair to say that PCRM publicizes a vegan-oriented message at every opportunity. Indeed, if anyone has a "hidden agenda" it's not PCRM but rather the National Dairy Council.

The National Dairy Council concluded its June 1 press release with the words: "Consumers are warned against taking nutritional guidance from activist groups that are trying to promote their own agendas." But isn't it much more hazardous for consumers to take nutritional guidance from business groups that are trying to promote their own agendas, namely selling a product? According to the Dairy Council's logic, we should ignore non-profit publicly funded groups like PCRM and instead base our eating decisions on information provided by industry-funded "science" groups. The point of attacking PCRM is that the Dairy Council does not want consumers to realize that calcium is abundant in numerous non-dairy foods. Contrary to the Dairy Council's propaganda, it's easy to construct a dairy-free diet that delivers sufficient calcium. By relying on plants rather than cows to provide your calcium needs, you also avoid cholesterol, saturated fat, somatic (pus) cells, potential risks arising from rBGH injections, and a number of other undesirable elements that come in every glass of milk.
Letter to “Dear Abby”

Dear Abby:

In your May 27 column, you gave "Future Orthopedic Surgeon in Virginia" an A+ for his letter about osteoporosis. I suggest you take a second look and reduce his grade to a "C." It's surprising in this day and age, but almost no medical school requires courses in human nutrition, and some don't even offer one! So it's not surprising he was a little confused.

It is important to get enough calcium, but according to Dr. John McDougall, "Calcium deficiency caused by an insufficient amount of calcium in the diet is not known to exist in humans." And Dr. Walter Willett studied 80,000 women over a twelve year period and found that women who consumed three or more servings of dairy a day did not add any protection against bone fractures.

In addition, milk and dairy products are not the best sources of calcium. For one thing, "skim" or not, they're still loaded with fat, and -- if you're not careful where you shop -- could contain growth hormones, the carcinogenic IGF-I, antibiotics, and traces of other drugs, like tranquilizers. The Federal Trade Commission forced milk producers to pull their original ad campaign ("Everybody needs milk"), calling it "false, misleading and deceptive." In fact, contrary to what was printed in your column, excess protein prevents absorption of calcium, and can actually leach it from your bones, causing osteoporosis. Dr. Neal Barnard writes, "Dairy products contain sodium and animal protein, both of which encourage calcium losses."

Abby, the average American eats double the amount of protein they need! No wonder we have a higher incidence of osteoporosis than, say, Japan, where they rarely drink milk. The low fat Japanese diet also helps explain why severe symptoms of menopause are virtually unknown there.

Based on absorption characteristics, the best sources of usable calcium are collard greens, turnip greens, and kale. Yes, greens -- the stuff your grandmother made you eat. One cup of kale, for instance, contains only 179 mg of calcium vs. 302 mg for milk, but your body can use 50-70% of it, yielding, on average, 107 mg. You can only use about 30% of the calcium in milk, so you only get 91 mg of calcium per cup of milk. And collard greens have almost twice as much! Other excellent sources include turnip greens, soy, broccoli, cornbread, and beans.

By avoiding dairy products, you can help not only the cows, but yourself, by reducing the risk of osteoporosis, food allergies, asthma, obesity, and heart disease.

Excessive Calcium Causes Osteoporosis

2007-04-05T00:20:00.024-07:00

The older you get, the higher your risk of osteoporosis.

Obviously, osteoporosis is about aging.

Osteoporosis patients originally had very strong bones, like everybody else.

Osteoporosis is not about the inability to build strong bones, but about premature degeneration of the bones.

What makes the bones degenerate prematurely?

Somehow, osteoporotic bones have degenerated more than healthy bones of the same age. In osteoporotic patients, the bones have obviously aged faster. Osteoporosis is about prematurely aged bones.

So, the key question is:

What accelerates aging of the bones?

All our organs age. In all our organs cells constantly replicate themselves; they wear out and are replaced by new ones. And because the number of times cells can replicate is fixed, organs eventually age. Like the skin eventually becomes wrinkled when there are less cells available to replace the dehydrated old skin-cells.

We all know that if we expose our skin to the sun too much, that we will look older sooner. Excessive sun-exposure accelerates he aging of the skin. It does so because the sun burns the outer skin cells, which must be replaced by new cells sooner. And the sooner cells must be replaced, the sooner the moment will come that these cells cannot replicate anymore.

Accelerated aging of cells is about a higher turnover of cells; new cells replacing old cells more frequently.

What causes old bone-cells to be replaced by new ones sooner?

We know that estrogen is protective. (and androgens to a lesser extent) All bone-scientists acknowledge that if the female body has sufficient estrogen at it's disposal all the time, osteoporosis risk is far lower.

That is why osteoporosis risk is 3-fold higher in women: In women the estrogen level is far lower every 4th week, and the bones are less protected at that time. And in post-menopausal women, estrogen level is permanently decreased.

If we knew exactly how estrogen protects against premature aging of the bones, we would also know how the opposite process enhances osteoporosis.

So, how exactly is bone-metabolism influenced by estrogen?

Estrogen inhibits both the uptake of calcium into the bones (1) and deportation of calcium from the bones. (See Calcium Hormones)

But how exactly can processing more calcium cause osteoporosis?

The absorption of calcium requires the activity of specialized cells: osteoblasts. These osteoblasts also compose pre-calcified bone-matrix, upon which the calcium can precipitate. Deportation of calcium from the bones requires the activity of osteoclasts.

If more calcium is absorbed into the bones, like due to a lack of estrogen (2), the production and activity of both osteoblasts and osteoclasts is increased (3) (as in hyperparathyroidism). If much calcium is absorbed, much calcium is deported. But 50 to 70% of the composing osteoblasts die in the composition of new matrix. (4) The more their activity is stimulated, the more they die (5). And since estrogen inhibits uptake of calcium, estrogen prevents the death of osteoblasts (6).

If you consume higher amounts of calcium all your life, the replacement of osteoblasts maybe increased all this time; many people succeed in increasing bone-mineral density by consuming more calcium. (7) That is why the average BMD is higher in residents of countries where much milk is consumed.

Since the number of times a cell can be replaced is fixed, the replicative capacity will be exhausted sooner if much calcium is absorbed on a regular basis. And if replacement capacity is exhausted, there will be a lack of new osteoblasts. And since only these osteoblasts can compose bone-matrix, too little new bone-matrix can be composed. But without the matrix, the calcium cannot precipitate, and new bone cannot be composed, while old bone is constantly being decomposed anyway, to be replaced by new bone. Since there is a lack of pre-calcified bone matrix upon which to build, replacement cannot occur, and porous holes will begin to appear.

And this is exactly what happens in osteoporosis: in osteoporotic bone the osteoblasts cannot be replaced adequately anymore, and thus less osteoblasts are available (8) and/or the activity of osteoblasts is at least impaired, (9) like ‘exaggeratedly aged’ bones. (10) In osteoporotic bones there is less matrix available that can yet be calcified than in healthy bones. (11) In osteoporosis dead cells cannot be replaced and micro-fractures cannot be repaired. (12)

Does that mean that dietary calcium causes osteoporosis?

Only if too much calcium is actually absorbed into the bones.

As with all minerals, the body normally absorbs just as much calcium from our food as it needs. Only about 200 mg is absorbed into the blood, on the average, whether we consume 300 mg or 700 mg calcium daily, or sometimes even when we consume up to 1200 mg supplementary calcium daily. (13) In order to absorb the right amount of calcium, absorption rate decreases when we consume more calcium.

But if we consume too much calcium, the absorption rate cannot be sufficiently decreased; about 5% of dietary calcium on top of 1500 mg a day is yet absorbed into the blood. For example: Consuming 5-fold more calcium than before, a group of girls did, in fact, absorb twice as much calcium (as before) into the blood. (14)

But why is this extra calcium absorbed in the bones?

This is to prevent blood-calcium level from rising too much.

Muscles can only function if calcium from inside the muscle cells can be deported outside the cells. If blood-calcium level were too high, this wouldn't be possible; it would be lethal since breathing requires muscle-action. To save your life excessive dietary calcium is temporarily stored in the bones, prior to excretion. Normally the blood contains a total of 500 mg calcium. The difference between highest and lowest blood-calcium level is only 26%, thanks to the three different hormones that prevent our blood from containing too much (or too little) calcium. After the calcium has been absorbed into the bones two of these hormones stimulate deportation of calcium from the bones, and the third one stimulates excretion of calcium into urine.

But why don’t the bones hold on to that extra calcium?

According to the old doctrine, we can prevent osteoporosis by stacking more calcium in the bones. “The more calcium your bones contain, the longer it will take before they are empty.”

This would be a simple solution if the bones did indeed hold on to that extra calcium, but…

Our bones are built according to a plan - just like a house, and the amount of calcium in the bones has to be according to that plan. Just as piling up bricks in your living room does not make your house better or stronger, stacking extra calcium in the bones is not an improvement either. To be able to watch TV and clean your house properly, you throw the bricks out.

The redundant calcium in your bones is always deported eventually. To preserve redundant calcium in your bones, you have to keep on consuming lots of calcium daily. But no matter how much milk you drink, or supplementary calcium you take (or not at all), your bones always contain less calcium at the age of 70 than at the age of 30.

The problem is that all this extra calcium is processed by osteoblasts and osteoclasts. If you have been absorbing 400 mg instead of 200 mg dietary calcium into the blood daily, these cells have had to process 2.9 million mg more calcium during these 40 years.

Since all this extra calcium is absorbed due to the action of osteoblasts, these osteoblasts die sooner, leaving you with too little new bone-matrix and too many porous holes once you are old. Similarly, excessive vitamin A, and also the administration of corticosteroids (15) and elevated cortisol levels can cause osteoporosis by killing osteoblasts; all prematurely exhaust the capacity to produce new osteoblasts.

If less calcium is consumed, the bone-cells age slower, and a low calcium intake throughout adolescence has been shown to both retard and prolong longitudinal bone growth in rats. (16)

So, yes, you can increase your bone mineral density (BMD) by consuming much calcium, but that will exhaust your bones sooner.

Yes, a high BMD means (temporarily) stronger bones, but not healthier bones. Just as bodybuilders have stronger muscles, but not healthier muscles. Actually, as they grow older, they experience more muscle problems.

The same is true for the bones; the more their aging is accelerated, the sooner their bone modeling capacity will be exhausted

That is why in those countries where the average BMD is highest, the hip fracture incidence is highest too.

Does this mean that a low BMD is preventive?

If BMD is low because you consume little calcium all your life; yes.

If calcium intake is very low, there will still not be a lack of calcium for the calcification of bone-matrix. (17) The only difference will be that the bones will not age prematurely, and that they will not contain redundant calcium.

But if the BMD is low as the result of exhausted osteoblasts; no.

BMD is decreased in osteoporosis due to the lack of new bone-matrix. Holes do not contain calcium.

So BMD can be low in very strong bones and in weakened bones, which is what makes it so confusing for so many scientists.

Proof

Supplementary calcium / milk has short term ‘beneficial’ effects on bone-mineral density (BMD) and adverse long-term (lifetime-) effects.

One can increase BMD by a high-calcium intake (7) or not. (18) The average short term effect of extra calcium is the increase in bone-mineral density, and thus strength. That is why average BMD is highest in those countries where much milk is consumed.

If you investigate this correlation, extra calcium will have ‘beneficial’ effects on bone-strength (19) or not. (20)

But this does not say anything about the lifetime effects; it just confirms what initially happens if you consume much calcium; this is just the first effects, not the eventual result.

But is there no other way to find proof?

Yes there is.

Compared to other foods, only dairy products (or supplements of course) can be consumed in such large quantities on a daily basis that their consumption strongly increases calcium intake, which is proven by the fact that average BMD is highest in those countries where the most milk is consumed. There is, in fact, a tradition of consuming high amounts of milk in these countries..

And there also many scientific studies about hip-fracture incidence per country.

If extra calcium eventually has adverse effects, osteoporosis / hip-fracture incidence should be clearly higher in those countries where the most milk is consumed…

Statistics

And yes….

For example:

In Greece the average milk consumption doubled from 1961 to 1977 (21) (and was even higher in 1985), and during the period 1977 - 1985 the age adjusted osteoporosis incidence almost doubled too. (22)

In Hong Kong in 1989 twice as much dairy products were consumed as in 1966 (21) and osteoporosis incidence tripled in the same period. (23) Now their milk consumption level is almost “European”, and so is osteoporosis incidence. (24)

It is very simple: where the most milk is consumed, the osteoporosis incidence is highest. Compared to other countries, the most milk is consumed in Sweden, Finland, Switzerland and The Netherlands (300 to 400 kg / cap / year), and osteoporosis incidence in these countries has sky rocketed. (25)

Like Australians and New Zealanders, (26) Americans consume three fold more milk than the Japanese, and hip-fracture incidence in Americans is therefore 2½ fold higher. (27) Among those within America that consume less milk, such as the Mexican-Americans and Black Americans, osteoporosis incidence is two-fold lower than in white Americans, (28) which is not due to genetic differences. (29)

In Venezuela and Chile much less milk is consumed than in the US, Finland, Sweden and Switzerland, while the hip fracture incidence in Venezuela and Chile is over 3 fold lower. (61)

Chinese consume very little milk (8 kg / year), and hip-fracture incidence, therefore, is among the lowest in the world; hip-fracture incidence in Chinese women is 6 fold lower than in the US. (30) (The average American consumes 254 kg milk / year)

The less milk consumed, the lower is the osteoporosis rate. (31)

In other countries where very little milk is consumed, on the average, as in Congo (32), Guinea (33) and Togo (34) (6 kg / year) osteoporosis is extremely rare too.

In the Dem. Rep. Congo, Liberia, Ghana, Laos and Cambodia even less milk is consumed (average person: 1 to 3 kg a year !!), and they've never even heard of age-related hip fracture.

See:
milk consumption per country in 1998

Of course, 'they' will say : "that's because blacks and Asians are genetically different from whites", but that is rubbish ; Osteoporosis incidence in female Asians is much lower than in Asian females living in the USA (35) just like osteoporosis incidence (and calcium consumption) in African Bantu women (36) is much lower than in Bantu women living in the USA. (37) And both calcium intake and hip-fracture rate is far lower in South African Blacks than in African Americans. (38)

Brief responses on these findings, questioning and more.

Alternative hypotheses about osteoporosis incidence;

The excessive-phosphorus hypothesis
Water fluoridation and fracture incidence
Osteoporosis and protein- and soy consumption
Some think it is because of low milk-calcium bio-availability
The magnesium-calcium ratio hypothesis
Osteoporosis and a high-fat diet

Smarter Than Nature

''Nature has made a mistake but fortunately we are smarter than nature, and know how to correct this; Mother's milk, by mistake, contains far too little calcium, which has to be corrected through giving to humans cow's milk which contains 4 times as much calcium.''

Of course this is nonsense.

If calcium requirements really were four fold higher, pre-historic infants would never have been able to grow up, and ultimately, to have children. If we really need cows' milk, man could never have existed.

Why ?

Because we have already been on this planet for millions of years. And we have only consumed milk for a maximum of 0.01 million years. This means that we did not drink a single drop of milk from other animals in more than 99% of human existence; in our entire development from ape to modern human being, we never drank, nor needed animals' milk.

1.6 million years ago there were already humans well over 6 feet tall (39), with apparently strong bones.

Some argue that our prehistoric diet contained more calcium, but that is not true

Babies' Food

Of all humans, babies need the most calcium because their bones are still weak and need to be calcified much more. And mothers' milk does, of course, contain all the calcium (and other nutrients) babies need in their first two years. Babies fed on mother’s milk are perfectly able to increase bone-mineral density (BMD).

So, exactly how much calcium does mothers' milk contain ?

Not much:

Calcium in mg / 100 g

226 Hazelnuts

140 Egg yolk

132 Brazil nuts

96 Olives, green

87 Walnuts

54 Figs

44 Black berries

42 Orange

40 Raspberries

38 Kiwi

33 Mandarin

32 Human milk

20 Coconut

18 Grapes

16 Apricot

16 Pineapple

14 Plum

13 Salmon

12 Mackerel

12 Mango

11 Watermelon

10 Avocado

9 Banana

6 Muskmelon

What does this mean?

Adults and infants always need less calcium than babies (per kg bodyweight). Food for adults therefore does not need to contain as much calcium (in %) as mother’s milk.

And because our natural foods, on the average, contain about as much calcium as mother's milk, it is absolutely impossible that these natural foods contain too little calcium.

If they did, mother’s milk would contain too little calcium too, and babies would not be able to increase BMD on mother’s milk.

And because many foods contain more calcium than mother’s milk, the average calcium absorption rate is low, to prevent the uptake of excessive calcium.

Vitamin D

The body needs broad daylight to transform cholesterol into vitamin D. The hormone that increases dietary calcium absorption (calcitriol), is composed of vitamin D.

Some say osteoporosis incidence is, therefore, higher in countries with little sunlight.

However, if you consume some fish and / or egg yolk once in a while, you'll absorb all the vitamin D you need - even living in Greenland, Canada or Northern Europe.

Is osteoporosis incidence really lower in countries with more sunlight?

Not necessarily. Though Italy is much sunnier than Poland, hip-fracture incidence in Italy is much higher (40) than in Poland (and Spain) (41), simply because in Italy 25% more dairy products are consumed. (21) Kuwait is extremely sunny, but, nevertheless, osteoporosis incidence in Kuwait is about as high as in Great Britain and France (35), because in Kuwait, also, lots of milk is consumed. (21)

Furthermore, the effects of this vitamin D-hormone can be very different.

This hormone increases calcium absorption from food and absorption of calcium into the bones, (42) and therefore induces death of osteoblasts (43). Calcitriol also stimulates deportation of calcium from the bones into the blood. (See The Calcium-hormones")

On the other hand, this hormone also inhibits secretion of PTH (excessive PTH strongly accelerates ageing of the bones). (See hyperparathyroidism) Thus, indirectly, this hormone can be protective, per saldo decreasing both uptake of calcium into the bones and deportation of calcium from the bones. (44) (See "The Calcium-hormones")

However, since supplementary vitamin D / calcitriol increases the blood-calcium level (45), this extra calcium can precipitate in arteries and on the outside of the bones, causing arteriosclerosis and bone-deformities (46). It can also settle in joints and ligaments, and can cause muscle-cramps because the blood-calcium level needs to be low enough to deport calcium from muscle cells. It can even kill muscles cells (if the calcium cannot be deported), eventually causing fibromyalgia.

Osteoporosis is often accompanied with a very low vitamin D level. (47)

This can have multiple causes:

· Osteoporosis is caused by consuming too much calcium year after year. The body tries to counteract this by taking up as little calcium as possible. Vitamin D increases the calcium-absorption rate. So to prevent the uptake of excessive calcium, the body composes as little vitamin D as possible.

· Hyperparathyroidism strongly increases both uptake of calcium into the bones and deportation from the bones, eventually causing osteoporosis. If too little calcitriol is available, the secretion of PTH is not sufficiently inhibited.

· If always very, very little calcium is consumed (less than 300 mg / day which is a very hard thing to achieve), a lack of vitamin D / calcitriol can cause osteoporosis by making it impossible to increase calcium absorption.

In general, it is not a problem at all to have little vitamin D / calcitriol at our disposal. This even protects us against absorbing too much calcium.

In 52% of examined Saudi Arabian females for example, vitamin D level was extremely low (because of clothes that block almost all sunlight), but their bones were not affected. (48)

In alcoholics the levels of the vitamin D-hormones were decreased by3 to 48%, but BMD was not affected. (49)

In general, we do not need much vitamin D to either inhibit PTH secretion or to increase calcium absorption.

In fact, in countries where the people consume high amounts of fish and eggs (which are the only vitamin D containing foods), the hip fracture rates are high too; because when both the intake of calcium (due to consuming dairy products) and vitamin D is high, the vitamin D causes a high uptake ratio of the calcium (accelerating the aging of osteoblasts.

Exercise

If osteoporosis was about a lack of exercise, all healthy but physical inactive people would have osteoporosis, which is not the case. That is why bone-loss with age cannot be explained by declining physical activity levels. (50)

Loading determines the maintenance of bone-strength. If the bones are not loaded at all (like in space), they rapidly lose calcium. If we are normally active, our bones contain sufficient calcium to cope with incidental falls.

Furthermore, a lack of exercise does not accelerate the aging of osteoblasts, so it cannot possibly be the cause osteoporosis. If one lacks exercise, one can easily increase BMD through exercise. In osteoporosis the lack of osteoblast activity is irreversible.

Exercise causes microfractures which stimulates the osteoblasts to increase their activity. Logically, then exercise also increases the death rate of osteoblasts. (51) (excessive exercise is detrimental (52))

But exercise can increase bone-strength in elderly, can’t it?

Yes, but only as long as osteoblast reproductivity is not almost totally exhausted. Exercise increases activity and reproduction of the remaining osteoblasts, temporarily increasing bone-strength (exercise does not guarantee future bone-strength (53)), but also accelerating aging of the bones.

If osteoblast reproductivity is almost totally exhausted, one cannot increase BMD through exercise (or extra calcium) anymore, which is often the case in osteoporotic patients. (54) That is why the possible exercise-induced bone mass gain is far less than the disuse-induced bone loss. (55) This is why in osteoporosis exercise only partially (20 – 40%) decreases hip-fracture risk - even in the short term. (56) The later in life, the smaller the effects of exercise will be. (57)

Normal activities are all the exercise you need to maintain bone health. Increased physical activity accelerates aging of the bones. On the other hand, exercising specific muscles can be effective since strong muscles can absorb the shock when falling. (58).

Athletes & Stress-fractures

Overweight & Osteoporosis

That menopause favors osteoporosis and obesity inhibits it, are well-known clinical observations.

In menopause the estrogen level is lower, and adequate natural estrogen levels areprotective because estrogeninhibits uptake of calcium in the bones and bone-formation by osteoblasts. (1)

In obesity the leptin level is elevated (59) and leptin also inhibits bone-formation by the osteoblasts. (60)

Some think that obesity is protective because there is more loading on the bones, increasing their strength, but if that would be the case, osteoporosis could easily be stopped and even reversed by increasing physical activity / loading of the bones. Osteoporosis however is irreversible. Osteoporosis is not caused by a decreased bone mass, but is due to the exhaustion of osteoblasts, which is irreversible since it is about aging. The low bone mass is the result of the lack of new matrix, not the cause.

Sources

Abstracts of most sources can be found at the National Library of Medicine ;

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(11) Delany AM, et al, Osteopenia and decreased bone formation in osteonectin-deficient mice. J. Clin. Invest. 2000 / 105 (7) / 915-923. , Gazit D, et al, Bone loss (osteopenia) in old male mice results from diminished activity and availability of TGF-beta. J. Cell. Biochem. 1998 / 70 (4) / 478-488. , Arlot M, et al, Impaired osteoblast function in osteoporosis: comparison between calcium balance and dynamic histomorphometry. Br. Med. J. (Clin. Res. Ed.) 1984 / 289(6444) / 517-520.

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(19) Holbrook TL, et al, Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet 1988 / 2 (8619) / 1046-1049. , Lau EM, et al, Epidemiology and prevention of osteoporosis in urbanized Asian populations. Osteoporos Int 1993 / 3 (Suppl 1) / 23-26. , Ribot C, et al, Risk factors for hip fracture. MEDOS study: results of the Toulouse Centre. Bone 1993 / 14 (Suppl 1) / S77-80. , Perez Cano R, et al, Risk factors for hip fracture in Spanish and Turkish women. Bone 1993 / 14 (Suppl 1) / S69-72. , Kreiger N, et al, Dietary factors and fracture in postmenopausal women: a case-control study. Int J Epidemiol 1992 / 21 (5) / 953-958.

(20) Turner, L.W. et al, Dairy-product intake and hip fracture among older women : issues for health behaviour. Psychol. Rep. 1999 / 85 (2) / 423-430. , Mussolino ME, et al, Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up Study. J Bone Miner Res 1998 / 13 (6) / 918-924. , Turner LW, et al, Osteoporotic fracture among older U.S. women: risk factors quantified. J Aging Health 1998 / 10 (3) / 372-391. , Owusu W, et al, Calcium intake and the incidence of forearm and hip fractures among men. J Nutr 1997 / 127 (9) / 1782-1787. , Feskanich, D. et al, Milk ,dietary calcium ,and bonefractures in women, a 12 year prospective study. Am. J. Public Health 1997 / 87 (6) / 992-997. , Meyer HE, et al, Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study. Am J Epidemiol 1997 / 145 (2) / 117-123. , Tavani A, et al, Calcium, dairy products, and the risk of hip fracture in women in northern Italy. Epidemiology 1995 / 6 (5) / 554-557. , Meyer HE, Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Osteoporos Int 1995 / 5 (4) / 239-246. , Michaelsson K, et al, Diet and hip fracture risk: a case-control study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment. Int J Epidemiol 1995 / 24 (4) / 771-782. , Cumming RG, et al, Case-control study of risk factors for hip fractures in the elderly. Am J Epidemiol 1994 / 139 (5) / 493-503. , Nieves JW, et al, A case-control study of hip fracture: evaluation of selected dietary variables and teenage physical activity. Osteoporos Int 1992 / 2 (3) / 122-127. , Wickham CA, et al, Dietary calcium, physical activity, and risk of hip fracture: a prospective study. BMJ 1989 / 299 (6704) / 889-92. , Cooper C, et al, Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. BMJ 1988 / 297 (6661) / 1443-1446.

(21) FAO database on the internet ; www.fao.org/ Statistical Database / Food Balance Sheet Reports. Hong Kong has been removed from the database since the unification with China.

(22) Paspati, I. et al, Hip fracture epidemiology in Greece during 1977-1992. Calcif. Tissue Int. 1998 / 62 (6) / 542-547.

(23) Lau, E.M. & C. Cooper, Epidemiology and prevention of osteoporosis in urbanized Asian populations. Osteoporosis 1993 / 3 / suppl. 1 : 23-26.

(24) Ho SC, et al, The prevalence of osteoporosis in the Hong Kong Chinese female population. Maturitas 1999 Aug 16;32(3):171-8.

(25) Versluis, R.G. et al, Prevalence of osteoporosis in post-menopausal women in family practise (in Dutch). Ned. Tijdschr. Geneesk. 1999 / 143 (1) / 20-24. , Oden, A. et al, Lifetime risk of hip fractures is underestimated. Osteoporosis Int. 1998 / 8 (6) / 599-603. , Smeets-Goevaars, C.G. et al, The prevalence of low bone-meineral density in dutch perimenopausal women : the Eindhoven perimenopausal osteoporosis study. Osteoporosis Int. 1998 / 8 (5) / 404-409. , Lippuner, K.o et al, Incidence and direct medical costs of hospitilizations due to osteoporotic fractures in Switzerland. Osteoporosis Int. 1997 / 7 (5) / 414-425. , Lips, P. ,Epidemiology and predictors of fractures associated with osteoporosis. Am. J. Med. 1997 / 103 (2A) / 3S-8S / discussion 8S-11S. , Parkkari, J. et al, Secular trends in osteoporotic pelvic fractures in Finland : number and incidence of fractures in 1970-1991 and prediction for the future. Calcif. Tissue Int. 1996 / 59 (2) / 79-83. , Nydegger, V. et al, Epidemiology of fractures of the proximal femur in Geneva ; incidence, clinical and social aspects. Osteoporosis Int. 1991 / 2 (1) / 42-47. , Van Hemert, A.M. et al, Prediction of osteoporotic fractures in the general population by a fracture risk score. A 9-year follow up among middle aged women. Am.J.Epidemiol. 1990 / 132 (1) / 123-135.)

(26) Lau, E.M. et al, Admission rates for hip fracture in Australia in the last decade. The New South Wales scene in a world perspective. Med.J.Aust. 1993 / 158 (9) / 604-606.

(27) Fujita, T. and M. Fukase, Comparison of osteoporosis and calcium intake between Japan and the United States. Proc.Soc.Exp.Biol.Med. 1992 / 200 (2) / 149-152.

(28) Bauer RL, Ethnic differences in hip fracture: a reduced incidence in Mexican Americans. Am J Epidemiol 1988 Jan;127(1):145-9.

(29) Kessenich CR, Osteoporosis and african-american women. Womens Health Issues 2000 / 10 (6) / 300-304.

(30) Xu. L. et al, Very low rates of hip fracture in Beijing, People's Republic of China ; The Beijing Osteoprosis Project. Am.J.Epedemiol. 1996 / 144 (9) / 901-907.

(31) Schwartz, A.V. et al, International variation in the incidence of hip fractures : cross-national project on osteoporosis for the World Health Organization Program for Research on Ageing. Osteoporosis Int. 1999 / 9 (3) / 242-253.Rowe, S.M. et al, An epidemiological study of hip fracture in Honan, Korea. Int. Orthop. 1993 / 17 (3) / 139-143.

(32) Bwanahali, K. et al, Etiological aspects of low back pain in rheumatic patients in Kinshasa (Zaire). Apropos of 169 cases. (in French) Rev. Rhum. Mal. Osteoartic. 1992 / 59 (4) / 253-257.

(33) Barss, P., Fractured hips in rural Melanesians : a nonepidemic. Trop. Geogr. 1985 / 37 (2) / 156-159.

(34) Mijiyawa, M.A. et al, Rheumatic diseases in hospital outpatients in Lome. Rev. Rhum. Mal. Osteoartic. 1991 / 58 (5) / 349-354.

(35) Memon, A. et al, Incidence of hip fracture in Kuwait. Int.J.Epidemiol.1998 / 5 / 860-865.

(36) Walker, A., Osteoporosis and Calcium Deficiency, Am. J. Clin. Nutr. 1965 / 16 / 327.

(37) Smith, R., Epidemiologic Studies of Osteoporosis in Women of Puerto Rico and South-eastern Michigan ... Clin. Ortho. 1966 / 45 /32.

(38) Abelow BJ, et al, Cross-cultural association between dietary animal protein and hip fracture: a hypothesis. Calcif. Tissue Int.1992 / 50 (1) / 14-18.

(39) Holly Smith in : Leakey, R. & Lewin, R., Origins Reconsidered : In Search of what Makes Us Human, London 1992 / 144-145. , Mc Henry, H.M. ,Femoral lengths and stature in Plio-Pleistocene hominids. Am. J. Phys. Anthropol. 1991 / 85 (2) / 149-158. , Brown, F. et al, Early Homo erectus skeleton from west Lake-Turkana, Kenya. Nature 1985 / 316 (6031) / 788-792.

(40) Mazzuoli, G.F. et al, Hip fracture in Italy : Epidemiology and preventive effeicacy of bone active drugs. Bone 1993 / 14 / suppl. /581-584.

(41) Lips, P., Epidemiology and predictors of fractures associated with osteoporosis. Am. J. Med. 1997 / 103 (2A) / 3S-8S / discussion 8S-11S.

(42) Erben RG, et al, Therapeutic efficacy of 1alpha,25-dihydroxyvitamin D3 and calcium in osteopenic ovariectomized rats: evidence for a direct anabolic effect of 1alpha,25-dihydroxyvitamin D3 on bone. Endocrinology1998 / 139 (10) / 4319-4328.

(43) Pascher E, et al, Effect of 1alpha,25(OH)2-vitamin D3 on TNF alpha-mediated apoptosis of human primary osteoblast-like cells in vitro. Horm. Metab. Res.1999 / 31 (12) / 653-656.

(44) Sairanen S, et al, Bone mass and markers of bone and calcium metabolism in postmenopausal women treated with 1,25-dihydroxyvitamin D (Calcitriol) for four years. Calcif. Tissue Int. 2000 / 67 (2) / 122-127.

(45) Sairanen S, et al, Bone mass and markers of bone and calcium metabolism in postmenopausal women treated with 1,25-dihydroxyvitamin D (Calcitriol) for four years. Calcif. Tissue Int. 2000 / 67 (2) / 122-127. , Gurlek A, et al, Comparison of calcitriol treatment with etidronate-calcitriol and calcitonin-calcitriol combinations in Turkish women with postmenopausal osteoporosis: a prospective study. Calcif. Tissue Int. 1997 / 61 (1) / 39-43.

(46) Giunta, D.L. ,Dental changes in hypervitaminosis D. Oral. Surg. Pathol. Oral. Radiol. Endod. 1998 / 85 (4) / 410-413. , Uehlinger, P. et al, Differential diagnosis of hypercalcemia - a retrospective study of 46 dogs. (duitst.) Schweiz. Arch. Tierheilkd. 1998 / 140 (5) / 188-197. , Qin, X. et al, Altered phosphorylation of a 91-kDa protein in particulate fractions of rat kidney after protracted 1,25-dihydroxyvitamin D3 or estrogen treatment. Arch. Biochem. Biophys. 1997 / 348 (2) / 239-246. , Niederhoffer, N. et al, Calcification of medical elastic fibers and aortic elasticity. Hypertension 1997 / 29 (4) / 999-1006. , Selby, P.L. et al, Vitamin D intoxication causes hypercalcemia by increased bone resorption with responds to pamidronate. Clin. Endocrinol. (Oxf.) 1995 / 43 (5) / 531-536. , Ito, M. et al, Dietary magnesium effect on swine coronary atherosclerosis induced by hypervitaminosis D. Acta Pathol. Jpn. 1987 / 37 (6) / 955-964.

(47) Le Boff, M.S., Occult vitamin D deficiency in postmenopausal US women with acute hip fracture. J. Am. Med. Assoc. 1999 / 281 (16) / 1505-1511. , Scharla SH, et al, Prevalence of low bone mass and endocrine disorders in hip fracture patients in Southern Germany. Exp. Clin. Endocrinol. Diabetes 1999 / 107 (8) / 547-554.

(48) Ghannam NN, et al, Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcif Tissue Int 1999 Jul;65(1):23-8

(49) Laitinen K, et al, Deranged vitamin D metabolism but normal bone mineral density in Finnish noncirrhotic male alcoholics. Alcohol Clin Exp Res 1990 Aug;14(4):551-6.

(50) Rutherford OM, et al, The relationship of muscle and bone loss and activity levels with age in women. Age Ageing 1992 / 21 (4) / 286-293.

(51) Meyer T, et al, Identification of apoptotic cell death in distraction osteogenesis. Cell. Biol. Int.1999 / 23 (6) / 439-446. , Landry P, et al, Apoptosis is coordinately regulated with osteoblast formation during bone healing. Tissue Cell 1997 / 29 (4) / 413-419.

(52) Cromer B, et al, Adolescents: at increased risk for osteoporosis? Clin. Pediatr. (Phila) 2000 / 39 (10) / 565-574. , Judex S, et al, Does the mechanical milieu associated with high-speed running lead to adaptive changes in diaphyseal growing bone? Bone 2000 Feb;26(2):153-9.

(53) Rutherford OM. , Is there a role for exercise in the prevention of osteoporotic fractures? Br J Sports Med 1999 / 33 (6) / 378-386.

(54) Kerschan-Shindl K, et al, Long-term home exercise program: effect in women at high risk of fracture. Arch. Phys. Med. Rehabil. 2000 / 81 (3) / 319-323. , Greendale GA, et al, Lifetime leisure exercise and osteoporosis. The Rancho Bernardo study. Am. J. Epidemiol. 1995 / 141 (10) / 951-959. , Jaglal SB, et al, Past and recent physical activity and risk of hip fracture. Am. J. Epidemiol. 1993 / 138 (2) / 107-118.

(55) Chesnut CH, Bone mass and exercise. Am. J. Med. 1993 / 95 (5A) / 34S-36S.

(56) Gregg EW, et al, Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J. Am. Geriatr. Soc. 2000 / 48 (8):883-93. , Layne JE, et al, The effects of progressive resistance training on bone density: a review. Med. Sci. Sports Exerc. 1999 / 31 (1) / 25-30. , Preisinger E, et al, Therapeutic exercise in the prevention of bone loss. A controlled trial with women after menopause. Am. J. Phys. Med. Rehabil. 1995 / 74 (2) / 120-123. , Lau EM, et al, The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporos. Int.1992 / 2 (4) / 168-173.

(57) Rutherford OM, Is there a role for exercise in the prevention of osteoporotic fractures? Br. J. Sports Med. 1999 / 33 (6) / 378-386. , Commandre F, et al, [Physical activities and bone mass in women]. [Article in French] Bull. Acad. Natl. Med. 1995 / 179 (7) / 1483-1491; discussion 1491-1492.

(58) Kaastad TS, et al, Training increases the in vivo fracture strength in osteoporotic bone. Protection by muscle contraction examined in rat tibiae. Acta Orthop. Scand. 1996 / 67 (4) / 371-376.

(59) Chu NF, et al, Plasma leptin concentrations and four-year weight gain among US men. Int. J. Obes. Relat. Metab. Disord. 2001 / 25 (3) / 346-353. , Szymczak E, et al, The role of leptin in human obesity. Med. Wieku. Rozwoj. 2001 / 5 (1) / 17-26. , Hu FB, et al, Leptin concentrations in relation to overall adiposity, fat distribution, and blood pressure in a rural Chinese population. Int. J. Obes. Relat. Metab. Disord. 2001 / 25 (1) / 121-125. , Bahceci M, et al, The effect of high-fat diet on the development of obesity and serum leptin level in rats. Eat. Weight. Disord. 1999 / 4 (3) / 128-132. , Milewicz A, et al, Plasma insulin, cholecystokinin, galanin, neuropeptide Y and
leptin levels in obese women with and without type 2 diabetes mellitus. Int. J. Obes. Relat. Metab. Disord. 2000 / 24 / Suppl 2 / S152-3. , Nakamura M, et al, Association between basal serum and leptin levels and changes in abdominal fat distribution during weight loss. J. Atheroscler. Thromb. 2000 / 6 (1) / 28-32. , Bunger L, et al, Leptin levels in lines of mice developed by long-term divergent selection on fat content. Genet`. Res. 1999 / 73 (1) / 37-44.

(60) Takeda S, et al, Leptin regulates bone formation via the sympathetic nervous system. Cell 2002 Nov 1;111(3):305-17. , Burguera B. et al, Leptin reduces ovariectomy-induced bone loss in rats. Endocrinology 2001 / 142 (8) / 3546-3553. , Takeda S, et al, Central control of bone formation. J. Bone Miner. Metab. 2001 / 19 (3) / 195-198. , Anselme K, et al, Comparative study of the in vitro characteristics of osteoblasts from paralytic and non-paralytic children. Spinal Cord 2000 / 38 (10) / 622-629. , Ducy P, et al, Leptin inhibits bone formation through a hypothalamic relay: a central control of bone mass. Cell 2000 / 100 (2) / 197-207.

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4 proven steps to prevent osteoporosis fractures

2007-04-05T00:20:00.023-07:00

While it receives a lot of attention in the media, still few people understand how prevalent osteoporosis and related fractures—which bring painful disability—truly are, especially within the high risk population. In the U.S., about 8 million women and 2 million men have osteoporosis, and another 34 million Americans have low bone mass. In total, these 44 million people represent 55 percent of the people aged 50 and older in the United States. After age 50, one in every two women and one in every four men will sustain some type of osteoporosis-related fracture1.

Osteoporosis is a condition marked by low bone mass (a thinning of the bone), which can lead to a weakening of the bone architecture and increased susceptibility to fracture (usually of the hip, wrist and/or spine). In the spine, fractures can lead to chronic pain, decreased physical function, spinal deformity (e.g. dowager’s hump), social isolation, and, in rare cases, complications that can cause death. Spinal fractures from osteoporosis are quite common, with an estimated 700,000 compression fractures occurring each year2.

Unlike many other common causes of back pain, osteoporosis and associated spinal fractures (also called “vertebral compression fractures” or “vertebral fractures”) are largely preventable. This article focuses on the most important action steps for people at risk for osteoporosis, those with a diagnosis of osteopenia (low bone density, the precursor to osteoporosis), or those already diagnosed with osteoporosis:

1. Understanding risk factors for osteoporosis
2. Getting a bone density test to assess bone mass
3. Developing an individualized plan to fight osteoporosis
4. Making lifestyle and health changes (including taking prescribed medications and actively monitoring bone health) designed to slow bone loss and build bone density

Osteoporosis risk factors
The first step in preventing osteoporosis and associated spine fractures is to determine whether you are at risk or high risk for developing the bone condition.

Risk factors for osteoporosis3 include:

*

Advanced age. Those over 65 years of age are at particular risk.
*

Gender. Women are at much greater risk, losing bone more rapidly than men due to menopause. However, men are also at risk and constitute 20% of the patient population with osteoporosis.
*

Family and personal history. This includes family history of osteoporosis, history of fracture on the mother’s side of the family, and a personal history of any kind of bone fracture as an adult (after age 50).
*

Race. Caucasian and Asian women are at increased risk.
*

Body type. At greater risk are small-boned women who weigh less than 127 pounds.
*

Menstrual history and menopause. Normal menopause alone increases a woman’s risk of osteoporosis. Early menopause or cessation of menstruation before menopause increases the risk even more.
*

(Males) Hypogonadism (small gonads, e.g., testosterone deficiency)
*

Lifestyle. Lifestyle behaviors that increase osteoporosis risk include: calcium and/or vitamin D deficiency; little or no exercise, especially weight-bearing exercise; alcohol abuse; cigarette smoking.
*

Chronic diseases and medications. Certain types of medications can damage bone and lead to what is termed “secondary osteoporosis”. This type of osteoporosis is estimated to occur in almost 50% of pre-menopausal women with osteoporosis and from 30% to 60% of men with osteoporosis. Also, secondary osteoporosis can cause further bone loss in postmenopausal women and older men with primary osteoporosis4. Included in this category are certain medications to treat endocrine disorders such as hyperthyroidism, marrow disorders, collagen disorders, gastrointestinal problems and seizure disorders. Use of glucocorticoids (steroids) to treat diseases such as asthma, rheumatoid arthritis and inflammatory bowel disease, especially the oral form of these medications (at higher doses and over longer periods of time e.g., more than 2 months), can be particularly damaging to bone. Given the serious nature of the diseases these medications treat, it is not advisable to alter or stop taking these drugs unless under a physician’s advice.

People considered at especially high risk for developing osteoporosis include:

*

All women over age 65.
*

Women less than age 65 who are postmenopausal and have one or more of the above described risk factors for osteoporosis.
*

Postmenopausal women who experience any type of bone fracture.
*

Men who have a testosterone deficiency.

For those with any of the above risk factors for osteoporosis, it is advisable to get a bone density test to assess bone mass and the presence of osteoporosis. Knowledge of one’s bone density is vital to developing an appropriate action plan to prevent worsening of the condition and hopefully prevent a painful osteoporosis-related fracture.

Men With Osteoporosis Often Fall Through the Cracks

2007-04-05T00:20:00.022-07:00

Osteoporosis and its associated fractures are as devastating in men as they are in women, yet the rates of osteoporosis detection and treatment in men are dismal, Dr. Eric Orwoll said at the annual meeting of the International Society for Clinical Densitometry.

In a study of 110 men and 253 women admitted to the hospital with atraumatic hip fractures, the mean age was about 80 years. At discharge, 27% of the women but only 4.5% of the men were receiving treatment of any kind for osteoporosis. Up to 5 years later, 27% of the men and 71% of the women were being treated. The 12-month mortality rate was 32% in men and 17% in women (Arch. Intern. Med. 162[19]:2217-22, 2002).

Fracture risk factors in men include advanced age, a history of falls or previous fractures, low body weight, a calcium or vitamin D deficiency, cigarette smoking, a history of medical conditions associated with low bone mineral density (BMD), alcohol abuse, and a family history of osteoporosis or fractures, said Dr. Orwoll of Oregon Health and Science University, Portland.

The International Society for Clinical Densitometry recommends regular BMD assessments for men who are aged 70 years or older or have a history of fragility fractures or have a medical condition known to increase the risk of bone loss, such as hypogonadism or hyperparathyroidism.

Men with a T score <�2, especially if they are elderly or have other risk factors, should be considered potential candidates for treatment, he said, but often it's a judgment call. Dr. Orwoll said he might delay treating a 50-year-old patient with a T score <�2 but no other risk factors, but would prescribe treatment for a 30-year-old with a similar T score who smoked, drank heavily, and had a family history of fractures.

Treatment consists of vitamin D 600-800 IU/day, calcium 1,200 mg/day, and a bisphosphonate or parathyroid hormone 20 �g/day. Other treatments, such as testosterone for a patient with hypogonadism, may be prescribed as needed. These approaches build bone density and decrease fracture risk in men, but have been underused, Dr. Orwoll said.

About one-third of men aged 75-79 years have vertebral deformities. At age 60, the lifetime fracture risk is 26% in a white male and 56% in women. Men aged 50-64 years have a greater risk of vertebral fracture than women in the same age group. After age 64, women's fracture rate increases sharply, outpacing that of men.

�Vertebral deformities herald lower bone density and skeletal fragility, so if you see a vertebral deformity on a chest x-ray, that has some implications for that person's risk of subsequent fracture,� he said.

Of men who sustain a hip fracture, one-third will develop another fracture within 3 years. In one study of a Medicare population, men who sustained a hip fracture had 2-year mortality of about 50%.

The etiology of osteoporosis in men hasn't been studied as extensively as it has in women, he said. In one study of 47 men with vertebral and appendicular fractures or osteopenia referred to a metabolic bone center, 30 had osteoporosis secondary to factors such as glucocorticoid treatment, excessive alcohol consumption, or severe hyperthyroidism. The others were presumed to have primary osteoporosis (Ann. Intern. Med. 123[6]:452-60, 1995).

More on Osteoporosis

2007-04-05T00:20:00.021-07:00

A 58-year-old active woman has learned that the bone density in her back has slipped to just 87% of normal levels. She takes a wide range of vitamins plus calcium and magnesium and has just started on silica. She would like to avoid taking Fosamax if at all possible. Can anyone offer her advice? One doctor agrees, saying you should “avoid Fosamax like the plague.” Instead, start taking strontium two hours before – or two hours after - the calcium, and begin a regimen of weight-bearing exercise (go lightly at first and increase it slowly). In fact, almost everyone who wrote in on the subject advises weight training, sticking to compound exercises like squats, pull-ups (use an assist machine if necessary), press-ups or bench presses. Use good form, and drop your weight if you can’t use good form. Ideally you should be lifting weights heavy enough that you can only manage about 10-12 reps a set. Exercise is site-specific, says a pilates teacher and personal trainer, so walking will increase bone density in legs and ankles, while jumping and squats will increase hip and thigh bones, and so on. Because you have problems with your spine, beware of forward flexion (no sit-ups or bending forward to pick things up, for example). For cardiovascular exercise, dancing, skipping, running, or rebounding (on a trampoline) are ideal. Or try reading “Osteopilates” by Karena Lineback for some good pilates photos and instructions. Another take on treatment: cut out all dairy products, which leech calcium from the bones, and eliminate carbonated sodas, sugar and caffeine from the diet. The best place to get calcium is from fresh, organic fruits and vegetables (especially spinach and broccoli). Read “Fresh Vegetable and Fruit Juices – What’s Missing in Your Body?” by NW Walker. Add wholemeal bread and nuts to your diet and Vitamin D, Vitamin K and MCHC (a special form of calcium) to your list of supplements. For more information about MCHC, read the booklet “How to Fight Osteoporosis and Win,” by Beth M. Ley. Topically, try a natural progesterone cream, derived from the Mexican Wild Yam (Dioscorea villosa) – this stimulates the production of osteoblasts (bone-building cells). Read “What Your Doctor May Not Tell You About Menopause” by John R. Lee, MD, for more information on the topic. An effective homeopathic remedy: Calc Phos 6x Tissue Salts, 4 tablets 4 times a day. Finally, make sure your medicines aren’t compounding the problem, as many of them do deplete vital nutrients. Ross Pelton wrote a great handbook on “Drug-Induced Nutrient Depletion,” which is a good place to start.

Osteoporosis - General Information

2007-04-05T00:20:00.020-07:00

Q A bone density test has revealed that I have signs of osteoporosis. My doctor has offered me drug treatment together with calcium and vitamin D, but I am very reluctant to take drugs because of the side-effects, and calcium makes me constipated.

I am on a vegetarian diet to control irritable bowel problems, so can you recommend a vegetarian diet I can follow to combat osteoporosis? - EC, Isle of Wight

A Women are more likely than men to develop osteoporosis, a disease that involves the loss of protein matrix tissue from the bone, causing it to become brittle. It’s often associated with the menopause because that’s when the ovaries stop producing oestrogen hormones, which help maintain bone mass.

But osteoporosis is just as likely to be a lifestyle disease, linked to our modern, protein-rich diets. We eat up to five times the protein our bodies actually need, and it’s the acid byproducts of protein that leach calcium and other minerals from our bones. This suggests that even young women (and men) eating a high-fat diet could be unwittingly weakening their bones. We begin to lose more bone than we make at around age 30, and the menopause may only be accelerating an already established pattern unless we have made efforts to reduce our protein intake.

It is simplistic to suggest that calcium on its own - either as a supplement or from dairy products - will reverse or even prevent osteoporosis. Eskimos have the highest intake of calcium in the world, with a daily consumption of 2000 mg per person mainly from fish bones, and yet they also have the highest rate of osteoporosis in the world. Fish, along with meat and eggs, are the most acid-forming foods - and the ones that cause the greatest loss of calcium.

In contrast, the Chinese eat only half the daily amounts of calcium consumed in the West every day - and that mainly from vegetables - yet osteoporosis is rarely seen.

>From this, it’s not surprising to learn that vegetarians often have a higher bone density than carnivores. Research involving 1600 women, roughly half vegetarian and half meat-eaters, found that the average meat-eater had lost 35 per cent of her bone density by the time she reached age 80, whereas a vegetarian of at least 20 years’ standing would have lost, on average, only 18 per cent of her bone density (Am J Clin Nutr, 1988; 47: 1022-4).

Your being a vegetarian suggests that you’ve already taken the biggest step to slow the progress of your osteoporosis. It is important, nonetheless, to have a varied diet to combat the disease, and the best foods for this include the green leafy vegetables, alfalfa, kelp and cabbage, and all vegetables that are rich in boron, a mineral that reduces the excretion of calcium, and improves calcium and magnesium uptake. Nuts (especially almonds, hazelnuts and peanuts), avocados, and kidney and borlotti beans are also good sources of boron.

Fruits that are rich in vitamin C, such as blackberries, strawberries, raspberries, blackcurrants, citrus, kiwi, peaches and apples can slow osteoporosis, as can dried figs, apricots and dates.

Nuts and seeds are a great source of omega-3 essential fatty acids. Eat unsalted nuts, such as walnuts and brazil nuts, and sunflower, linseed and pumpkin seeds. Of the pulses and grains, try soybeans, wheatgerm, lentils, chickpeas and brown rice.

Your doctor is right to suggest vitamin D, as this helps the body absorb calcium, but the best source comes from the sun itself. The next best non-vegetarian source is oily fish; otherwise, you will need to take supplements. Other supplements to consider include magnesium, vitamin C, zinc and boron, although much of what you need can be derived from your diet.

Things to avoid other than meat include sugar, alcohol, cigarettes, coffee and, to a lesser extent, ordinary tea - use green or herbal teas instead. Finally, keep your weight down to a reasonable level, and try to take some gentle exercise every day, even if it’s just a walk to the shops and back.

OSTEOPOROSIS - Preventing Bone Loss Without Drugs

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Thinning bones has less to do with the menopause than with Western dietary practices, but it can largely be prevented by diet and regular exercise.

Although osteoporosis was never much of a health issue in previous generations, today it is a major public health concern, now affecting some 25 million Americans and one in four in the UK. There are all kinds of books written about it, and millions of women are swallowing millions of pills to keep it at bay.

The thinning of bones that can indicate risk of fracture, most commonly in old age, can occur from a number of causes. However, news reports about the issue have reduced it to two main causes: lack of calcium and lack of oestrogen. Older, alcoholic men are at serious risk for osteoporosis and bone fractures as well, but it has been women who have been targeted by the marketing campaigns of those who sell drugs and milk products. What we are actually being sold is a large helping of fear. Because of that fear, women are swallowing calcium pills and oestrogen pills by the ton, even if they are not individually appropriate.

One of the most interesting epidemiological aspects of osteoporosis is that it occurs more in cities and in "first world" countries, where these practices are common, rather than in rural areas and "third world" countries, where they are not. Specifically, it occurs more in the European and North American countries where people eat large amounts of milk products, than in the African countries, where people eat almost none. It is lowest in those areas of South Africa where people follow traditional ways of life.

Even though osteoporosis and bone fractures usually occur during the later stages of a woman's life, menopause is not the cause of these problems. They are only temporally related. More important for bone health is how we treat our bodies, and especially what we eat.

There are aspects of our diet that impact on our bones because they cause an active calcium loss, or drain, and over time this drain can cause as much trouble as any nutritional deficiency.

The women I know who have broken bones after menopause generally share two or more of the following characteristics:

Their diet was rich in meats, white flour, sugar, potatoes and tomatoes.

They didn't hesitate to take pharmaceutical medicines, either over the counter or prescribed.

They didn't do much exercise.

They were thin, either because they didn't eat enough or because they dieted to stay that way.

The acid alkaline balance

Acids are substances containing hydrogen atoms that are missing electrons, so their tendency is to go steal electrons elsewhere: that thieving tendency makes them corrosive. In the body, acids generally result from metabolic processes such as moving or breathing: these acids are either excreted, or they're buffered (neutralised) by minerals or mineral salts, which in turn are considered alkaline (or basic). For the proper function of our metabolism, our blood plasma has to be slightly alkaline, at a pH of about 7.45 (a pH of 7 is neutral, below 7 is acid, above it is alkaline). This is a highly delicate balance.

The more minerals there are in a food, the more they alkalise the body. Protein and carbohydrate foods are acid forming because they leave behind an acid residue; acid forming foods include sugar, flour, beans, grains, fish, fowl, meat and eggs. Alkalising foods include fruits, vegetables, sea vegetables, soy sauce, miso and salt.

The trick, of course, is to eat from both groups, and pick the healthier foods from each. Eating too high a proportion of acid forming foods will draw minerals out of the bones; while eating a high proportion of alkalising foods often tends to create cravings for sweets, as many vegetarians will attest to.

The buffer foods are milk products and tofu (if made with calcium carbonate); they will balance either side, because they contain both calcium (alkalising) and protein (acid forming). Thus, if a diet is high in sugar, flour, and/or meats, yet low in vegetables, dairy produce will help alkalise the body because of its calcium content. Conversely, if a diet is high in alkalising fruits, vegetables, and potatoes, yet low in protein or grains, dairy products will provide supplementary acid forming protein.

For people who prefer not to use milk products, the solution is to consume instead plenty of dark green, leafy vegetables (kale, collards, mustard greens, watercress, arugula), roots (carrots, turnips, parsnips, radishes), broccoli, squash and especially chopped parsley. Parsley contains both calcium and vitamin C, as well as ergosterol, a precursor to vitamin D, which helps absorb and utilise the calcium. Although spinach is rich in calcium, it is also high in oxalic acid, which interferes with the absorption of calcium.

Acid forming foods promote a tendency toward acidosis in the bloodstream; to counteract this acidosis, calcium and other minerals will be immediately withdrawn from the bones. Thus, bone resorption (breakdown) would increase to rebalance the blood, and calcium and other minerals would be excreted in the urine. Studies done on mice at the University of Rochester School of Medicine and Dentistry (Curr Opin Nephrol Hypertens, 1993; 2: 588-96) have shown that calcium does indeed leave the bones when they are in an acid environment. In other words, metabolic acidosis stimulates bone resorption and inhibits bone formation.

An increase in alkalising foods can balance this equation, by replacing the minerals that have been "borrowed" from the bones. However, if the diet is low in vegetables and other mineral rich foods, and if this persists for year after year, the amount of calcium and other minerals needed for bone deposition would be too low, and slowly the needs of bone resorption would exceed the the amount of incoming calcium.

Both too much and too little protein can cause trouble with the bones. Vegetarians have been shown to have higher bone density than omnivores, or people who eat everything. In one study (Amer J Clin Nutri, 1972: 25: 555-8) the mean bone density of the 70 to 79 year old vegetarians was greater than that of the 50 to 59 year old omnivores. Therefore, it is considered that vegetarians have a lesser risk of osteoporosis. But another way to interpret these studies is to note the rest of the dietary context: it could mean that the omnivores eat too many sweets and not enough greens and other plant foods. A 1997 Norwegian study found that there was an elevated risk of fracture in women with a high intake of protein and a low calcium intake.

Dr T Colin Campbell of Cornell University, in collaboration with the Institute of Nutrition and Food Hygiene of the Chinese Academy of Preventative Medicine in Beijing, conducted a famous study of the dietary patterns and nutritional status of Chinese people in the early nineties (Bol Assoc Med P R, 1990; 82: 132-4). That study clearly showed that the composition of urinary acids and calcium in middle aged and elderly women is influenced considerably by their dietary intakes. The consumption of acid forming foods such as animal protein increased calcium excretion in the urine, which indicates bone mineral loss. Plant protein intake was not related to urinary calcium excretion.

This finding may be one of the reasons why vegetarians have less osteoporosis than meat eaters. However, I am convinced that acidosis can also occur from too much flour or sugar. Metabolic acidosis from excess acid forming foods in general would then have a calcium wasting effect, or drain. The theory that protein foods such as red meat cause bone loss was debunked by the studies of Herta Spencer of the Veterans Administration Hospital in Hines, Illinois, in the 1980s (cited in Health Journal, Summer 1996). Dr Spencer found that studies correlating calcium loss with high protein diets used fractionated, isolated amino acids from milk or eggs; complex dietary proteins such as red meat did not cause calcium losses.

In the last quarter century we have focused on the excess of animal proteins in the diet and found them damaging. Many studies of protein foods determined that their acid residue is bad for the bones. However, Weston Price, DDS, author of Nutrition and Physical Degeneration, who traveled all over the world in the early 1930s studying the health and diet of traditional societies, observed that excellent bone health is found in traditional populations with diets high in fish and meats, so long as they also contain plenty of animal fats and vegetables.

Although much attention has been paid to protein, refined carbohydrates have received relatively little notice, mostly because of the unfortunate viewpoint that "all carbohydrates are equal". In traditional societies, such as those examined by Dr Price, osteoporosis only appears in countries where the diet includes the habitual use of refined foods. The natives who remained on their traditional diet, regardless of the amount of protein consumed, were, on the other hand, found to be without these defects and in good health.

As their metabolic byproducts include carbonic acid, carbohydrate foods, particularly refined carbohydrates, are seriously acid forming. The regular consumption of white flour, white rice and refined sugar will, therefore, contribute mightily to bone weakness; these are, without a doubt in my mind, probably your worst calcium drainers. Perhaps that explains the high rates of osteoporosis in Western countries whose inhabitants, in addition to dairy and meats, also consume a high proportion of white breads, sweet snacks and pastries.

Refined white sugar also interferes with the absorption of calcium and magnesium and so contributes to osteoporosis even further.

Caffeine

A number of studies have shown that caffeine intake is related to both fractures and calcium depletion. A six year study by Stampfer and Colditz in the early eighties, completed at the Department of Medicine of Brigham and Women's Hospital in Boston, followed 84,484 women aged 34 to 59, and found that those with a higher caffeine intake (five or more cups of coffee daily) had an almost three times higher risk of hip fractures (Am Clin Nutri, 1991; 54: 157-63).

Caffeine consumption increases the excretion of calcium as well as magnesium through the urine, which indicates bone loss. Young women seem to be able to compensate for this loss and make it up faster through increased and more efficient calcium absorption from the intestines. Older women, on the other hand, with age and hormone related calcium imbalances, do not seem to be able to compensate as efficiently, and are at higher risk for thinning bones, especially if their calcium intake is low.

According to a study done at the Department of Family and Preventive Medicine at University of California at San Diego, a lifetime equivalent of two cups of coffee per day is associated with decreased bone density at both the hip and the spine in older women if they don't also drink milk (JAMA, 1994; 27: 280-3). (Moderate daily milk consumption, about one glass of milk per day, seems to counterbalance somewhat the calcium wasting effect of caffeine.)

Nightshades

The concept that the nightshade vegetables affect calcium balance has been put forth for over 20 years by Dr Norman Childers, a professor of botany at the University of Florida at Gainesville and formerly of horticulture at Rutgers University. The nightshades comprise a family named Solanaceae, which includes potato, tomato, aubergine, red, green, chili and other hot peppers, paprika, and tobacco. Professor Childers has shown that nightshade consumption contributes to osteoarthritis because these plants contain substances called alkaloids, which disturb the calcium metabolism and tend to remove calcium from the bones, causing aches, pains, even deformations.

It has been my speculation since the early 1980s that people eat so many nightshades simply to counterbalance their consumption of milk products, which have more calcium than human beings need. Theoretically, then, dairy products and nightshades are opposite and complementary: if you eat one, you need the other. Conversely, if you stop eating one (say, dairy), you might do well abandoning the other, or else there may be repercussions in the body's calcium balance. Many of my students and acquaintances have found that if they keep eating nightshades in a low fat, dairy free diet, their joints begin to ache.

I haven't found any studies that directly link osteoporosis and nightshades. Nevertheless, it may be sensible to pay attention to them because of their ability to affect calcium balance. For those at risk for osteoporosis, an occasional potato or tomato may not cause any trouble; however, it may be a good idea to refrain from relying heavily on these vegetables in the diet. In all cases in which I enquired, women with osteoporosis and a history of bone fractures relied on heavy daily use of potatoes as a major source of starch, and tomatoes as both a flavouring and a raw vegetable.

Caffeine, Sugar and Bone Loss

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Did you know that osteoporosis is now considered a pediatric disease? Did you ever suspect that soft drinks were unhealthy for you or your kids, but had no hard data to back it up? Well, now you do!

In this study eighteen kids aged 13-18 years, drank either a caffeine and sugar free soft drink, or a soft drink with caffeine or sugar sugar. When caffeine was added, three hour urinary calcium excretion increased by 25% (from 6 mg to 20 mg per hour). When sugar was added to the caffeine drink, urinary calcium loss almost doubled (from 16 mg to 30 mg per hour). They found that sodium, chloride and potassium loss were also increased by caffeine. Phosphorus, found in most cola drinks, accelerates calcium and bone loss even more. Colas with caffeine and sugar added cause the greatest calcium and bone loss.

Comment: Everyone recognizes the importance of calcium in the diet of young people ( and older too). What this study tells us is that, while it is important to have adequate calcium in our diets, it is just as important not to overeat foods that cause calcium loss. The combination of caffeine and sugar almost doubles calcium lost through the urine. . The experimental dose used in this study was far less than the average teen's daily consumption of caffeine and sugar. After a hard physical workout, drinking soft drinks can cause calcium and potassium loss, and that in turn can cause sore muscles and delayed recovery time after exercise.

Other foods that cause calcium loss are foods rich in phosphorus, including cola soft drinks. High protein diets can cause bone loss also.

Non-dairy high calcium foods include the dark leafy greens (Collards 360 mg/cup, kale 210 mg/cup, broccoli 160 mg/cup), tofu, navy, and pinto beans (100-150 mg/4 oz), black strap molasses (140 mg/Tbs), corn tortillas (120 mg/2) and whole grains, sardines, salmon, goat feta cheese.

Menopause and Bone Health

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Menopause represents a major transition period in the lives of most women. That is why it is called the "change of life." Women experience a decreased production of sex hormones by the ovaries, and many times there are symptoms representative of estrogen deficiency and withdrawal. Men may also experience some "change of life," but usually this is fairly mild compared to what women experience.

Most women enter menopause between the ages of 45 and 50, but it may occur anywhere between 40 and 55. Those whose ovaries are surgically removed before they have entered menopause will almost immediately experience menopausal symptoms and often are placed on estrogen alone or hormone replacement therapy (HRT), using estrogen and progesterone to simulate their natural cycle. While estrogen therapy or HRT is helpful to most women, there are potential risks and side effects, so many women eventually want to shift to a more natural program and go off synthetic hormones. The discussion here is therefore oriented toward a natural program of diet, nutritional supplements and herbs to minimize menopausal symptoms and enhance vitality.

The symptoms of menopause include a change in the frequency or volume of blood flow of the periods (or actual cessation of menstrual periods), irritability, hot flashes and night sweats, emotional swings, headaches, depression, insomnia, loss of sex drive, and weight changes. More internal metabolic shifts, such as the bone loss of calcium, may also occur.

There are many factors that influence the intensity of symptoms and probably even the time they appear. A poor diet, emotional stress, and lack of exercise may lead to an increase in symptoms, particularly when these lifestyle habits have been going on for years. Women who become aware of these relationships prior to menopause and change their habits to help build themselves up with diet and supplements, and deal with their stressful issues will most assuredly have an easier time. Not all women have a difficult menopause; some may not even experience symptoms at all.

A good diet along with supportive nutritional supplements and stress management may help to delay the onset of menopause and reduce symptoms when it does occur. Of other positive lifestyle habits, regular exercise is the most important. It strengthens the bones and improves calcium metabolism. It may also help mobilize some stored estrogen from the fatty tissues, which may make for an easier transition. Outdoor exercise, such as walking, bicycling, swimming, golf, or tennis, will add sunlight and thus aid the body's vitamin D production, and so improve calcium utilization.

During menopause, it is wise for women to get adequate sleep and even take naps if they feel tired. Menopause can often be a time of lowered energy. Stress reduction and dealing with the concerns and worries about aging are important. Embrac- ing maturity and wisdom adds a positive attitude and supports this process. Drinking plenty of water helps keep the body vital and young, with the internal processes functioning best.

A diet that contains vital and wholesome foods will support a stronger life force and the ability to better handle changes. As I have emphasized throughout this book, a vital diet is one that includes fresh fruits and vegetables, whole grains, nuts, seeds, and legumes; with fish, poultry, eggs, milk products, and cold-pressed oils used in moderation; and sugar, refined flour products, other refined processed foods, cured meats, fried foods, and chemicals avoided.

A diet with good quantity and quality of protein and one high in B complex foods may help delay the onset of menopause by supporting the pituitary gland, which regulates the ovaries and the female cycle. (It appears that strict vegetarian women and those with low cholesterol levels have an earlier menopause than more omnivorous women; further research in this area may help us to understand more about diet, cholesterol, and menopause.) Some of the protein foods suggested are fish, milk products such as yogurt and cottage cheese, eggs, whole grains and legumes, nuts, and seeds; foods high in B vitamins are green vegetables, whole grains, wheat germ, and yeast. Good levels of pantothenic acid, choline, and inositol also aid the adrenal and pituitary functions. Special foods that offer high amounts of vitamins, minerals, and energy include brewer's yeast, molasses, lecithin, and kelp (or other seaweeds). These can be used with milk or juice to make a high-nutrient drink.

Osteoporosis is a loss of bone minerals, density, and bone strength, particularly of the spine and long bones of the arms and legs; it is a common problem of menopausal women. Osteoporosis is a difficult problem to diagnose. Regular x-rays are not that sensitive, and they reveal bone loss only after it is fairly significant. The new technique available to measure bone density, photon absorbtiometry, is more sensitive at assessing early osteoporosis. Generally, though, women should be aware of early warning signs, such as periodontal disease, changes in the curvature of the spinal column, such as a "dowager's hump," or pain in the middle or lower back. The most important factor is preventing the loss of bone calcium; this is much easier than correcting bone loss after it occurs.

To prevent osteoporosis, it is wise to eat a good diet and maintain an adequate calcium intake through foods and supplements in the years before menopause. Many people eat a diet that is much higher in phosphorus than in calcium. This can lead to improper bone metabolism and loss of bone calcium. Meats, nuts, seeds, poultry, boneless seafood, and even whole grains have a much higher phosphorus than calcium content. Soda pops have added phosphates, increasing their phosphorus level. One advantage of using milk products is that they have a very good calcium-to-phosphorus ratio, with actually slightly more calcium. Eggs and many vegetables, especially the green leafy veggies, also have lower phosphorus content.

Premenopausal women should regularly consume 1,000-1,200 mg. of calcium per day. Supplementing some calcium without phosphorus will usually balance out these nutrients. Adding about 500-1,000 IUs of extra vitamin D and 500-800 mg. of magnesium per day will help the calcium be best utilized and protect against osteoporosis. Adequate boron, a trace mineral, in the diet and supplements to include 2-3 mg. is also shown to aid calcium utilization. A diet containing good amounts of fish, leafy greens, whole grains, and dairy foods will support healthy bones. Phosphorus, zinc, copper, and manganese are also important to building strong bones. If osteoporosis is present, research suggests that estrogen therapy may help slow its progress and even improve the bone health, though it also poses risks. Fluoride, 2-4 mg. per day in foods or even taken as a supplement, has been shown to strengthen bones, but it, likewise, may have other concerns.

When estrogen is used during or after menopause, it is wise to follow a program similar to that suggested for users of birth control pills (if the woman still has a uterus, a progestin agent should also be used to simulate the natural cycle and to protect the uterus from cancer development). Extra vitamins C, E, and B6, extra zinc, and minimum copper intake are the main suggestions. It is clear that estrogen or hormone replacement therapy does prevent osteoporosis, possibly better than any other program, especially with a good diet, adequate calcium intake, and plenty of exercise. Regular exercise has clearly been shown to minimize bone loss, especially postmenopausally. Weight-bearing exercises, such as walking, tennis, or golf, help to strengthen the bones, probably more than swimming. When taking estrogen, usually less calcium is needed than when no hormones are used. Still, a natural program such as the one described here will help prevent osteoporosis and ease the symptoms and transition of menopause. (For more on osteoporosis, see the Calcium discussion in Chapter 6.)

Younger women also can develop osteoporosis, usually due to a poor diet, low calcium intake, and excessive vigorous exercise. Dancers, gymnasts, and long-distance runners have this problem most commonly, and it is exaggerated with anorexia and weight loss. These young women often have associated low body fat, low estrogen levels, and irregular or nonexistent menstrual periods. A more nourishing diet, reduced activity, and calcium-vitamin-mineral supplements can help to correct this problem and prevent future ones.

For menopausal hot flashes, irritability, and/or night sweats, supplemental calcium and vitamins D and E will often help. Dong quai herb has also benefited many women with those symptoms. Two capsules taken two or three times daily is the standard usage in this regard. Ginseng has also been helpful, especially when there is associated fatigue. Other herbs that work are some of the female tonics, such as the cohosh herbs, unicorn root, and licorice root. The FE-G and female formulas described in the section on Premenstrual Syndrome in Chapter 17 may also be helpful in menopause, as they seem to support estrogen production by stimulating the female organs. Sarsaparilla root has been used as a female herb, and valerian root can be used for insomnia and irritability. Calcium-magnesium is helpful for muscle and back pains or cramps. Kelp tablets have been used to support thyroid function, which helps women through the changes of menopause. Iron is still needed in premenopausal amounts until there is no more bleeding; then the iron requirements decrease from 18-10 mg. per day.

The nutrient program presented here includes dietary plus supplemental needs. Nutrients such as chloride, phosphorus, fluoride, sodium, and potassium are usually not supplemented, but obtained from diet. The ranges allow for individual comfort in using the higher amounts, which may be best for this program. (See the following program for the Elderly for further information. The programs on Anti-Aging and Anti-Stress in Chapter 16 may also provide assistance to the menopausal woman.)

Brittle Bones? Take an Aggressive Stance

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It's obvious.

It affects more than 10 million people in our nation - mostly women. Unfortunately, fewer than one quarter of these individuals know it.

We see it in friends, co-workers and family members. It results in loss of self-esteem, diminished mobility, fractures, disability and even death.

We literally watch it develop progressively over the years. Yet rarely do we insist on, or receive treatment until it's too late.

The problem is osteoporosis, a rather common bone disease that affects older women and men. In March 2000, the National Institutes of Health (NIH) panel defined it as "a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture."

Although sometimes referred to as a "silent" disease, in many cases it's easy to spot. Individuals with osteoporosis often cannot stand straight. They also experience progressively shortened stature and a hunchback appearance. Dowager's hump, a protrusion at the base of the neck also frequently occurs.

Yet despite these obvious features, many people go untreated until a devastating hip fracture occurs that often leads to disability. Sometimes the diagnosis is heralded by back pain, collapsed vertebrae and spinal nerve involvement. By then, it may be too late.

Since early detection and education are paramount to effective treatment, let's spend a few moments reviewing what is known about this condition.

Two types of Osteoporosis exist. Type I typically affects postmenopausal women between 55 and 75. Type II, affects 70-80 year-old men and women equally. What is described as "bone weakness" typical results from mineral loss or inadequate bone development. According to the NIH, "the bone mass attained early in life is perhaps the most important determinant of life-long skeletal health." Prevention should actually be focused initially on nutrition in childhood.

With the exception of individuals who have a history of kidney stones, suggested calcium and Vitamin D requirements from the National Academy of Sciences are:

Children 3-8: Calcium - 800 mg./day
Children 9-18: Calcium - 1300 mg./day
Adults 19+: Calcium 1000 - 1800 mg./day
Adult (avg.): Vitamin D 500 - 700 IU/day

While the NIH is encouraging research for increasing peak bone mass in childhood, its panel is also emphasizing the unraveling of the genetic components of osteoporosis as well as the discovery of the best individual and combined treatment modalities. Yet from this physician's perspective, there's no time to wait for the medical establishment to become more aggressive - it's up to us to make a difference early on when it counts the most. One of the most frustrating aspects of medicine in our nation centers around the fact that advances in medical research seem to take an inordinate amount of time to reach the people who are in need.

So if you have even the slightest reason to suspect osteoporosis (especially if you are a menopausal or post-menopausal woman), speak with your physician during your next check-up and insist on a bone-density measurement. This is a simple, quick and painless screening procedure that has great value now and in the future. Bone density results not only document where you are today, but can also be used as a comparison for monitoring rates of progression or treatment efficacy.

Basic treatment and prevention options include weight-bearing exercises, calcium and Vitamin D supplementation. Whenever possible, one should avoid substances that promote calcium loss such as aluminum-based antacids, caffeine, carbonated and alcoholic drinks, high protein diets and sodium. It's also a fact that cigarette smoking can cause bone mineral depletion. So if you need just one more reason to quit, there's no better time than NOW!

In many cases basic treatment and prevention options may not be sufficient to prevent osteoporosis. Medications in the form of hormone-replacement therapies and other recently-released osteoporosis drugs can be prescribed. Several options exist.

Miacalcin (generic - Calcitonin), a hormone that prevents bone from breaking down is available as a nasal spray. A single spray in one nostril daily has been shown to be effective. In some cases, nasal dryness and irritation have been reported. When taking Miacalcin or other prescribed agents, remember that adequate intake of calcium and Vitamin D are still essential for effective treatment.

In 1999, more than 3.5 million patients were treated for Osteoporosis with Fosomax (generic - Alendronate). While approximately 10% of patients on Fosomax develop irritation of the esophagus, most tolerate it well.

Evista (generic - Raloxifene) was approved for Osteoporosis by the FDA last fall. Evista appears to be associated with venous blood clots in some patients. However, many women are using this medication without problems. The latest "kid on the block" just released in April 2000 is Actinel (generic - Risedronate) which has demonstrated significant benefits with few side effects when compared with placebos.

It's essential to realize that the treatment of Osteoporosis is in it's infancy and new drugs with fewer side effects are on the horizon. Yet based upon what is known today, it is unwise to take a "wait and see" attitude rather than seeking the best options available today. Speak with your physician, consider your individual circumstances, learn as much as you can, develop healthy eating habits and become an active member on your healthcare team. Since great ways to grow new bone have not yet been discovered, why not preserve what you already have? -- Mind Over Matter!

Osteoporosis

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Osteoporosis, which means "porous bone," is a bone-thinning disease that has affected over 200 million people worldwide. It has been called the "silent disease" because it comes on with few or no warning signs. It is the major cause of fractures, particularly of the spine, hip, ribs and wrist in older persons. Common symptoms include a loss of height, a hunched back, and back pain. While the condition itself is not fatal, it makes bones more susceptible to fractures and can make moving around increasingly difficult. It is important to note that osteoporosis is NOT merely a loss of calcium from the bone. That condition is called osteomalacia. Osteoporotic bone is losing not only inorganic (calcium mineral) density but organic bone matrix made up primarily of collagen and specific proteins.

The group at highest risk for osteoporosis may be characterized by the post-menopausal, slender, small-boned, fair complexioned Caucasian woman. Men are also at risk, but tend to have congenitally denser bone, and sustain weight bearing exercise for longer periods. African American and Hispanic populations are much less prone than Caucasians to loss of bone density because they inherit, for the most part, a sturdier skeletal structure.

A woman's risk of osteoporosis greatly increases after menopause because her production of the sex hormone estrogen dramatically drops off at her peak of maturity. After 50 a woman clearly has other concerns than caring for infants, and has no need to continue to maintain her endometrium for the possibility of pregnancy. It so happens that reduced estrogen results in diminished levels of active Vitamin D (crucial for calcium absorbtion) and in increased calcium excretion. For this reason, many physicians choose to routinely administer small doses of synthetic estrogen to menopausal women. Although this seems logical, it is also well known that estrogen ingestion bears many risks including increased incidence of breast, cervical and ovarian cancer. Weight bearing exercise, such as walking for 30
minutes daily or an hour 3 times weekly, plus adequate nutrition which will be discussed below, is far superior treatment, in this author's opinion, to hormone therapy.

In addition, something that many physicians may have forgotten from biochemistry or physiology classes is that adequate stomach acid (HCl) is mandatory for calcium absorption. After the age of 40, when we no longer need to eat as much, stomach hydrochloric acid drops off naturally. If you do supplement with calcium, you may want to take a small glass of lukewarm or room temperature water with the juice of a quarter lemon 20 minutes before each meal. And please make sure to use a bioavailable form of calcium. Calcium citrate is the state-of-the-art way to deliver calcium supplements. Calcium carbonate (such as in TUMS) is very inefficient. "About 45% of the calcium is absorbed from calcium citrate in patients with reduced stomach acid, compared to 4% absorption from calcium carbonate." (Recker R., "Calcium absorption and achlorhydria." New England Journal of Medicine, 1985, 313, pp 70-73)

Coffee, more than 2 ounces of alcohol daily, and smoking all deplete serum calcium and are associated with an increased risk of developing osteoporosis. (Heaney, R., "Nutritional factors and estrogen in age-related bone loss." Clin. Invest. Med., 1981, 5, pp 147-155) One of the worst offenders in osteoporosis is high-phosphate drinks such as soda pops. Serum phosphates compete with calcium in the blood for cellular absorption. Other dietary implications in osteoporosis are excessive protein (we rarely need more than 2 ounces daily) and trace mineral deficiencies. Complex carbohydrates turn out to be culprits, once again: After ingesting sugar, urine calcium increases. Vegetarian diets are associated with a lower risk of osteoporosis because they eat less dense protein (and no mammalian protein) and probably consume less phosphorus and more bioavailable calcium from leafy green vegetables and colorful fruits, particularly berries. (Thom J., Morris J., Bishop A., Blacklock NJ, "The influence of refined carbohydrate on urinary calcium excretion," British Journal of Urology, 1978, 50, pp 459-464.) The so-called "anthocyanadins" (a
class of dark blue and red, highly nutritious pigments found in berries) have a remarkable ability to stabilize collagen, including that found in bone matrix.

The best approach to preventing, and treating, osteoporosis is a comprehensive plan that involves regular weight-bearing exercise, a good source of calcium and Vitamin D (as well as magnesium, B6, folic acid, B12, Vitamin K and trace minerals boron and strontium), botanical medicines for women with estrogen deficiency or in menopause, and a vegetarian diet.

Great juicing sources of
Calcium: alfalfa, comfrey leaves, dandelion leaves, nettle leaves, parsley, mustard greens, red clover flowers, collard greens, kale, broccoli (best is lightly steamed first), cooked garbanzo and soy beans.

Vitamin D: Sunshine (not necessary to put through the hopper), alfalfa, watercress, nettles.

Flavonoids (to stabilize collagen structures): Blackberries, blueberries, cherries, raspberries, salmonberries.

If you suspect you may have, or be heading towards, osteoporosis, or know someone who is concerned about the disease, please consult a medical professional. The naturopathic physician or nutritionist will be the most skilled at dietary counselling. To find the closest naturopathic physician or nutrionist trained in biochemistry and physiology please call the American Association of Naturopathic Physicians at (206) 326-1612.

References (other than those specifically indicated)

Wm McGarey, "Osteoporosis: The silent disease," Patient Care, 1988, 5, pp 191-194.

M Murray, J Pizzorno, "Encyclopedia of Natural Medicine," Prima Publishing, Rocklin CA 95677.

Osteoporosis, Heart Disease, and Breast Cancer

2007-04-05T00:20:00.014-07:00

The decrease in hormones that occurs soon after menopause can cause a number of uncomfortable symptoms, but the long term effects of hormonal loss can produce devastating (and potentially life threatening) consequences. Estrogen protects the heart and bones from aging. With the loss of this hormone, the incidence of osteoporosis and heart attacks increases with age in high risk women. Breast cancer also occurs much more commonly in postmenopausal women, since immune function diminishes with age. This chapter presents basic facts about these three postmenopausal health problems and offers suggestions for vitamins, minerals, and herbs which can help to prevent them.

Osteoporosis
One of the most serious consequences of postmenopausal aging is the development of osteoporosis. In fact, osteoporosis is a major health problem affecting more than 20 million older Americans, 90 percent of whom are women. One out of three American women will develop osteoporosis after menopause.

The statistics surrounding osteoporosis are astounding. More than 1.3 million fractures occur in the United States each year because of this condition, including 250,000 hip fractures. Eighty percent of these fractures occur in women over 65 with osteoporosis. About one-quarter of these women die within one year from complications caused by their fractures, such as blood clots and pneumonia. Another one-third never regain the ability to function physically or socially on their own. These women spend the rest of their lives requiring long term care in nursing facilities. Besides causing hip fractures, osteoporosis is also responsible for loss of bone in the jaw, gum recession (both of which are early signs of this condition), dowager's humps, loss of height, back pain due to compression and fractures of the vertebra, and fractures of the wrist (known as colles fractures by physicians).

Often these fractures occur in situations that put only mild stress on the bone, and would not normally cause such an outcome. This can include missing a step and falling down, falling on an extended arm, or lifting a heavy object. Because of the underlying weakness of the bone, fractures can also occur spontaneously without any preceding trauma. This is often the case with vertebral fractures.

Risk Factors for Osteoporosis
Not all women have the same risk of developing osteoporosis. Some women maintain strong and heavy bones throughout the lives, while other women develop accelerated bone loss soon after menopause. If you suspect you are at higher risk of developing osteoporosis, become knowledgeable about which factors have actually been linked to a higher incidence of this disease. This will help you and your physician evaluate your own risk when planning an optimal treatment program. These factors include racial background, family history, hormonal status, lifestyle habits, and preexisting health conditions.

Racial Background
Skin pigmentation appears to correlate with bone mass. Black women are less likely to develop osteoporosis than white women. In fact, women at the highest risk are small and fairskinned. These are typically women of northern European ancestry such as Dutch, German, or English background with blond, reddish, or light brown hair and pale skin. Asian women also have a higher risk of developing osteoporosis.

Family History
If your close female relatives suffered from osteoporosis, you run a higher risk of developing this problem. Many women have seen their own mothers or grandmothers develop a dowager's hump or become disabled from fracturing their hips. This can be quite upsetting for the entire family who must deal with the long term disability.

Hormonal Status
The age at which women begin menopause and how much hormonal support they maintain during their postmenopausal years affects bone density. Women who have had a surgical menopause before the age of 40, with removal of their ovaries, are at high risk of developing osteoporosis because of the abrupt withdrawal of estrogen at a young age. Similarly, women who go through an early natural menopause are at high risk of osteoporosis. A woman going through early menopause at age 35 or 40 has as much as 10 to 15 years less estrogen protection of her bones than a woman going through menopause at age 50. Thus, the older you are when going through menopause, the more years of hormonal protection you provide for your bones.

While obesity is a health risk for many diseases such as osteoarthritis and uterine cancer, being overweight does confer some protection against osteoporosis in postmenopausal women. This is because the fat cells produce estrone, a type of estrogen, through conversion of the adrenal hormone androstenedione. This type of estrogen does provide some support for the bones once the ovarian source of estrogen has dwindled.

Lifestyle Habits
Women who engage in regular physical exercise and are more muscular have a lower risk of developing osteoporosis. Physical activity helps keep women flexible and agile, which also reduces the likelihood of fractures. Conversely, inactivity increases the risk. Even young men or women confined to bed for long periods of time show a decrease in bone mass.

Many nutritional factors affect the risk of developing osteoporosis. Women who drink more than two cups of coffee per day or excessive amounts of other caffeine containing beverages like black tea or colas, or consume more than two alcoholic drinks per day are at higher risk. High protein or high salt intake are risk factors, as is inadequate calcium intake. Smokers also run a higher risk of osteoporosis.

Preexisting Health Issues
Women with a history of bulimia, anorexia, or malabsorption syndrome run a higher risk of poor calcium absorption or low estrogen levels. This is often the case in women with anorexia who don't have enough body fat to produce adequate estrogen. Women who use thyroid medication, or cortisone for a variety of conditions or who suffer from an overactive thyroid gland are at higher risk. This is also true of women with chronic kidney disease. All of these conditions can adversely affect the calcium balance in the body.

Diagnosis of Osteoporosis
Excellent tests now exist to evaluate the likelihood of developing osteoporosis. They also allow physicians to diagnose osteoporosis in the early stages before the bone loss is so severe that it causes fractures. These tests include the single photon densitometer, which measures the density of the forearm bone; the dual photon densitometer, which measures the spine or hip bone; and the computerized axial topography scan (also called a CAT scan), which measures bone density in the spine. The CAT scan uses higher amounts of X rays and is a more expensive test. These tests are much more sensitive than the conventional X ray, which picks up osteoporosis only when 30 percent or more of the bone mass is lost.

You may want to have a bone density test if you are trying to decide whether or not to use hormonal replacement therapy (HRT). If the tests show accelerated bone loss for your age group, you should seriously consider the use of HRT unless other major health issues contraindicate the use of hormones. The use of estrogen and progesterone, in combination, not only help to retain calcium in the bones, but appear to promote the growth of new bone. A vegetarian-based diet is optimal for prevention of osteoporosis. A diet high in meat tends to promote loss of calcium from the body.

Heart Disease
Cardiovascular disease is the major cause of death for American women, claiming the lives of half a million women per year. This is twice the number of women who die from cancer per year. While younger women do die of heart disease, it is a rare occurrence; the numbers tend to escalate as women age. Cancer is the main cause of death in women from age 30 to 60 (with heart disease in second place from age 40 to 60). Heart disease becomes the leading cause of death in women by age 60.

Most women die from heart attacks due to coronary artery disease. With coronary artery disease, there is a narrowing of one or more of the arteries that supply blood and oxygen to the heart. This narrowing is due to the formation of plaque in the arteries. Plaque is a thick, waxy, yellowish substance consisting primarily of cholesterol, smooth muscle cells, and foam cells. As the formation of plaque progresses, it can obstruct the flow of blood through the blood vessels. Over time, this can seriously compromise the function of the heart, finally leading to a heart attack. Unfortunately, the obstruction is usually quite advanced before it even begins to cause symptoms. Usually the symptoms consist of chest pain (angina) and shortness of breath on mild exertion.

Risk Factors for Heart Disease
Much research has been done over the past few decades to determine if certain women run a higher risk of developing heart disease. A number of studies have pinpointed factors that appear to be linked to a higher likelihood of developing this disease. These include specific physical characteristics: health factors such as family history, blood lipid profile, hypertension, and diabetes; and lifestyle factors such as smoking, lack of activity, and stress.

Physical Characteristics
Age. As mentioned earlier, the older the woman, the greater her risk of developing heart disease. The highest incidence is in women over 65 years of age.

Body Weight.Women who are between 20 to 30 percent over their ideal weight are considered to be at greater risk of developing heart disease. This was noted in a study done by Harvard Medical School, which tested more than 115,000 women over eight years. Excess weight was found to be a significant factor in women developing coronary artery disease during the period of the study.

Body Shape Distribution of Fat.Not only is overall obesity a risk factor, but how fat is distributed on the body affects heart disease risk, too. Women who distribute their excess weight in their middle or are rounder, shaped like apples, have a higher risk of coronary artery disease than pear-shaped women who distribute their fat in their hips and thighs.

Health Factors
Family History of Heart Disease. You are at higher risk of developing heart disease if your close relatives have had a heart attack at an early age. Statistically, your risk is increased if your father had a heart attack before age 56 or your mother before age 60. Similarly, you are at a higher risk if your grandparents had a heart attack at a young age.

Blood Lipid Profile. Triglycerides are the form in which fat is stored in the body's tissues: three fatty acid molecules hooked to a glycerol backbone. Women with Elevated triglycerides, or triglycerides elevated in the blood to a level of 190 mg/dl or greater, run a higher risk of developing coronary artery disease.

Elevated total cholesterol and LDL cholesterol.Cholesterol is a yellowish, waxy substance manufactured in our body primarily by the liver and, to a lesser extent, by the intestines. We also ingest cholesterol when we eat dairy products or red meat. How effectively cholesterol is used depends upon how efficiently it is transported throughout the body and how well the body can store or dispose of any excess. Transportation in the body is potentially a problem because the fatty cholesterol isn't soluble in blood, which is mostly water. To solve this problem, the body packages the cholesterol with a protein that allows the fat to be mixed with the blood. This process takes place in the liver, where several types of cholesterol-protein mixtures are produced.

The major type of cholesterol-protein manufactured is the low density lipoprotein, or LDL. LDL is the body's main carrier of cholesterol. When levels of LDL are elevated they remain in the body streams and injure the endothelium (the inner lining of the blood vessel wall), thereby initiating plaque formation. Thus, LDL is considered to be the "bad" type of cholesterol. Women with a total blood cholesterol above 240 mg/dl and a LDL level above 160 mg/dl are thought to be at high risk of heart disease. Ideally, the total cholesterol should be below 180 mg/dl and the LDL below 130 mg/dl for the greatest degree of protection.

Decreased HDL cholesterol.The liver also makes another type of cholesterol-protein called the high density lipoprotein or HDL. The HDL is considered to be the "good" type of cholesterol. This is because HDL picks up and carries the excess cholesterol back to the liver, where it is secreted into the bile. The bile empties the excess cholesterol into the intestinal tract, where it is excreted from our bodies through bowel movements. When her HDL is less than 35 mg/dl, a woman is considered to be at high risk of coronary artery disease. The HDL should ideally be about 55 mg/dl.

Elevated LDL to HDL ratio.The ratio between the LDL and HDL is also an important indicator of heart disease risk. Ideally, your LDL to HDL ratio should be no higher than 4:1. For example, if your HDL is 30 and your LDL is 150, then your ratio is 5:1, which puts you in the high risk category.

Hypertension. High blood pressure is a significant risk factor for developing coronary artery disease. Sixty million Americans have elevated blood pressure readings, and nearly half of these people are women. Blood pressure is considered to be elevated when readings are above 140/90. The upper number is called the systolic pressure, which is the pressure that occurs when the heart contracts and pushes blood through the arterial circulation. The bottom number is called the diastolic blood pressure. This is the pressure in the arteries when the heart relaxes between beats. Not only does hypertension increase the likelihood of heart attacks, but it also increases the risk of strokes and kidney disease.

Diabetes. The Framingham Study, an important study of cardiovascular disease risk that has been ongoing in Massachusetts since 1949, found that women with diabetes are twice as likely to have a heart attack as nondiabetic women. Diabetic women are also at higher risk of developing serious visual problems and kidney complications, as well as hypertension and higher cholesterol levels.

Lifestyle Factors
Cigarette Smoking. Because smoking narrows the diameter of the blood vessels, impairing circulation, smokers have an increased risk of heart attacks and strokes. Smokers are also more likely to have higher levels of the bad LDL and lower levels of the good HDL. Unfortunately, 27 percent of all women smoke and this percentage is not declining rapidly, despite the great amount of public information on the health perils of smoking. Women smokers also enter menopause two to three years earlier than nonsmokers.

Physical Inactivity. Women with sedentary lifestyles have three times the risk of developing heart disease than women who are physically active. The heart is a muscle that needs to be exercised. Women who engage in aerobic exercise, such as walking at least three times a week for a half hour, have lower resting heart rate, greater lung capacity, and an improved ability to handle stress.

Stress. Several studies suggest that severe stress is a risk factor in developing coronary artery disease, though this link has been researched much less in women than in men. Many studies have been done on the Type A, hard driving, aggressive male personality. However, women with multiple home and work responsibilities are often as hard driving and stressed as men. This can predispose certain women over time to an increased risk of heart attack.

Female-Related Risk Factors
Menopausal Status. The risk of coronary artery disease increases twofold to threefold once a woman enters natural menopause. Research studies, including the Framingham Study, have confirmed that premenopausal women with intact ovarian function enjoy significant protection against the development of heart attacks.

Surgical or Natural Menopause Before Age 45. Recent studies have shown that women who, during their premenopausal years, undergo a hysterectomy involving removal of their ovaries have three times the risk of coronary artery disease compared to women who cease menstruating at a later age. Similarly, a study of 122,000 nurses found that women who went through surgical menopause before the age of 35 have two to seven times the risk of heart attack. The risk is also higher in women who go through natural menopause at an early age. Estrogen appears to confer significant protection against heart attacks during the active reproductive years. The longer a woman menstruates, the more years her vascular system has estrogenic protection.

Hormonal Therapy for Heart Disease Prevention. Both estrogen alone and combined estrogen-progestin therapy have been studied for the effects on the cardiovascular system. Estrogen appears to be beneficial; it lowers the levels of LDL cholesterol, which is linked to heart attacks, and raises the level of HDL cholesterol, which appears to confer protection. The one negative factor noted on studies of estrogen users was a moderate rise in triglycerides. On the other hand, however, physicians believe the use of estrogen will confer protection against heart attacks. The addition of progesterone to an estrogen treatment program does not appear to negate estrogen's positive effects on the heart.

Breast Cancer
The incidence of breast cancer has increased dramatically over the past two decades. During the 1950s, it was estimated that one out of every twenty Americans would develop this disease. These estimates have been revised many times over the past forty years as the incidence of breast cancer has skyrocketed. It is currently estimated that one out of eight women, or 12 percent of all women in this country, will develop breast cancer during her lifetime. This is a staggering number, placing breast cancer as the most common cancer of American women today. It is the second most common cause of cancer deaths in women, behind only lung cancer in its mortality rate. In absolute numbers, 180,000 new cases of breast cancer were projected for 1993, as well as 46,000 deaths from this disease.

Breast cancer cells, like other malignancies, invade and destroy normal tissue (unlike benign tumors, which remain confined within a specific area). Breast cancer cells first grow within the breast tissue itself. In the later stages of the disease, the cancerous cells spread to other parts of the body near or adjacent to the breast (as with invasion to the lymph nodes). The cancerous cells can also invade distant sites, like the liver and the bones.

How high a woman's chance of survival is depends on how early the cancer is detected. The earlier the detection and the more localized a tumor is to the breast tissue itself, the more likely a woman is to have a long term recovery from this disease (five years or more). For example, women with localized tumors are eight times more likely to survive the disease long term than a woman with an advanced case that has spread throughout her body.

Risk Factors for Breast Cancer
Not all women have the same risk of developing breast cancer. While any woman can develop the disease, certain factors do put some women statistically at greater risk:

* Previous history of breast cancer.

* Family history of breast cancer. This is particularly pertinent if a woman's mother or sisters had the disease.

* Early onset of menstrual periods.

* Late menopause - Women who menstruate for more than 40 years seem to be at particular risk of breast cancer.

* Postmenopausal age. Most breast cancers occur after age 50.

* Childlessness or having a first child after age 30.

* Bottle feeding. Women who nurse their children appear to be at lower risk.

* Certain types of "atypical" cell patterns with benign (noncancerous) breast disease.

* High fat diet - This seems to be a risk factor for some cases of breast cancer.

* Obesity - A high-fat and too-rich diet causes women to be overweight, which is a risk factor for the development of this disease.

* Alcohol use — more than nine drinks per week significantly increases the risk.

* Height or tallness is a risk factor.

* Affluence or degree of wealth.

* Radiation exposure.

* Prolonged estrogen and progesterone use (this is still a controversial area in medicine, with some studies supporting this view and other studies contradicting it).

* Urban lifestyle.

Diagnosis of Breast Cancer
Breast cancer is often discovered by the woman herself on breast examination or by her physician during a medical visit. A woman can usually feel a hard, nontender mass that is not particularly movable within her breast tissue. Other signs of breast cancer can include swelling, dimpling, or redness of the breast tissue. If the cancer has spread to the lymph nodes under the armpit or above the collarbone, they may feel enlarged and hard.

Mammography, or an X ray of the breast, is a tremendously helpful diagnostic tool to pinpoint breast cancer. In fact, many early stage cancers, too small to be felt manually, can be detected by mammography. As a matter of fact, it can detect 90 percent of all breast cancers. Undoubtedly, the use of mammography has saved many women's lives through early detection. Other techniques such as thermography, which detects heat changes in the breast tissue, and ultrasound, which uses highfrequency sound waves, are diagnostic tools used less often.

Despite the usefulness of all of these techniques, the definitive diagnosis of breast cancer can only be made by doing a surgical biopsy. This allows the tissue sample removed from the breast to be looked at under the microscope and examined for cancerous cells.

Once breast cancer is diagnosed, many treatment options are available. These include surgery and removal of the breast and lymph nodes, if indicated. Less radical surgery, which leaves the breast intact, is being used more for localized cancer. Radiation therapy and chemotherapy are also used with various treatment regimens. What regimen is finally selected depends on how localized or disseminated the tumor is, as well as the preference of the patient and physician. Women interested in prevention should follow a diet low in saturated fat and limit their alcohol intake.

Vitamins and Minerals for Prevention of Osteoporosis

These are nutrients that can be of help in promoting prevention:
Calcium. There are dozens of studies that reinforce the importance of calcium for the prevention of osteoporosis. Calcium is the most abundant mineral in the body, and 99 percent of it is deposited in the bones and teeth. (The other 1 percent of calcium is involved in blood clotting, nerve and muscle stimulation, and other important functions.) As a result, calcium is the most important structural mineral in bone. Along with phosphorus, calcium helps to build and maintain strong and healthy bones. However, calcium absorption becomes much less efficient by the time women reach their postmenopausal years due to the aging of the digestive tract. Calcium needs an acid environment in the stomach for proper digestion. As many as 40 percent of postmenopausal women lack sufficient stomach acid for proper calcium absorption.

Unfortunately, most women have too little calcium intake in their diets. The average American woman takes in 400 to 500 mg per day. This is far less than the recommended daily allowance (RDA) of 800 mg per day for women during their active reproductive years and the 1200 to 1500 mg per day needed by postmenopausal women.

As a result, adequate calcium supplementation is of major importance to prevent bone loss. The type of calcium used must be considered, also. The main type of calcium used in supplements has been calcium carbonate. This is an alkaline form of calcium and isn't absorbed well by some women. In contrast, calcium citrate, an acidified form of calcium, is well absorbed and a good source of this nutrient for women. Be sure to check the label of any calcium supplement to make sure the dosages and the type of calcium used are optimal for your needs.

Phosphorus. Phosphorus is the second most abundant mineral in the body, found in bones and soft tissues. A major structural mineral of bone, it is present in a specific ratio of 2.5 parts calcium to 1 part phosphorus. This balance is important for both minerals to be used efficiently by the body. Because the American diet contains abundant phosphorous in foods such as meat, eggs, grains, seeds, nuts, and soft drinks, phosphorus deficiency is relatively rare. In addition, phosphorus is easily absorbed from the digestive tract, with an absorption rate of approximately 70 percent. The RDA for phosphorus is 800 ma.

Magnesium. This is another important mineral for healthy bones. While not as prevalent as either calcium or phosphorus in bone, it is equally important. Magnesium is needed for bone growth, as well as for proper calcium absorption and assimilation. If the body has too little magnesium available, it deposits calcium pathologically in tissues and organs, so calcium accumulates in the muscles, heart, and kidneys. In susceptible women, calcium deposited in the kidneys can cause kidney stones. Therefore, a woman who increases her calcium intake should also increase magnesium intake in a ratio of 2:1 or 10:4 calcium to magnesium. Other minerals, like zinc, copper, manganese, and silicon, are also needed in trace amounts for healthy bone growth and regulation of bone metabolism.

Vitamin D. This fat soluble vitamin can either be ingested in the diet or formed on the skin by exposure to sunlight. Sunlight activates a type of cholesterol found in the skin, converting it to vitamin D. Vitamin D is usually included in multivitamin products and is also found in fish liver oil supplements, along with vitamin A and fortified milk.

Vitamin D helps prevent osteoporosis by aiding in the absorption of calcium from the intestinal tract. It is needed for the synthesis of enzymes found in mucous membranes, which are, in turn, needed for the active transport of calcium. It also helps break down and assimilate phosphorus. A deficiency of vitamin D causes inadequate absorption of calcium from the intestinal tract and retention of phosphorus by the kidneys. This causes an imbalance in the calcium-phosphorus ratio, leading to faulty mineralization of the bones. Menopausal women should be sure to take the RDA of 400 IU per day of vitamin D.

Herbs for Prevention of Osteoporosis
Herbs as Mineral Sources. While they are not the primary source of calcium and other minerals for most women, herbs can still provide a valuable source of minerals along with other foods in the diet. Certain plants like kelp and other sea vegetables, as well as dandelion root, horsetail, and oat straw, are good sources of calcium, magnesium, and trace minerals needed for strong and healthy bones. Kelp and the other sea vegetables can be used as condiments to flavor food such as soups, casseroles, and salads. The other herbs may be taken in capsule form as supplements.

Vitamins and Minerals for Cardiovascular Disease Prevention
Beta Carotene. Oxygen-related damage to LDL cholesterol has been linked to the development of cardiovascular disease. Laboratory testing and a few clinical studies suggest that beta carotene can prevent this oxygen-related damage and, thereby, help protect the blood vessels from the disease process. It does this by inactivating singlet oxygen, a form of oxygen that is unstable and attacks cells in the body to gain a second electron. While the protective benefits of beta carotene have not been definitively proven, the studies to date suggest that its use may be beneficial in preventing heart disease. The U.S. Physicians' Health Study found that in a group of 333 participants with chest pain but no prior history of heart attack, beta carotene appeared to have a protective effect (with 50 percent fewer major cardiovascular events, such as heart attacks, strokes, and cardiac related deaths). I recommend the use of beta carotene or beta carotene-containing foods because of its many benefits for good health, aside from any possible cardiovascular protection.

Vitamin C. Like beta carotene, vitamin C is a water soluble vitamin that appears to be helpful in preventing LDL cholesterol oxidation, a process which can initiate atherogenesis (the destruction of the blood vessel wall and the formation of plaque) and eventually, major incidents like heart attacks and strokes. In the recent Nurses' Health Study, sponsored by Harvard University, in which over 87,000 women between the ages of 34 and 54 were tested, the association between dietary intake of vitamin C and the risk of developing coronary artery disease was evaluated. The risk of developing heart disease was at least 42 percent lower for women who took high doses of vitamin C than for women with a low vitamin C intake. Another study done in the Boston area found that both male and female users of vitamin C supplementation had lower levels of blood pressure, lower LDL cholesterol, and higher levels of HDL cholesterol (the type of cholesterol that confers protection against coronary artery disease) than participants with a lower vitamin C intake. Vitamin C is also necessary for the regeneration of vitamin E in the body, another important antioxidant nutrient. These results make a good case for vitamin C's cardiovascular protective effects.

Vitamin E. This nutrient completes the triumvirate of antioxidant vitamins that appear to confer protection against cardiovascular disease. Vitamin E is the main fat-soluble antioxidant nutrient in the body. It lodges within the membranes inside and surrounding the cells, protecting the body against attack by singlet (unstable) oxygen and other free radicals that cause cell destruction. As mentioned earlier, singlet oxygen or other free radical destruction of LDL cholesterol may be one of the early steps leading to atherogenesis and ultimately, cardiovascular disease. Vitamin E, along with beta carotene and vitamin C, provides protection for both the water compartment as well as the fat compartment of our cells. This is necessary for the most complete protection against oxidative damage. Vitamin E also has a beneficial anticlotting effect on the blood. While a diet high in saturated fat tends to make blood cells become sticky and clump together, vitamin E causes the cells to disperse. This helps prevent blood clots from forming, an advantage for women past midlife who are at higher risk of stroke and heart attack.

Essential Fatty Acids. The supplemental use of Omega-3 fatty acids derived from fish oils like mackerel, salmon, and halibut, as well as plants like flax seed, pumpkin seed, and soybeans, have protective effects against cardiovascular disease. A number of studies have shown that these fatty acids can relax and dilate the blood vessels, as well as inhibit platelet cell aggregation (important in preventing clot formation). In addition, the Omega-3 fatty acids lower triglyceride level. This is beneficial because the elevation of triglycerides is a risk factor for coronary artery disease. However, the evidence for reduction of LDL cholesterol is not as conclusive. Also, since fish oil consumption can impair insulin secretion and increase blood glucose, its intake should be monitored in diabetics. Otherwise, the use of Omega-3 fatty acids may be a good idea for women wanting to prevent cardiovascular disease.

Herbs for Cardiovascular Disease Prevention
Anticlotting Herbs. Garlic and ginger are two delicious herbs which are used commonly as flavoring agents. They are also tremendously beneficial in reducing the risk of heart disease. These two plants should be used frequently as part of your preventative program if you have a strong family history of heart disease with early mortality (parents or siblings dying in heir 50s or 60s of heart disease.) They should also be used if you have many risk factors yourself, such as hypertension or elevated cholesterol. Both garlic and ginger have been researched for their ability to prevent aggregation or clotting of the blood. This is important for the prevention of strokes and heart attacks. In addition, both herbs help reduce cholesterol levels. Garlic has the additional benefit of reducing blood pressure.

If you find these foods too spicy for your taste, they can be taken in capsule form or as a liquid tincture. Women taking these herbs for cardiovascular disease prevention may want to eat several raw cloves of garlic a day or as many as 6 capsules of the herb used as a supplement. I also recommend as many as 4 capsules of ginger per day, if you do not use it as a food favoring. These are maximum dosages; you may find that 1 to 2 capsules per day suit your needs better.

Vitamins and Minerals for Breast Cancer Prevention
Vitamin A. Beta carotene, the provitamin A found in fruits and vegetables, has been cited in a number of studies as an important nutrient in breast cancer prevention. In the Nurses' Health study mentioned earlier, beta carotene proved protective against breast cancer for more than 87,000 women. A study published in 1992 by the State University of New York compared 310 women having breast cancer to 316 women without the disease. The study found that the cancer-free group ate many more beta carotene-containing fruits and vegetables than he women with breast cancer. In addition, the National Cancer Institute studied 83 women with breast cancer and found that they had lower blood levels of beta carotene. Beta carotene both in supplemental form and in foods like fresh fruits and vegetables should be included in your diet if you are interested in breast cancer prevention.

Vitamin C. In a 1991 review of 46 studies of the protective effect of vitamin C on cancer, in 33 studies vitamin C helped safeguard against the development of many cancers. This included nonhormone-dependent breast cancer. Vitamin C did not appear to confer any protection against hormone-dependent (including estrogen-dependent) breast cancers.

Fruits and vegetables are rich sources of both beta carotene and vitamin C. Supplemental vitamin C is helpful for women who want to lower their cancer risk for all types of cancer (including certain breast cancers).

Herbs for Breast Cancer Prevention
Anticancer Herbs. Many herbs show promise in the prevention and treatment of many human cancers, although their specific role in treating breast cancer is not clear. Herbs with possible anticancer activity include garlic, burdock root, alfalfa, and a host of others. One herb, in particular, may hold some promise for breast cancer prevention. This is red clover, an herb traditionally used by several different cultures to treat cancer. Research done at the National Cancer Institute has found anticarcinogenic compounds in red clover, including several bioflavonoids, genistein and daidzein, which are both weakly estrogenic and antiestrogenic (as described earlier in this book). Women who have preexisting breast cancer may want to check with their own physicians to see if red clover can be used safely as a nutritional adjunct to their regular medical program.

Two compounds that have been linked to a lower risk of breast cancer are bioflavonoids and lignans. Both are natural plant sources of very weak estrogens. Rich sources of biofavonoids include soy, buckwheat, alfalfa sprouts, the inner peel of citrus fruits, and many berries. Lignans are particularly abundant in raw ground flax seed and are also found in whole grains and legumes. Diets that are rich in these foods seem to be a factor in preventing the development of breast cancer in women. There is also evidence to suggest that such a diet may help decrease the mortality rate of men from prostate cancer. In Asia, most notably in Japan, the rates of hormone-dependent cancers are significantly lower than those in Western Countries.

Osteoporosis & Other Physical Changes

2007-04-05T00:20:00.013-07:00

One of the most serious consequences of postmenopausal aging is the development of osteoporosis. In fact, osteoporosis is a major health problem affecting more than 25 million older Americans, 90 percent of them women. One out of three American women will develop osteoporosis, most after menopause.

The statistics surrounding osteoporosis are astounding. More than 1.3 million fractures occur each year as a result of this condition. Eighty percent of the 250,000 hip fractures in the United States each year occur in women over age 65 as a result of osteoporosis. About one-quarter of these women die within one year from complications, such as blood clots and pneumonia, caused by their convalescence. Another one-third never regain the ability to function physically or socially on their own. These women spend the rest of their lives requiring long-term care in nursing facilities. In addition to causing hip fractures, osteoporosis is also responsible for loss of bone in the jaw, gum recession (both of which are early signs of this condition), dowager's hump, loss of height, back pain due to compression and fractures of the vertebra, and fractures of the wrist (called colles fractures by physicians).

Often these fractures occur when only mild stress is put on the bone. This can include missing a step and falling down, falling on an extended arm or lifting a heavy object. Because of the underlying weakness of the bone, fractures can also occur spontaneously without any preceding trauma. This often occurs with vertebral fractures.

This chapter will discuss what happens to bones with osteoporosis, risk factors for osteoporosis, diagnosis of osteoporosis and other structural changes associated with menopause. Finally, therapies for osteoporosis and other structural changes will be explored.

What Happens to Bones with Osteoporosis
Bones are living tissue; we are constantly forming new bone cells to add to our skeletal mass and removing old cells that are no longer useful. This simultaneous addition and subtraction of bone from our skeleton is called bone remodeling; from five to ten percent of our bone is replaced through this process every year. Bone remodeling involves two types of bone cells. Osteoblasts create new bone cells, while osteoclasts are responsible for removing old cells from the skeleton. This delicately balanced process is carefully regulated by many of the hormones in our body such as estrogen, progesterone, calcitonin and thyroid (as well as other hormones).

During the first 30 to 35 years of life, we deposit more bone in our skeleton than we lose, provided our health status is normal. In fact, our bone mass is at its peak in our 20s and begins to decrease in the mid-30s. According to peak bone mass theory, our bones reach their peak level of healthy density by the early 20s. The more healthy our bones are at this stage, the less risk of osteoporosis later in life. In the years preceding menopause, bone loss begins to exceed the addition of new bone to the skeleton. As a result, bones begin to lose important minerals such as calcium, as well as their matrix or intracellular substance. This causes a decrease in bone density as well as an increased brittleness or porousness of the bones

Initially, this process occurs very slowly, and women are not even aware that it is going on. However, with loss of hormonal support to the bones at the time of menopause, this process accelerates. The first years after the onset of menopause can be a time of rapid bone loss for many women unless they have instituted therapies that emphasize prevention. Bone is lost at the rate of one to three percent per year for five to ten years after menopause. If the process of bone loss continues unabated, osteoporosis may eventually result. Unfortunately, most women are unaware that they are losing bone during their early postmenopausal years. By the time osteoporosis becomes apparent as they begin to suffer from pain and fractures, women are already in their 60s or 70s. Older women with osteoporosis may have lost as much as 40 to 45 percent of their total bone mass.

Men also start to lose bone mass around age 40 (approximately three to five percent per decade). However, they have thicker bones to start with; men have approximately 30 percent more bone mass than women. In addition, the male hormone, testosterone, helps maintain bone mass and strength. Both estrogen in women and testosterone in men help control calcium absorption by the bones. These hormones prevent the resorption of calcium from the bones into the blood circulation where calcium can be excreted from the body. However, unlike women whose estrogen levels drop precipitously at menopause, men can maintain their testosterone levels well into old age. As a result, their bones remain thicker and stronger far longer than those of women. This translates into more osteoporosis related fractures for women than men eight times more hip fractures and ten times more wrist fractures.

Although gender and age contribute greatly to the fractures that occur in old age because of osteoporosis, these are not the only factors. Many physicians also attribute fractures in the elderly to poor balance and lack of ability to right oneself when tripping or stumbling. Many older people lack flexibility, so when they fall, they absorb a much greater shock than if they could cushion themselves effectively or right themselves quickly. As a result, hip fractures increase with age, mirroring the loss of agility that occurs for many elderly women (and men).

Risk Factors for Osteoporosis
Not all women have the same risk of developing osteoporosis. Some women maintain strong and heavy bones throughout their lives, while other women develop accelerated bone loss soon after menopause. If you suspect you are at risk of developing osteoporosis, become knowledgeable about which factors have been linked to a higher incidence of this disease. This will help you and your physician evaluate your risk when planning an optimal treatment program. These factors include racial background, family history, hormonal status, lifestyle habits and pre-existing health conditions.

Racial Background
Skin pigmentation appears to parallel bone mass. African-American women are less likely to develop osteoporosis than white women. In fact, women at the highest risk are small and fairskinned. These are typically women of Northern European ancestry such as Dutch, German or English background with blond, reddish or light brown hair and pale skin. Oriental women have a higher risk of developing osteoporosis, too. Even among similar groups, the risk is lower with women who have darker skin. For example, in Israel the darker skin Sephardic Jews have a lower rate of fractures than do Jewish women of European origin.

Family History
If your close female relatives suffered from osteoporosis, you have a higher risk of developing this problem. Many women have seen their mothers or grandmothers develop a dowager's hump or become disabled after suffering a hip fracture. This can be quite upsetting for the entire family who must deal with the longterm disability.

Hormonal Status
The age at which women begin menopause and how much hormonal support they maintain during their postmenopausal years affects bone density. Women who have had a surgical menopause before age 40 with removal of their ovaries are at high risk of osteoporosis because of the abrupt withdrawal of estrogen at a young age. Similarly, women who go through an early natural menopause are at high risk. A woman going through early menopause at age 35 or 40 has as much as 10 to 15 years less estrogen protection for her bones than a woman going through menopause at age 50. Thus, the older you are when going through menopause, the more years of hormonal protection are provided for your bones.

Although obesity is a health risk for many diseases such as osteoarthritis and uterine cancer, being overweight does offer some protection against osteoporosis in postmenopausal women. This is because the fat cells produce a type of estrogen called estrone through conversion of an adrenal hormone called androstenedione. This type of estrogen provides some support for the bones once the ovarian source of estrogen has dwindled.

Lifestyle Habits
Women who engage in regular physical exercise and are more muscular have a lower risk of developing osteoporosis. Physical activity also helps keep women flexible and agile which reduces the likelihood of fractures. Conversely, inactivity increases your risk. Young women and men confined to bed for long periods show a decrease in bone mass.

Many nutritional factors affect your risk of developing osteoporosis, too. Women who drink more than two cups of coffee per day or large amounts of other caffeine-containing beverages such as black tea or colas, or who consume more than two alcoholic drinks per day, are at higher risk. Smokers also run a higher risk of osteoporosis. High protein or salt intake are risk factors, as is inadequate calcium intake. When you do not have an adequate intake of calcium, the body takes it from your bones to maintain a blood level necessary for various processes such as heart rhythm and blood clotting.

Pre-Existing Health Issues
Women with a history of bulimia, anorexia or malabsorption syndrome have an increased risk of poor calcium absorption or low estrogen levels (often the case in women with anorexia who do not have a body fat level high enough to produce adequate estrogen). Women who use thyroid medication, suffer from an overactive thyroid gland, or use cortisone for a variety of chronic conditions are at higher risk. This is also true of women with chronic kidney disease. All these conditions can adversely affect calcium balance in the body.

Risk Factors for Osteoporosis

* Membership in a nonblack ethnic group
* Fair, pale skin color
* Having female relatives with osteoporosis
* Early menopause (before age 40)
* Being short and thin
* Childlessness
* High alcohol use (more than 5 ounces per day)
* High caffeine use
* Smoking
* Low calcium diet
* Lack of vitamin D
* High-salt diet
* High-protein diet
* Chronic diarrhea or surgical removal of stomach or small intestine
* Lactose deficiency
* Daily use of cortisone
* Use of thyroid medication (over 2 grains), Dilantin, or aluminum-containing antacids
* Uremia (kidney disease)

Diagnosis of Osteoporosis
If you are not sure about the status of your bones, excellent tests are available to evaluate the likelihood of developing osteoporosis. The tests also allow physicians to diagnose osteoporosis in the early stages before the bone loss is so severe that fractures occur. These tests include the single photon densitometer, which measures the density of the forearm; dual photon densitometer, which measures the spine or hip bone; and computerized axial tomography (also called a CAT scan), which can measure bone density in the spine. The CAT scan uses higher x-ray dosages and is a more expensive test. These tests are much more sensitive than conventional x-ray, which picks up osteoporosis only when 30 percent or more of the bone mass is lost.

You may choose to have a bone density test done if you are trying to decide whether or not to use HRT. If the tests show accelerated bone loss for your age group, you should seriously consider the use of HRT unless other major health issues contraindicate the use of hormones.

Another test for osteoporosis involves collecting a 24 hour urine sample. The laboratory then determines the ratio in the urine of calcium to a chemical called creatinine. A high calcium ratio indicates increased calcium excretion and accelerated bone loss.

Other Structural Changes Associated With Menopause
The loss of hormonal support affects not only the bones and teeth but other structural elements of the body such as the joints, muscles, body shape, skin and hair. Although bone loss may occur silently for many years, women notice changes in these other structural elements within a few years of entering menopause.

For instance, the incidence of osteoarthritis increases at the time of menopause; women who have never experienced joint pain suddenly become symptomatic. In addition, women with pre-existing arthritis find that their symptoms get worse. Many women reaching menopause complain of increased stiffness in their hands and shoulders as well as low back pain.

The lack of sex hormones also affects muscle tone. Muscles throughout the body tend to sag and lose tone after menopause. Women tend to be very conscious of pelvic muscle tone loss, as well as sagging of the facial and arm muscles. The loss of pelvic muscle tone can affect sexual pleasure and the ability to hold urine. Facial drooping can appear fairly rapidly within a year or two of menopause. This change can be a cause of distress in many women who don't like this visible sign of aging. Other tissues, such as the breasts, lose their tone and droop more. The lack of estrogen is probably also responsible for the increase in low back and pelvic pain that women experience around this time.

Another visible sign of aging for many women after menopause is a change in body shape as the distribution of weight on the body changes. The waist and upper back get thicker, while the hips and breasts tend to lose some of their fat. The result is that the female shape changes from an hourglass figure to a pear shape. Many women find that not only does their figure shape change, but they gain weight more easily (10 to 15 pounds in the year or two following menopause isn't unusual). This can occur no matter how diligently they diet or how much they exercise. The lack of female hormonal support plus the slowing of the metabolism are probably responsible for these changes. Women after menopause don't burn calories as efficiently as during their younger years. Careful attention to diet and regular exercise can certainly help, but may not entirely correct, these physical changes. Examine the self help chapters in this book for more in-depth information.

The skin and hair undergo many changes after menopause due to loss of estrogen. There is a gradual tendency toward thinning and dryness of the skin. Skin pigmentation becomes uneven which affects coloration. Some women may lose their even skin tone and notice patches of lighter and darker skin. As collagen production in the skin slows down, the skin loses its elasticity. The underlying muscle and fat tissues that help give skin its underlying support begin to shrink. There is also a reduction in sweat gland activity and decreased tolerance to temperature changes. As a result, many visible signs of skin aging become apparent such as pronounced wrinkling and creasing. Many women find these changes cosmetically unappealing and employ a variety of dermatologic aids in an attempt to make their skin look younger and healthier.

Women who smoke, have poor nutritional habits or have had excessive exposure to sunlight are more likely to show signs of skin aging at a younger age. Conversely, women who tend to carry a little extra weight or have reached menopause at a later age will have better looking skin. This is because they have had higher circulating levels of estrogen in their bodies for more years than a thin woman who enters menopause at an early age.

Lack of estrogen also affects the hair. With menopause, hair on the head and in the pubic area becomes drier, coarser and sparser. Women may also notice the growth of darker or coarser hair in areas where they've never had hair before, such as the chin, upper lip, chest or abdomen. This unusual growth of hair is due to the stimulation of the hair follicle by low amounts of androgens, a type of male hormone. High estrogen levels block the action of these male hormones on hair follicle receptors. However, after menopause, these low amounts of androgen may not decrease to the same extent that estrogen does in certain women. These unopposed androgens can then affect the pattern of hair growth and hair loss, taking on a more malelike pattern.

Therapies for Osteoporosis and Other Structural Changes
Osteoporosis and other age related changes in the joints, muscles, skin and hair can be treated through the use of HRT. Other medications and supportive measures may also play a useful supporting role for certain conditions.

Hormone Replacement Therapy
Medical studies show that hormonal therapy not only helps prevent osteoporosis but also protects women against further bone loss. Both estrogen and progestins by themselves are protective, but used together they may provide benefits exceeding the use of either hormone alone. A Danish study done in 1991 showed that a combination of estrogen and a progestogen, given no later than three years after the onset of menopause, completely prevented bone loss in 18 women. In contrast, untreated women suffered significant bone loss.

Hormonal replacement therapy with conjugated estrogens (Premarin) at a dose of 0.625 mg per day has been shown to prevent osteoporosis in 90 percent of postmenopausal women who had no pre-existing osteoporosis. However, in one study done by Dr. Bruce Ettenger, even minimal estrogen supplementation (0.3 mg) prevented bone loss. If osteoporosis is already present, then a high dosage of estrogen is utilized, normally 1.25 to 2.5 mg per day. The estrogen oral tablet and transdermal patch appear to be equally effective in preventing bone loss. The vaginal cream should not be used for this purpose because absorption into the bloodstream may be erratic.

Various studies comparing women using estrogen with control women not on ERT showed significant differences in bone health. In one study done in Scotland by Dr. Robert Lindsay, women on ERT maintained their normal stature, while control women had a significant loss of height. Another study of 1,000 women treated with ERT for 15 years found a 70 percent reduction in wrist fractures from the expected rate. Even more striking was the observation that no hip fractures were seen in these women over the same 15 year period. A study was done at the Mayo Clinic comparing vertebral fracture rate in postmenopausal women treated with various combinations of estrogen, calcium and sodium fluoride. The group utilizing ERT had, by far, the lowest rate of vertebral fractures.

Estrogen appears to protect the bones through several mechanisms. Estrogen reduces urinary calcium and hydroxy-proline excretion which suggests it inhibits osteoclast function, the cells that break down bone tissue. Current research suggests that estrogen may even have a stimulatory effect on osteoblast cells, the cells that build up new bone. Estrogen also facilitates calcium absorption from the intestinal tract and increases parathyroid hormone and calcitonin production. The parathyroid hormone facilitates calcium absorption, while calcitonin stimulates bone formation. Estrogen appears to be critical to bone remodeling; therefore, it may well be the most essential component of prevention for osteoporosis.

The question of how long to stay on ERT is an important one for many women. Although the research data on this issue is not yet definitive, women who want to protect their bones from developing osteoporosis should consider using ERT at least ten years, possibly for life. Ideally, estrogen should be started within three years of the last menstrual period. Women already showing accelerated bone loss and considered at high risk for osteoporosis should probably make a lifetime commitment to ERT.

The longer you use ERT, the more protection your bones will have. As soon as you stop using it, your bones will begin to show signs of calcium loss and bone aging. It is never too late to begin estrogen therapy. Women in their 80s and 90s who had preexisting osteoporosis showed some benefit after starting estrogen therapy. According to one recent study, supplemental hormones benefited women 15 years after initial diagnosis of osteoporosis. In another study, estrogen therapy increased vertebral bone mass and bone density at the femoral head. Interestingly, the best response was in women farthest away from menopause who had the lowest bone mass.

The addition of a progestin to the estrogen therapy may provide even better benefits. Though estrogen alone helps protect against calcium loss, at least eight medical studies suggest that the use of estrogen and a progestin in combination has the additional benefit of increasing bone mass by promoting new bone formulation. Recent research has led to the conclusion that progesterone acts directly to stimulate new bone by attaching to the osteoblast cell receptors. Progesterone also appears to increase bone turnover. Animal studies found that bone volume was greater in animals receiving both hormones than those who received only estrogen.

One study followed women using cyclic estrogen progestin and women receiving a placebo for a ten-year period. Women who began the combined therapy within three years of entering menopause showed an increase in bone density throughout the entire study period. Women who began HRT later than three years following the onset of menopause showed some demineralization but much less than the placebo group. This study underlines the importance of beginning HRT in the early stages of menopause.

Another study compared the effects of estrogen therapy alone with combined estrogen progestin therapy on the metabolic parameters of bone. This included measurements of the blood level and the urinary calcium/creatinine ratio. All values decreased (indicating decreased calcium excretion) with the use of estrogen. The addition of a progestin, however, decreased these values even more, showing substantial bone protection.

In addition to protecting bone, HRT has been shown to help reduce symptoms of osteoarthritis. As mentioned earlier, joint pain tends to become worse in early menopause. Many women with muscle and joint pain, including low back and pelvic pain, note relief of these symptoms within two weeks of beginning HRT. As an additional side benefit, HRT may provide protection against developing rheumatoid arthritis. Reported in the Journal of the American Medical Association, one study found that there was a greater than three-fold reduced incidence of rheumatoid arthritis in 1,000 women who had taken HRT compared with those who had not taken HRT.

HRT may also benefit postmenopausal women suffering from loss of muscle tone and firmness. If these effects are particularly pronounced in the pelvic area, urinary incontinence or uterine, bladder or urethral prolapse may result. HRT helps restore muscle tone and may relieve mild symptoms of incontinence and prolapse. However, women with severe cases may still require more drastic therapy, such as surgery. As mentioned earlier, muscle pain may accompany joint pain, particularly in the low back. HRT may help relieve more generalized muscle aches and pains, too.

Although estrogen will not restore skin to its youthful appearance, it can have a significant impact on skin quality. Women on estrogen therapy usually have thicker, oilier, moister and firmer skin. ERT improves subcutaneous fat deposition, which makes the skin tighter, and collagen turnover, which thickens and firms up the skin. Estrogen also increases fluid retention in the skin, making it look moister and plumper. However, to improve skin condition estrogen should be started soon after entering menopause because it cannot completely reverse any significant skin damage that has already occurred.

ERT does not have quite as dramatic an effect on the hair, but it will balance the androgen levels in the body again. As a result, unwanted hair on chin, chest and abdomen will stop growing. Once a woman has started ERT, these hairs can be pulled out and will not regrow as long as estrogen therapy continues.

Other Therapies for Healthy Bones
Other drugs have been used besides HRT to prevent bone loss and protect against the development of osteoporosis. Some therapies have been found more effective than others.

Sodium Fluoride
Fluoride has been studied as a preventive therapy for osteoporosis with mixed results. On the positive side, people living in areas in which the water has a high-fluoride content have higher average bone density than people living in a low fluoride area. However, according to studies done using supplemental fluoride therapy in postmenopausal women, different types of bone show unequal changes in response to fluoride. A study done by the Mayo Clinic found that fluoride therapy increases bone density in one type of bone, called trabecular bone, but decreases cortical bone density. This may increase skeletal fragility and increase the risk of hip fractures. As a result of this study, the Mayo Clinic abandoned the use of fluoride therapy. Fluoride therapy may also cause other side effects such as anemia and intestinal disturbances.

Etidronate Disodium (Didronel)
Didronel has been used to treat women with osteoporosis who are at high risk of developing vertebral fractures and deformity. This drug coats the bone cells and specifically helps to prevent further bone loss in the spine. It has even been found to reverse some of the spinal damage that osteoporosis causes. Etidronate does not appear, however, to reverse damage in the hips, femur and other bones. In addition, some studies indicate that women who took this drug experience a higher rate of fractures than those who did not. However, this drug is continuing to be studied. Etidronate is usually administered daily for two weeks, followed by daily calcium supplementation for ten to twelve weeks. The treatment regimen is repeated every three months.

Other Supportive Measures
Besides the use of HRT and drugs, there are many actions a woman can take to prevent damage to her bones, joints, muscles, skin and hair after menopause. Healthy lifestyle habits can slow down the aging of all these bones and tissues, helping them remain healthy and at peak function. These beneficial measures include the following.

* Do regular weight bearing exercise, such as walking or weight training, at least thirty minutes per day. This helps keep bones strong and intact and promotes good blood circulation.

* Practice yoga or other stretching exercises to keep your joints and muscles limber and flexible.

* Limit cigarette use and alcohol intake.

* Avoid sun exposure unless you use a high SPF sunscreen (15 or more). The sun causes damage and aging of the skin if protection from its rays is not used regularly.

* Drink lots of water at least eight glasses per day—to thoroughly hydrate your skin and other tissues.

* Apply moisturizers to your skin to help lock in the fluid.

* Lose weight slowly if you diet. Rapid weight loss can accelerate the aging of your skin's appearance.

* Avoid overprocessing your hair with permanents and other hair care techniques that can cause excessive dryness and splitting of the hair.

* If you want to have unwanted hair removed, consider electrolysis. This is the only permanent method for hair removal. It is important, however, to work with an experienced and knowledgeable operator. Your health care practitioner can probably recommend an operator in your community.

Structural Components of the Body that Show Menopausal Changes

* Bones
* Joints
* Muscles
* Skin
* Hair

Treatment Options for Osteoporosis

* Hormone replacement therapy
o Estrogen
o Progestins
o Estrogen-progestin combinations
* Drugs
o Sodium fluoride
o Etidronate Disodium (Didronel)
* General supportive measures

Healthy Bones

2007-04-05T00:20:00.012-07:00

Osteoporosis is a clinical condition which is characterized by a high susceptibility to bone fracture. It is due to excessive bone loss and decreased bone density. The "disease" occurs most commonly in post-menopausal women because of reduced levels of the hormone estrogen, although some consider lifestyle, diet and exercise to be important factors affecting the disease as well. After menopause, 25% of white-skinned, Asian and brown-skinned women develop serious osteoporosis. Here are some easy-to-follow guidelines on maintaining healthy bones for both men and women:

Exercise
Exercise is the single most important thing one can do to preserve and increase one's bone mass. It is clear from research that the best kind of exercise for strong bones is weight bearing in nature. Activities such as running and brisk walking are ideal. But don't forget "fun" exercise like dancing, rope jumping, hiking, tennis and volleyball. Each of these activities is useful in strengthening the bones. I usually recommend 45 minutes of weight bearing exercise, three times each week. In addition, walk 20 to 30 minutes, three times a week. And remember, you are never too young or too old to begin an exercise routine. If you have any questions about how much exercise you should start with, consult your physician.

Diet
As far as your bones are concerned, what you shouldn't eat is as important as what you should eat. Sugar is a big culprit, and as recommended in any healthy diet, it should be reduced. In addition, using too much table salt in the diet can actually cause calcium to be excreted through the urine. One study revealed that adding a teaspoon of salt to the diet of young women increased the amount of calcium lost in the urine -- enough to diminish bone mass by 1.5% per year. It is important to include moderate amounts of animal protein and make certain that one includes two vegetable servings with any protein meal. And, of course, you should also include calcium-rich foods such as green, leafy vegetables and moderate amounts of dairy products in your diet.

Caffeine, Nicotene and Alcohol
Caffeine will also cause calcium to be excreted in the urine. One study has demonstrated that three cups of coffee will secrete 45 milligrams of calcium into the urine. Cigarette smoke has been shown to curtail estrogen activity, and anything that interferes with estrogen is very likely to increase one's chances of osteoporosis. Women who smoke are clearly at high risk for osteoporosis. And alcohol should be reduced or eliminated. Chronic alcoholics are notorious candidates for poor bone density since research indicates that most osteoporosis in middle age men is associated with alcoholism.

Nutritional Supplements
Both calcium and magnesium are clinically used in the prevention and management of osteoporosis. These nutrients can be so effective that the Harvard Health Letter considers recent research (showing that calcium with vitamin D prevents hip fractures in the elderly) to be one of the top ten medical advances of 1993. In a recent clinical study, it was found that calcium supplementation alone significantly retarded the degree of bone loss and improved calcium balance in recently post-menopausal women. In a study comparing the incidence of several types of fractures in women ages 50 to 84, it was found that those with a calcium intake of 1000 mg a day or greater were less likely to suffer from bone fractures. And some additional data indicates that magnesium is also valuable in the treatment and prevention of osteoporosis. In one study, supplemention using 500 mg of calcium and 600 mg of magnesium had a significant effect on reversing post-menopausal bone loss.

I usually recommend at least 1000 mg of calcium and 500 mg of magnesium daily. It is wise to use supplements that include multiple forms of each mineral (i.e., citrate, chelate, aspartate, carbonate, etc.). If you prefer taking a single form, such as calcium citrate, it may be wise to occasionally rotate to another type to ensure that your body is assimilating the nutrient efficiently.

Herbal Medicine
Dong Quai (Angelica sinensis root) has seen decades of clinical use in the Orient and the West for the treatment of menopause and the management of osteoporosis. Because declining estrogen levels are associated with increased risk of osteoporosis, botanicals that are estrogenic in function are commonly used in the clinic to support healthy bones. In a Japanese study, menopausal women showed a 5-7% increase in bone mineral content after being treated with an herbal formula containing Dong Quai and vitamin D3. I often recommend using a Dong Quai formula two to three times daily, for one or two weeks out of the month.

There are other herbs that may act "synergistically" to support calcium metabolism. These include Horsetail, Oatstraw and Nettle. These botanicals are rich in calcium and other trace minerals, and should also be considered in a program.

Summary
So, it is important to begin with looking at your lifestyle -- proper exercise and diet are essential. Take a calcium/magnesium supplement and consider herbal support to help you on your way to stronger, healthier bones.

A Guide to Osteoporosis

2007-04-05T00:20:00.011-07:00

* Both bones and eggshells are made primarily of calcium. Although bones can be impressively strong, depending upon their density, they can break like an eggshell.
* Osteoporesis, a common condition of the elderly, affects women more than men because they have less bone mass and because they produce less estrogen after menopause which reduces the body's ability to keep calcium in the bones. Osteoporesis leads to degeneration of the spine, humpback, and fragile bones--which are more easily fractured. This condition is creating an elderly population which is fragile, weak, and, like an eggshell, breakable.

Osteoporesis is also creating a legion of shorter elderly people whose vertebrae are compressing against each other due to the loss of calcium from the bone. Perhaps this explains why the Incredible Shrinking Woman got so small.

This epidemic of osteoporesis has created a major market for calcium supplementation. If calcium supplements were listed on the stock exchange, their price would have skyrocketed in recent years. However, if people knew the research about calcium that follows here, the stock's value would have fallen as fast as it rose.

There are numerous countries that have a very low rate of osteoporesis despite the fact that the people consume as little as 200 mg of calcium a day, considerably less than the 1,000 to 1,500 mg. of calcium that most doctors recommend for pre- and post-menopausal women. The problem in this country is that most women consume too many things that leech the calcium out of their bones.

* Despite the fact that Eskimo women get over 2,000 mg. of calcium a day (from their consumption of fish bones), and even though exercise is a regular part of their life, they are known to have one of the highest rates of osteoporesis in the world. This problem is not due to bad luck. It is because they eat so much protein (as much as 250 to 400 grams a day) and so much fat; this excess causes increased calcium loss. This example highlights the importance of looking at factors that help AND hinder calcium absorption.

Conventional physicians often recommend hormone replacement therapy as a preventive to osteoporesis. Research has shown that lifelong use of these hormones helps to maintain bone strength, though it does not restore bone loss that has already occurred. More troublesome about the use of these drugs are the numerous studies indicating that they create side effects including increased chances of endometrial cancer and heart disease. Also, once a woman stops taking these drugs, calcium excretion is significantly increased.

Here are some strategies which are less costly than drugs, both financially and otherwise, and with fewer side effects. Since having adequate calcium levels in the bone is dependent on building bone strength during youth, it is best to take measures to prevent osteoporesis as early in life as possible. Although the best time to start was when you were a child; the second best time is today.

Strategy #1: Move your bod. Exercise, especially weight-bearing exercise such as walking, tennis, dancing, rope-jumping, basketball, and backpacking, helps build strong bones. Swimming is not considered a weight-bearing exercise because of the zero-gravity environment of water.

Strategy #2: Do kinder gentler exercises. Free the neck! Power to the pelvis, Liberate the vertebrae 31! Doing yoga and other gentle exercises help make you limber and stronger. However, headstands and shoulderstands should not be done if you already have osteoporesis.

Strategy #3: Avoid calcium vampires. Calcium vampires are substances that suck the calcium out of your bones. In other words, they stimulate the body to excrete more calcium than is being put into it. Substances which are calcium vampires are alcohol, caffeine, salt, animal protein, fats, tobacco, distilled water, oxalic acid-rich foods (chard, rhubarb, spinach, and chocolate), and aluminum (absorbed from baking soda, aluminum pots, and from certain deodorants). Phosphorus-rich foods and drinks also impair calcium absorption, the worse offenders being soda drinks, milk and milk products, and many processed foods.

Strategy #4: Avoid the calcium vampire drugs. Many drugs disrupt calcium absorption or metabolism, including antacids, antibiotics, anti-depressants, barbituates, cholesterol-reducing drugs, corticosteroids, diuretics, laxatives, and chemotherapeutic drugs.

Strategy #5: Support stomach acid. An inadequate amount of stomach acid can lead to poor absorption of calcium. To increase stomach acid, eat charcoal-barbequed foods or charcoal supplements, eat more slowly, and don't wash your food down too quickly with a drink.

Strategy #6: Go outside. Vitamin D is important for calcium absorption. You can absorb vitamin D by being exposed to the sun. Get a healthy dose of this sun vitamin (an hour or two), but don't overdo it.

Strategy #7: Fish for fish oil. Fish oil has a healthy dose of vitamin D which helps the body absorb calcium.

Strategy #8: Do the calcium-magnesium team. Calcium and magnesium are a team that work together in your body, so if you take calcium, you should also take magnesium. Pre-menopausal women should take approximately 1,000 mg. of calcium a day, and during menopause they should take about 1,500 mg. The best calcium supplements (in order of preference) are hydroxyapatite, citrate, lactate, gluconate, and carbonate. It is best to avoid taking large doses of calcium at one time; better to take smaller doses more frequently. Also, don't think that megadoses of calcium are better than the above recommendations; too much calcium can create problems because it displaces iron, manganese, and zinc, and it can lead to kidney stones. The dose of magnesium should be at least 50% of the dose of calcium. For additional help, take 1,000 mg. of vitamin C, which helps to create collagenous fibers to which the calcium of the bone is attached.

Strategy #9: Supplemental supplements. Boron, zinc, copper, and manganese are essential for bone integrity. They are all in green leafy vegetables. Boron is of special value; it has been found to stimulate higher estrogen levels and increase bone density. Supplementation of 5 mg. per day is recommended.

Strategy #10: Calcium-rich foods. Sardines, salmon, green leafy vegetables, broccoli, tofu with calcium sulfate, mineral water, and sesame seeds all will supply your body with calcium. If you choose to get your calcium from milk, yogurt, or cheese, it is recommended to consume low-fat or non-fat products because the body will be better able to assimilate their calcium.

Strategy #11: Horsetail tea. It won't grow you a tail, but this herb is rich in calcium and silica and can help build strong bones.

Strategy #12: Be born black. While this too is not a one-minute strategy, evidence does show that black people do not experience as much osteoporesis as white people, possibly because they have greater bone mass.

What is Osteoporosis?

2007-04-05T00:20:00.010-07:00

A generalized, progressive diminution in bone tissue mass(i.e., a reduced amount of bone) causing weakness of skeletal strength, even though the ratio of mineral to organic elements is unchanged in the remaining morphologically normal bone.

A slow progressive thinning and loss of calcium content of the bones occurs and the skeleton becomes brittle and susceptible to fractures from seemingly minor injuries or even everyday activities. It is a major health problem affecting about 20 million Americans.

98% of the calcium in the body is deposited in the skeleton along with other minerals, the rest is in the tissues and blood stream involved in blood clotting and the activity of muscle and nerve cells. The skeleton reaches its peak mass at around age 35, and after the fourth decade bone content is lost at the rate of 1-2% a year. This process accelerates after menopause such that by 65, most women have lost 30-50% of their skeletal mass. Men are affected to a lesser degree.

To sustain life, the level of calcium in the bloodstream must be kept within a very narrow range. This is accomplished by a homeostatic mechanism that adjusts for diet, intestinal absorption, excretion and hormonal functions as well as growth, physical activity and disease. Under the influence of vitamin D and parathyroid hormone, skeletal calcium is kept in a state of equilibrium with the circulating blood pool. A slight drop in blood calcium stimulates the release of calcium from the bones and its absorption from the intestine and decreases its loss into the urine. The process is reversed and bone mineral content is continuously being replenished and reformed through the actions of vitamin D, calcitonin, estrogen's and other hormones.

From this it is clear that treatment of osteoporosis is not simply a matter of taking calcium supplements. A whole range of factors are involved in calcium absorption, including:

* genetic makeup, e.g. inherited bone disease
* disease that might decrease amount retained, e.g. over activity of the thyroid or adrenal gland
* estrogen levels - as it enhances calcium absorption, partially explaining bone density loss after menopause. Post-menopausal bone loss is the most common cause of osteoporosis.
* calcium absorption declines with increasing age in men and women, but decline comes earlier in women.
* exercise increases absorption; prolonged bed rest or inactivity decreases it.
* medications, drugs, smoking, caffeine and certain foods impede absorption, increase excretion of nutrients and decrease their utilization. Prescription drugs known to interfere with calcium absorption include:

- corticosteroids
- anticonvulsants
- antacids that contain aluminium
- diuretics

* stress depletes immediate supply and stored levels of calcium if it is a chronic problem
* lack of other specific nutrients will deter absorption, especially vitamins D, C, K and the minerals magnesium and phosphorous

Actions indicated for the processes behind this disease:

Hormonal normalizers may be helpful if started early enough.
`Anti-rheumatics' will help with pain and discomfort in the joints and muscles.
Anti-inflammatories will similarly reduce the discomfort associated with this problem.

Specific Remedies
There is a tradition in North America of using herbs such as Horsetail (Equisetumarvense), Oat straw (Avena sativa) and Alfalfa (Medicago sativa) for the long term treatment of osteoporosis. They have been described as being effective because of a high calcium content. They do not have a particularly high level of calcium in them, but they are effective.

One possible prescription:

Vitex agnus-castis --- --- --- 2 parts
Equisetum arvense --- --- --- 1 part
Apium graveolens --- --- --- 1 part
Avena sativa --- --- --- 1 part
Medicago sativa --- --- --- 1 part to -- -- -- 5ml of tincture taken 3 times a day

This supplies the following actions:

Hormonal normalizer (Vitex agnus-castis)
`Anti-rheumatic' (Apium graveolens, Equisetum arvense, Medicagosativa)
Anti-inflammatory (Apium graveolens, )

Broader Context of Treatment
Regular exercise, cessation of tobacco and maintenance of normal body weight are advised. The addition of the following supplements may prove beneficial:
Calcium = 1, 000 mg before menopause; 1, 500-2, 000 mg after
Magnesium = 500 ng before menopause; 750-1, 000 mg after
Vitamin C = 1, 000 mg
Vitamin D = 400-800 IU

Exercise and Osteoporosis: A Primer on Tomorrow's Therapy

2007-04-05T00:20:00.009-07:00

Perhaps the worst health epidemic in this country is one that few people recognize as an epidemic at all. It will affect more people than heart disease, stroke, or cancer. One in every two women over the age of 60, and one in every two men over the age of 80 is at risk. This epidemic is osteoporosis.

Osteoporosis is defined as a a reduced density of the bone. The causes seem to be multiple, but inadequate storage of calcium during the younger years, and a rapid loss of calcium after middle age are the main culprits.

A net loss of calcium occurs in many adults, especially women after menopause or hysterectomy suggest that hormonal changes may be responsible. Many minerals and vitamins are required to form and stabilize the structure of bones, including magnesium, fluoride, vitamin A, and others. Any of these may be essential for preventing osteoporosis. One obvious line of defense is to maintain a lifelong adequate intake of calcium.

Although calcium seems to be one of the most talked-about types of therapy, most medical practitioners are touting HRT (hormone replacement therapy) to keep the regulation of hormones constant in the system. After a hysterectomy, the hormones estrogen, progesterone, and to a lesser extent, testosterone, which are normally secreted by the ovaries to influence general health, bone strength, sexuality, and reproduction, no longer secrete. It is then prescribed medically to mimic these levels.

However, many women are concerned about the association of hormone therapy and the increased incidence of cancer, and some of hysterectomy in general. A logical question to ask is: what, if any measure may be taken to prevent the decline in hormones later in life, and help with a decline in overall function after menopause. One measure may be exercise. It has been shown to have profound effects on overall health, reduction of cardiovascular disease, increase in bone strength, reduction in body fat, increases in self esteem, improvement in muscle mass Ð even after 80 years of age.

With all of these positive benefits, why aren't more people taking advantage of exercise as both a preventive and therapeutic avenue for improved health for osteoporosis. One - there is simply not enough information about the benefits that filters down to the general population. In many physician's offices, there is a lack of information that is dispensed to patients. The results of many sports medicine studies are not reported on a regular basis, and perhaps the most important Ð the correct type of exercise program may not be provided to the general population.

Most people are convinced after 20 years of reports that aerobic conditioning is the most beneficial type of exercise for most conditions, whether they are cardiovascular, or orthopedic. Aerobic training does produce many important physiological changes in the body. However, the specific needs of many individuals, especially those over 60 years of age have to do with functional ability Ð or the need to perform day to day tasks without undo effort. Strength training is coming into its own as an important aspect of overall health, and not just to improve sports performance.

In almost everyone with osteoporosis, the density of the bone in the lower lumbar, and femoral neck regions are most affected by mineral loss. The effect of strength training is to enhance the uptake of minerals by the bone to handle the stress imposed by the increased stress of lifting weights. This increased stress must produce some physical change in the muscle, tendon, and bone, or else injury will occur. Therefore, a properly designed program will avoid injury, and strength the musculature while adding density to the bone over time.

This portion of our article will concentrate on the most important areas of the body to strengthen, what types of exercises to perform, and the proper progression to perform them in to enhance muscular and bone development.

Section #1 is the hip area. Comprised of the largest muscles in the body, the hip area is the foremost section of the body to train. The most important types of machines to condition this area are the leg press, and total hip machine, shown in photos 1 and 2. The leg press is a compound machine, working the muscles of the hip and thigh during each push. The hip machine is an isolation machine, concentrating on one muscle group at a time (in this case, the gluteus maximus). Working the upper body major muscles (chest, shoulders, back) comprises section #2, and provides resistance to the bones of the upper vertebrae, long bones of the arms, and ribs. Photo 3 illustrates a weight-assisted machine for working the chest area (dip exercises), and the back (pull up exercises).

The most important element of exercise for this group is training progression, as the goal is to strengthen weak and porous bone to its natural density. A beginning program would start with low intensity, and more repetitions. It would look something like this:

PHASE I: Intensity Sets Reps
Chest Dips Low 2-3 10-15
Lat Pulls Low 2-3 10-15
Hip Extensions Low/medium 3-4 10-15
Leg Press Low/medium 3-4 10-15

After a period of adaptation (phase I), it is time to increase the intensity, and change the number of sets and reps.

PHASE II: Intensity Sets Reps
Chest Dips Medium 3 10-10-8
Lat Pulls Medium 3 10-10-8
Hip Extensions Medium-high 4-(5) 10-8-6-4
Leg Press Medium-high 4-(5) 10-8-6-4

The goal is to progress to a level that is is perceived as difficult, strengthens the musculature, and over time (4-8 months), has a positive effect on the bone density (as seen by DEXA scan). Medically, the density should improve from -10% loss to normal (0% loss in bone).

Both of the phases of training can be manipulated by the therapist/trainer depending on the initial conditioning level of the participant. Training should proceed in phases, as staying with the same level of resistance will not improve bone density or muscle strength.

This beginning program should give some hope to those who have not thought of strength training as a method of therapy for their osteoporotic condition. It is "good medicine" that can be performed, and enjoyed for a lifetime.

References
1. Greenwald, S. Menopause, Naturally. Volcano Press, Volcano, CA, 1984.

2. Whitney, E.N., Hamilton, E.M.N. Understanding Nutrition, 3rd Edition. West Publishing Company, St. Paul, MN, 1984.

3. Bompa, T.O. Periodization of Strength: The New Wave in Strength Theory. Veritas Publishing, Toronto, Canada 1993.

Women's Health: Osteoporosis

2007-04-05T00:20:00.008-07:00

Osteoporosis is a major health problem that affects about one fourth of women over the age of 60. Persons with osteoporosis suffer from a loss in bone mass and bone strength. Their bones become weak and brittle which makes them more prone to fracture. Any bone can be affected by osteoporosis, but the hips, wrists and spine are the most common sites. Peak bone mass is reached between the ages of 25 and 35 years. After 35, bone mass is stable until, in women, it starts to drop with menopause. This drop occurs more slowly in males. About one in two women over the age of 65 will develop fractures due to osteoporosis.

The actual causes of osteoporosis are unknown. Certain risk factors, however, increase the likelihood of developing osteoporosis:

* Being female - women are four times more likely to develop osteoporosis than men. The reasons are:
o Their bones are generally thinner and lighter.
o They live longer than men.
o They have rapid bone loss at menopause due to a sharp decline of estrogen. The risk increases for women who have:
* Natural menopause before age 40; a hysterectomy which includes removal of both ovaries with no hormone replacement therapy (HRT); a lack of/or irregular menstrual flow.
* Having a thin, small framed body.
* Race - Caucasians and Asians are at a higher risk than African Americans.
* Having red or blond hair or freckles may also increase the risk.
* Lack of physical activity especially activities such as walking, running, tennis and other weight-bearing exercises.
* Lack of calcium and vitamin D - adequate intake of these nutrients throughout life helps to insure that calcium deficiency does not contribute to a weakening of bone mass.
* Heredity - the risk increases if there is a history of osteoporosis and/or bone fractures in your family.
* Cigarette smoking.
* Alcohol - regularly consuming alcoholic beverages, even as little as two to three ounces per day, may damage bones. Heavy drinkers often have poor nutrition and may be more prone to fractures from their predisposition to falls.
* Taking certain medicines such as corticosteroids (anti-inflammatory drugs used to treat a variety of conditions such as asthma, arthritis, lupus, etc.) and aluminum containing antacids like Rolaids or Di-Gel.
* Some anti-seizure drugs and inappropriate overuse of thyroid hormones may also increase the risk.
* Other disorders such as hyperthyroidism, hyperparathyroidism, certain forms of bone cancer, anorexia nervosa, scoliosis and gastrointestinal disease can also increase the risk.

Signs and Symptoms

Osteoporosis is a silent disease because it can progress without any noticeable signs or symptoms. The first sign is usually when a bone fracture occurs. Symptoms include:

* Osteoporosis, continued
* A gradual loss of height.
* A rounding of the shoulders.
* Gum inflammation and loosening of the teeth.
* Acute lower backache.
* Swelling of a wrist after a minor fall or injury.

Treatment and Care

Osteoporosis can only be prevented. (See self-care/prevention procedures on page 47). Reversing the disease is rarely possible.

Medical tests, such as the dual-energy X-ray absorptiometry (DEXA) and densitometry, can measure bone mass in various sites of the body. They are safe and painless. These tests can help doctors decide if and what kind of treatment is needed.

Treatment for osteoporosis includes:

* Medical management. Check with your doctor, especially if you are at a high risk of getting the disorder. He or she may prescribe hormone replacement therapy (HRT) and/or calcium. These can prevent fractures from osteoporosis if taken during or soon after the start of menopause and then on a continual basis. HRT does not rebuild bone, but it does prevent further bone loss.
* There are risks with HRT though, so you need to check with your doctor to see how they apply to you.
* Surgery, such as hip replacement, if necessary.
* Dietary and lifestyle measures. (See self-care/prevention procedures on page 47).

Self-Care/Prevention Procedures

To prevent or slow osteoporosis, take these steps now:

* Plan to get enough calcium every day: The Recommended Dietary Allowance (RDA) for females aged 11-24 is 1,200 milligrams (mg)/day. For women 25 years and older, the RDA is 800 mg/day. The National Osteo-porosis Foundation recommends 1000 milligrams a day for adult women and 1,500 milligrams a day for post-menopausal women not on hormone replacement therapy.
* Choose high calcium foods daily:
o Skim and low-fat milks, yogurts and cheeses.

[Note: If you are lactose intolerant, you may need to use dairy products that are treated with the enzyme lactase or you can add this enzyme with over-the-counter drops or tablets].
# Soft-boned fish and shellfish, such as salmon with the bones, sardines and shrimp.
# Vegetables, especially broccoli, kale, collards.
# Beans and bean sprouts as well as tofu (soy bean curd, if processed with calcium).
# Calcium-fortified foods such as some orange juices, apple juices and ready-to-eat cereals and breads.
# Get adequate vitamin D. You can get vitamin D from exposure to sunlight and from foods such as vitamin D-fortified milks; salmon, tuna and shrimp. The RDA for vitamin D ranges form 250 to 500 IU (Internations Units) per day for females. Vitamin D helps your body absorb calcium.
# Check with your doctor about taking calcium and vitamin D supplements.
# Follow a program of regular, weight-bearing exercise at least three or four times a week. Examples include: Walking, jogging, low-impact or non-impact aerobics.
# Do not smoke. Smoking makes osteoporosis worse and may negate the beneficial effects of estrogen replacement therapy (ERT).
# Limit alcohol consumption.
# Pay attention to your posture. Keep your back straight when you sit, stand and walk.
# Take measures to prevent falls and injury to your bones.

* Use grab bars and safety mats or non-skid tape on your tub or shower.
* Use handrails on stairways.
* Stay off icy sidewalks and wet or waxed floors.
* Don’t stoop to pick up things. Pick things up by bending your knees and keeping your back straight.
* Wear flat, sturdy, non-skid shoes.
* If you use throw rugs, make sure they have non-skid backs.
* Use a cane or walker if necessary.
* See that halls, stairways and entrances are well lit. Put a night light in your bathroom.
* Avoid taking sedatives or tranquilizers or be careful when you take them as prescribed. They can increase the risk of falls.

Concerning Osteoporosis

2007-04-05T00:20:00.007-07:00

Osteoporosis is a major health problem that affects more than 25 million Americans. Persons with osteoporosis suffer from a loss in bone mass and bone strength. Their bones become weak and brittle which makes them more prone to fracture. Any bone can be affected by osteoporosis, but the hips, wrists, and spine are the most common sites. Peak bone mass is reached between the ages of 25 and 35 years. After 35, everyone's bones lose density.

The actual causes of osteoporosis are unknown. Certain risk factors, however, increase the likelihood of developing osteoporosis.

Women are four times more likely to develop osteoporosis than men. The reasons are as follows:

* Their bones are generally thinner and lighter.
* They live longer than men.
* They have rapid bone loss at menopause due to a sharp decline of estrogen. (The risk also increases for women who experience menopause before age 45 naturally or as a result of surgery which removes the ovaries, and for women who experience a lack of or irregular menstrual flow).

Risk factors for women and men are:

* Having a thin, small framed body.
* Race - Caucasians and Asians are at a higher risk than African Americans.
* Having red or blond hair or freckles may also increase the risk.
* Lack of physical activity especially activities such as walking, running, tennis, and other weight-bearing exercises.
* Lack of calcium - adequate calcium intake throughout life helps to insure that calcium deficiency does not contribute to a weakening of bone mass.
* Heredity - the risk increases if there is a history of osteoporosis and/or bone fractures in your family.
* Smoking cigarettes.
* Alcohol - regularly consuming alcoholic beverages, even as little as two to three ounces per day, may be damaging to bones. Heavy drinkers often have poor nutrition and may be more prone to fractures because of their predisposition to falls.
* Taking certain medications, such as corticosteroids (anti-inflammatory medicines used to treat a variety of conditions such as asthma, arthritis, lupus, etc.) can lead to bone tissue loss. Some anti-seizure medicines and inappropriate overuse of thyroid hormones may also increase the risk.
* Other disorders such as hyperthyroidism, hyperparathyroidism, and certain forms of bone cancer can also increase the risk.

Prevention
To prevent or slow osteoporosis, take these steps now:

* Be sure to eat a balanced diet including adequate daily intakes of calcium. The National Osteoporosis Foundation recommends 1,000 milligrams a day for adults, and 1,500 milligrams a day for women who are not on hormone replacement therapy. The Recommended Dietary Allowance (RDA) is 800 milligrams a day for adults over 24 years of age.

Other age groups should get the following RDAs:
Birth-6 months - 400 mg calcium a day.

6 months-1 year - 600 mg calcium a day.

1-10 years - 800 mg calcium a day.

11-24 years - 1200 mg calcium a day.

To get your recommended calcium:

* Choose high calcium foods daily.
o Skim and low-fat milks, yogurts, and cheeses. [Note: If you are lactose intolerant, you may need to use dairy products that are treated with the enzyme lactase or you can add this enzyme using over-the-counter drops or tablets.]
o Soft-boned fish and shellfish such as salmon, sardines or shrimp.
o Vegetables, especially broccoli, kale or collards.
o Beans and bean sprouts as well as tofu (soy bean curd, if processed with calcium).
o Calcium-fortified foods such as some orange juices, apple juices, and ready to eat cereals.
o Check with your doctor about taking calcium supplements if necessary.
* Follow a program of regular, weight-bearing exercise at least three or four times a week. Examples include walking, jogging, low-impact or non-impact aerobics.
* Do not smoke. Smoking makes osteoporosis worse and may negate the beneficial effects of estrogen replacement therapy.
* Limit alcohol consumption.
* Check with your doctor regarding medical management to prevent and treat osteoporosis especially if you are at a high risk for getting the disorder. He or she may prescribe hormone replacement therapy (HRT), if you are female.
* This can prevent fractures from osteoporosis if started during or soon after menopause and taken for several years. There are risks with ERT, though, so you need to check with your doctor to see how they apply to you.

Signs and Symptoms
Osteoporosis is a "silent disease" because it can progress without any noticeable signs or symptoms. Often the first sign is when a bone fracture occurs. Symptoms include:

* A gradual loss of height.
* A rounding of the shoulders.
* Gum inflammation and loosening of the teeth.
* Acute lower backache.
* Swelling of a wrist after a fall.

Treatment and Care
Medical tests, such as the dual energy X-ray, absorptiometry (DEXA), and densitometry can measure bone mass in various sites of the body. They are safe and painless. These tests can help doctors decide if and what kind of treatment is needed. Treatment for osteoporosis includes:

* Dietary measures: A balanced diet rich in calcium and calcium supplementation if necessary.
* Daily exercises approved by your doctor.
* Fall prevention strategies.
o Use grab bars and safety mats or non-skid tape on your tub or shower.
o Use handrails on stairways.
o Don't stoop to pick up things. Pick things up by bending your knees and keeping your back straight.
o Wear flat, sturdy, non-skid shoes.
o If you use throw rugs, make sure they have non-skid backs.
o Use a cane or walker if necessary.
o See that halls, stairways and entrances are well lit. Use night lights in hallways, bathrooms, etc.
* Proper posture.
* Medication therapy - two medicines have been approved by the Food & Drug Administration (FDA) to treat osteoporosis. They are estrogen replacement therapy and calcitonin.
* Surgery (such as hip replacement), if necessary.

Osteoporosis - What You Eat Affects Your Bones

2007-04-05T00:20:00.006-07:00

The Hippocratic Oath
In the practice of medicine one basic principle stands out: What you eat has a major influence on your health. That principle is so simple and so logical that it is surprising the medical profession has had such a difficult time grasping it. The average doctor, despite having taken the Hippocratic oath, rejects the famous words proclaimed by Hippocrates: "Let your food be your medicine and let your medicine be your food." Had these doctors only met my late Uncle Ruben, who, well into his nineties, was still able to walk a brisk five miles every morning, they would have understood why he believed that "health comes from the farm, not the pharmacy."

A theme that keeps recurring in nutritional medicine is that degenerative diseases are caused, at least in part, by our modern diet, which contains too much sugar, fat, salt, refined flour, caffeine, alcohol, processed foods, and food additives. I routinely advise my patients, regardless of their specific medical problems, to try to clean up" their diet; that is, reduce their consumption of these junk foods" and to increase their intake of whole grains, fruits, vegetables, nuts and seeds, beans, and other unprocessed foods. The majority of people who follow that advice find that their health improves in some way. Many individuals report an increase in energy, less depression and anxiety, fewer headaches, better bowel and bladder function, and less fluid retention. They often sleep better, their joints do not hurt as much, and they are more alert and productive. Laboratory reports, such as serum cholesterol, triglycerides, liver enzymes, and uric acid also improve in many cases.

Specific medical conditions may also be relieved as a result of these general dietary changes. Patients with asthma, irritable bowel syndrome, peptic ulcer, gallbladder attacks, acne, psoriasis, high blood pressure, diabetes, angina, or other problems frequently find that their symptoms are better when they eat a healthier diet. Part of the appeal of improving your diet is that, even if it does not help, it rarely causes harm.

Diet and Bone Health
Considering that bone is living tissue, just like the rest of the body, it is likely that what you put in your mouth will determine in part how strong your bones will be. Many people believe that, aside from its calcium content, diet has little to do with osteoporosis. However, that assumption ignores the fact that bone tissue has diverse nutritional needs and engages in complex interactions with the rest of the body. It is improbable that our modem-day diet could be sparing our bones while damaging the rest of our body. Although it is impossible to determine the precise effect of diet on bone health, there is at least circumstantial evidence that the typical American diet promotes the development of osteoporosis.

There are three reasons that our modem diet might not be good for our bones. First, many of us ingest too much sugar, caffeine, salt, and alcohol. Consumption of each of these substances is reportedly associated with an increased risk of osteoporosis. Second, because of the way our food is grown and refined, today's diet probably contains much lower quantities of various vitamins and minerals than it used to. As you will learn later, some of these vitamins and minerals play a key role in maintaining healthy bones. Third, some of the processing techniques used by the food industry cause chemical changes in our food that may adversely affect the health of the tissues in our bodies, including bone. The possible influences of diet on bone health are reviewed next.

Sugar
In the early part of the nineteenth century, sugar was considered a condiment, rather than a major component of the diet. Back then, the average per capita intake of sugar was only about 10 to 12 pounds per year. Today, according to some statistics, the average American ingests approximately 139 pounds of refined sugar each year. That enormous quantity translates to about 41 teaspoons of sugar per day, or 19% of all of the calories we consume. Since refined sugar contains virtually no vitamins or minerals at all, it dilutes our nutrient intake, resulting in an across-the-board 19% reduction in all vitamins and minerals in our diet. Thus, because of our high intake of sugar we are getting less magnesium, folic acid, vitamin B6, zinc, copper, manganese, and other nutrients that play a role in maintaining healthy bones.

Ingesting sugar may also deplete our bodies of calcium. In one study, administering 100 grams (about 25 teaspoons) of sugar (sucrose) to healthy volunteers caused a significant increase in the urinary excretion of calcium. When the same amount of sugar was given to people with a history of calcium oxalate kidney stones or to their relatives, the increase in calcium excretion was even greater.) Since 99% of the total-body calcium is in our bones, this increase in calcium excretion most likely reflects a leaching of calcium from bone. This study suggests that a high-sugar diet may reduce the calcium content of bone, and that people with kidney stones or their relatives are especially susceptible to the adverse effects of sugar. Thus, the extent to which dietary sugar affects calcium metabolism is in part genetically determined, just as there is a hereditary component to osteoporosis risk. It is interesting to note that individuals with a history of kidney stones are at increased risk for developing osteoporosis.2 Researchers have also suggested that consumption of refined sugar is one of the factors that promotes kidney stones. Perhaps what people with kidney stones and osteoporosis have in common is an increased sensitivity to refined sugar.

Ingestion of large amounts of sugar has another effect on the body that may promote osteoporosis. Dr. John Yudkin, a British physician, has been studying the effects of dietary sugar for more than thirty years. Yudkin found that ingesting large amounts of sucrose by healthy volunteers causes a significant increase in the fasting serum cortisol level. Cortisol is the primary corticosteroid l (cortisonelike hormone) secreted by the adrenal gland. Although corticosteroids have important biological functions, an excess of these hormones can cause osteoporosis. Indeed, doctors are reluctant to prescribe corticosteroids precisely because they can cause severe bone loss. Yudkin's work demonstrated that eating too much sugar is in a way analogous to taking a small amount of cortisone, which could cause your bones to become thinner. This possibility is supported by a study on hamsters, in which feeding a diet containing 56% sucrose caused osteoporosis, despite adequate intake of calcium.3

Refined Grains and Flour
Another significant dietary change occurring during the past century is an increase in the consumption of refined grains, such as white bread instead of whole wheat bread, and white rice instead of brown rice. During the refining of grains and flour the nutrient-rich germ and bran portions are removed, resulting in a significant loss of vitamins and minerals. For example, when whole wheat is refined to white flour the following percentages of selected vitamins and minerals are lost: vitamin B6 (72%), folic acid (67%), calcium (60%), magnesium (85%), manganese (86%), copper (68%), zinc (78%).4 Since grains make up about 30% of the average diet, consumption of refined grains would have a substantial impact on the total daily intake of micronutrients (vitamins and minerals). Because nearly 50% of the typical American diet is composed of nutrient-depleted sugar and refined grains, the intake of many important micronutrients is probably much lower than it was during the previous century

Caffeine
Caffeine is found in coffee, tea, cola beverages, and certain pain medications. Substances similar to caffeine are also present in chocolate. Caffeine has certain pharmacologic (druglike) effects in the human body and is known primarily as a stimulant of the central nervous system. Tens of millions of people depend on caffeine to help them wake up in the morning and to stay alert during the day. Athletes sometimes use caffeine to enhance their performance.

Although the dangers of caffeine have long been a topic of debate, it is well known that caffeine is an addictive substance. Withdrawal from caffeine after prolonged use usually results in severe headaches, which can last several days. It is also well known that excessive caffeine use is a cause of anxiety and insomnia.

Nutrition-oriented practitioners and some conventional doctors believe that caffeine can also cause certain other problems in susceptible individuals. Problems attributed wholly or in part to caffeine include fibrocystic breast disease, cardiac arrhythmias (heart rhythm disturbances), diarrhea, constipation, abdominal pain, elevated serum cholesterol or blood sugar, high blood pressure, and chronic migraines or other headaches. There is evidence that caffeine may also promote heart disease and cancer, although the studies in this area are conflicting.

It should not be surprising that a substance that appears to cause problems in so many different systems of the body would also adversely affect bone tissue. Most of the evidence is circumstantial, but studies do suggest that caffeine ingestion may contribute to bone loss. In one study, thirty-one women ingested a cup of decaffeinated coffee on three different occasions. In two of the cups, caffeine was added at concentrations of 3 mg/kg and 6 mg/kg of body weight, respectively. The excretion of calcium in the urine during the next three hours was significantly greater after caffeine ingestion than after decaffeinated coffee. The increases in calcium excretion were 50% and 69%, respectively, after low and high doses of caffeine.5 These results demonstrate that ingestion of caffeine causes excess calcium loss from the body in the short term.

Another study suggests that this effect of caffeine is not just limited to the short term. Calcium balance, a measure of the amount of calcium retained in the body, was assessed in 168 women between the ages of 35 and 45. The results showed that calcium balance decreased with increasing dietary intake of caffeine. In other words, women who habitually ingested a great deal of caffeine retained less calcium than did those who used little caffeine. Women who consumed 50% more caffeine than average had an estimated; reduction in calcium balance of 6 mg/day.6 Although 6 mg/day might seem like a small amount, a loss of that much calcium every day for years would add up to a significant degree of bone loss.

The potential consequences of caffeine ingestion on bone health was assessed in a study of 84,484 women the ages of 34 and 59. In 1980, each of the women completed a questionnaire pertaining to their intake of various foods and beverages. During the ensuing six years, there was a positive association between caffeine intake and the risk of sustaining a hip fracture. That is, the risk of a hip fracture increased with increasing levels of caffeine intake. Women who consumed the most caffeine (above the 80th percentile) had nearly three times as many hip fractures as women who consumed the least caffeine (below the 20th percentile).7 One possible confounding factor in this study is that women who use caffeine also tend to smoke cigarettes, which are known to contribute to the risk of osteoporosis. It is possible that some of the risk attributed to caffeine intake was actually due to tobacco. However, the weight of evidence suggests that anyone interested in maintaining healthy bones should avoid excessive caffeine intake.

Alcohol
Consumption of excessive amounts of alcohol is a known risk factor for osteoporosis. In a study of ninety-six male chronic alcoholics): ages 24 to 62, 47% had osteoporosis. Among those under the age of 40, 31% had osteoporosis.8 Although a similar study has not been done on women, it is likely that drinking too much alcohol would also promote osteoporosis in women. The effect of moderate alcohol consumption on bone health is not known.

Protein, Phosphorus, and Sodium
The American diet tends to contain too much, rather than too little protein. Studies have shown that excessive dietary protein may promote bone loss. With increasing protein intake, the urinary excretion of calcium also rises, because calcium is mobilized to buffer the acidic breakdown products of protein. In addition, the amino acid methionine is converted to a substance called homocysteine, which is also apparently capable of causing bone loss.

Animal studies have shown that excessive intake of phosphorus can cause osteoporosis, as well. The effect of dietary protein on osteoporosis might be explained in part by the phosphorus content of many high-protein foods because phosphorus does appear to have an adverse effect on bone health. High-phosphorus beverages such as colas (which also contain a lot of sugar and caffeine) are among the worst foods imaginable for someone trying to prevent osteoporosis.

Several studies have shown that individuals who consume a vegetarian diet have stronger bones later in life than those who eat animal flesh.9,10 However, other studies have failed to find a difference in bone mass between vegetarians and meat eaters.

A substantial minority of human beings also appears to be Susceptible to the effects of high-sodium intake. When these individuals ingest moderate amounts of salt, their urinary excretion of calcium increases markedly." In people with this sodium-dependent hypercalciuria, ingestion of too much salt probably increases the risk of both kidney stones and osteoporosis. In today's fast paced society, great emphasis is placed on readily available, easily prepared food, which can be stored on the shelf for prolonged periods of time. The food technology industry has developed many ways to achieve these goals. Unfortunately, the nutritional quality of processed, adulterated food is far inferior to that of fresh, perishable foods. Modern food is bleached, radiated, extracted with organic solvents, subjected to enormous temperatures and extremes of acidity or alkalinity, and contaminated with thousands of chemicals designed to preserve, texturize, color, or otherwise modify the food so that it will look, feel, and taste like the real thing.

Hundreds of articles have been written about how these harsh processing techniques can affect the nutritional value of food. One I example is the possibility that food processing can promote lysine deficiency. Lysine is one of the eight essential amino acids from which protein molecules are synthesized in the body. Studies have shown that when proteins are subjected to alkali treatment (as in the production of isolated soy protein or textured vegetable protein), a substantial amount of the lysine is destroyed.l2 Exposure of lysine to temperatures of 250¡C for one hour also caused significant losses of lysine.l3 Heating proteins even at moderate temperatures in the presence of sugars such as lactose, glucose, or sucrose can also destroy significant amounts of lysine.14 Thus, in the baking of pies, cookies, breads, and other grain products, where flour and sugar are heated together, substantial amounts of lysine may be lost.

You might assume that, with all of the protein in the American diet, it would be difficult to develop a deficiency of an amino acid. The problem is, however, that amino acid imbalance can be just as damaging as amino acid deficiency. Animal studies have shown that the ratios of essential amino acids in the diet are as important as the absolute amount of each. If a single amino acid, such as lysine, is being systematically destroyed by food processing, then ingesting more of all of the amino acids will not correct a relative lack of lysine.

It is therefore possible that millions of Americans are marginally deficient in Iysine, even if their diet is high in protein. The modern epidemic of herpes simplex infections is certainly consistent with that possibility. Lysine is known to inhibit the growth of herpes viruses and oral supplementation with Iysine has been shown to prevent recurrences of herpes simplex outbreaks in susceptible individuals.15, l6 Since the doses of lysine that were effective against herpes infections (312 to 3,000 mg/day) are similar to the amounts obtainable in the diet, it is possible that dietary lysine deficiency is a factor in the increased incidence of herpes simplex infections.

It is also possible that lysine deficiency contributes to the development of osteoporosis. Individuals with a rare genetic condition known as lysinuric protein intolerance develop osteoporosis during childhood. In lysinuric protein intolerance, a defect in the kidneys causes large amounts of lysine to be lost in the urine. Scientists have suggested that lysine deficiency is the cause of osteoporosis in individuals with this disorder.17 Although the typical American diet would not result in Iysine deficiency that severe, it is possible that prolonged, subtle lysine deficiency caused by harsh food processing techniques could have an adverse effect on bones.

Soil Factors
The reduction in vitamin and mineral intake resulting from refining of foods can be made even worse by farming techniques that deplete the soil of essential minerals. Traditional methods of farming include using manure and compost to increase the trace mineral content of the soil. In modern times, however, with the emphasis on producing higher crop yields per acre, farmers use large amounts of inorganic fertilizers, which are often deficient in important trace minerals and which may disturb soil mineral balance. For example, the use of ammonia as a fertilizer causes essential minerals such as magnesium' manganese, zinc, and copper to be leached from the soil.18 Repeated application of inorganic fertilizers, which are low in essential trace minerals, can further reduce the soil concentration of these trace minerals. Many scientists and nutritionists are unaware of the effect the depleted soil can have on the mineral content of edible plants i Indeed, nutrition textbooks often contend that mineral-deficient soil will reduce crop yield, but will not adversely affect the nutritional quality of crops that do grow. However, the facts indicate otherwise. The presence of a "goiter belt" in the midwestern United States attests to the fact that foods grown on iodine-deficient soil can cause iodine deficiency. The relationship between mineral concentrations in soil and food is also underscored by the epidemics of selenium deficiency that have occurred in cattle grazing in low selenium areas of the country. As another example, dairy cattle an horses are sometimes stricken by a condition known as grass staggers, characterized by unsteady gait and twitching and spasm of the muscles. This disorder can be cured either by supplementing the diet with magnesium or by adding magnesium to the soil.19 It appears that overuse of nitrates, phosphates, and potassium salts as fertilizers depletes the soil of magnesium and causes a deficiency of this mineral in grazing animals. In the Florida Everglades the soil is low in copper. Domestic animals grazing in this area develop copper deficiency which makes them unusually susceptible to sus~ taining bone fractures. But, when copper is added to their diet fractures no longer occur.20 In another study, the manganese content of turnips was directly related to the manganese content of -the soil. Addition of calcium carbonate to the soil (a common practice by modern farmers) decreased the accumulation of manganese by turnips.

Conclusion
These studies indicate that modern farming practices deplete the soil of essential minerals, resulting in lower levels of these minerals in our food. The vitamin and mineral content of our diet is further reduced by overconsumption of nutrient-depleted foods, such as sugar and white flour. The net result is that the food we consume today contains far less of many vitamins and minerals than it did in the past. One of the major theses of this book is that chronic, low level deficiencies of a wide range of micronutrients may increase the risk of developing osteoporosis.

In summary, many factors related to the modern American diet may promote not only osteoporosis, but other chronic diseases, as well. A health-promoting diet is one that emphasizes fresh, unprocessed foods, such as whole grains, fruits and vegetables, nuts and seeds, and legumes Animal foods, dairy products, and salt should be used in moderation, and sweets, caffeine, refined flours, and chemical food additives should be avoided as much as possible. While some studies suggest that moderate alcohol intake improves health, others have shown that even small amounts of alcohol are not good for you. Certainly, excessive alcohol intake can cause many different problems, including osteoporosis. The human body is remarkably resilient and is capable of withstanding numerous stresses, but it is also true that the more closely you follow the principles of good eating, the healthier you will be.

Notes

1. Lemann, J., Jr., W. F. Piering, and E. J. Lennon. 1969. Possible role of carbohydrate-induced calciuria in calcium oxalate kidney-stone formation. No Engl J Med 280:232-237.

2. Lawoyin, S., et al. 1979. Bone mineral content in patients with calcium urolithiasis. Metabolism 28:1250-1254.

3. Yudkin, J., Dr. 1973. Sweet and dangerous. New York: Bantam Books, 112. Saffar, J. L, et al. 1981. Osteoporotic effect of a high-carbohydrate diet (Keyes 2000) in golden hamsters. Arch Oral Biol 26:393-397.

4. Schroeder, H. A. 1971. Losses of vitamins and trace minerals resulting from processing and preservation of foods. Am J Clin Nutr 24: 562-573.

5. Hollingbery, P. W., E. A. Bergman, and L K Massey. 1985. Effect of dietary caffeine and aspirin on urinary calcium and hydroxyproline excretion in pre and postmenopausal women. Fed Proc 44:1149.

6. Heaney, R P., and R R Recker. 1982. Effects of nitrogen, phosphorus, and caffeine on calcium balance in women. J Lab Clin Med 99:46-55.

7. Hernandez-Avila, M., et al. 1991. Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women. Am J Clin Nutr 54: 157-163.

8. Spencer' H., et al. 1985. Alcohol-osteoporosis. Am J Clin Nutr 41:847.

9. Marsh, A. G., et al. 1980. Cortical bone density of adult lacto-ovo-vegetarian an omnivorous women. J Am Diet Assoc 76:148-151.

10. Marsh, A. G., et al. 1983. Bone mineral mass in adult lacto-ovo-vegetarian an omnivorous males. Am J Clin Nutr 37:453-456.

11. Silver,J., et al. 1983. Sodium-dependent idiopathic hypercalciuria in renal-stor formers. Lancet 2:484-486.

12. de Groot, A P., and P. Slump. 1%9. Effects of severe alkali treatment of prose on amino acid composition and nutritive value. J Nutr 98:45-56.

13. Breitbart, D. J., and W. W. Nawar. 1979. Thermal decomposition of Iysine. J Agric Food Chem 27:511-514.

14. Hurrell, R. F., and K J. Carpenter. 1977. Mechanisms of heat damage in prose

8. The role of sucrose in the susceptibility of protein foods to heat damage Br J Nutr 38:285-297.

15. Griffith, R S., A. L Norins, and C. Kagan. 1978. A multicentered study of Iysine therapy in herpes simplex infection. Dermatologica 156:257-267.

16. Griffith, R S., et al. 1987. Success of L-lysine therapy in frequently recurrence herpes simplex infection. Dermatologica 175:183-190.

17. Carpenter, T. O., et al. 1985. Lysinuric protein intolerance presenting as child hood osteoporosis. N Engl J Med 312:290-294.

18. Hall, R. H. 1981. The agri-business view of soil and life. J Holistic Med 3:15 166.

19. Ebeling, W. 1981. The relation of soil quality to the nutritional value of plant crops. J Appl Nutr 33(1):19-34.

20. Rose, E. F. 1968. The effects of soil and diet on disease. Cancer Res 28:2390 2392.

21. Hopkins, H. T., E. H. Stevenson, and P. L Harris. 1966. Soil factors and food composition. Am J Clin Nutr 18:390-395.