Osteoporosis: Recognize this often silent bone loss condition

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People often say how they are shrinking and becoming shorter with age, and we often see the elderly in a stooped posture. What has only become known relatively recently is that the compression of the spine, due to weakened bones that make up the vertebrae, is what causes this posture and reduced height.  It’s not to be taken lightly. Osteoporosis causes bones to become weak and brittle — so brittle that in advanced stages even a small fall or mild stresses such as bending over or coughing can cause a fracture. The bones that make up your spine can weaken to the point that they may crumple, which can result in back pain, lost height and the hunched forward posture. The symptoms are often silent in the early stages of bone loss, but there are steps that can help to avoid it.

It’s important to address bone loss. Fractures, particularly in the spine or hip, are the most serious complication of osteoporosis. Hip fractures often are caused by a fall and can result in disability and even an increased risk of death within the first year after the injury. One in two Caucasian women will fracture a bone due to osteoporosis. 

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone. Osteoporosis affects both men and women of all races. Most people reach their peak bone mass by their early 20s. But small framed white and Asian women — especially older women who are past menopause — are at highest risk. How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.

Risk factors that are not changeable are being female, advancing age, a small body frame size, medical conditions and treatments such as for cancer, transplant rejections/treatments, long term steroid treatment, being of white or Asian descent, and family history of osteoporosis or broken bones in advanced age. Some dietary factors are low calcium and Vitamin D intake, eating disorders and being very underweight, or having gastrointestinal surgery which reduces the absorption of nutrients. Hormonal changes such as loss of estrogen in menopause or testosterone as men age, thyroid problems, and adrenal gland disorders also contribute to bone loss.  Lifestyle choices such as excessive alcohol consumption and tobacco use contribute to weakened bones.

There are steps to take to prevent osteoporosis. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weakened bones. Good nutrition and regular exercise are essential for keeping your bones healthy throughout your life.

Protein is one of the building blocks of bone and while most people get plenty of protein in their diets, some do not. Vegetarians and vegans can get enough protein in the diet if they intentionally seek suitable sources, such as soy, nuts, dairy and eggs if allowed. Older adults may also eat less protein for various reasons, and protein supplementation is an option. Calcium is also critical. Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70. Good sources of calcium include: low-fat dairy products, dark green leafy vegetables, canned salmon or sardines with bones, soy products, such as tofu calcium-fortified cereals and orange juice. If you find it difficult to get enough calcium from your diet, consider taking calcium supplements. However, too much calcium has been linked to kidney stones. Although yet unclear, some experts suggest that too much calcium especially in supplements can increase the risk of heart disease. Total calcium intake, from supplements and diet combined, should be no more than 2,000 milligrams daily for people older than 50. Vitamin D improves your body’s ability to absorb calcium and improves bone health in other ways. People can get adequate amounts of vitamin D from sunlight but it’s not easy as we avoid the sun for skin cancer reasons. A good starting point for adults is 600 to 800 international units (IU) a day in supplements with food adding the additional requirement.

Avoid a sedentary lifestyle. ‘Use it or lose it’ definitely applies to bones. People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Exercise can help you build strong bones and slow bone loss. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful. Combine strength training exercises with weight-bearing and balance exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, and impact-producing sports — affect mainly the bones in your legs, hips and lower spine. Balance exercises such as tai chi can reduce your risk of falling especially as you get older. Swimming, cycling and exercising on machines such as elliptical trainers can provide a good cardiovascular workout, but they’re not as helpful for improving bone health.  It’s never too late; walking every day is proven to be extremely effective in bone building and improving balance which helps prevent falls. Always check with your doctor before starting an exercise program.

—By Nancy Scheetz, APRN, B.C. Executive Director, Farmington Valley Visiting Nurse Association