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Bone Up for Better Health

HEALTHTRACK - JULY 96
A SUPPLEMENT TO THE PHYSICIAN AND SPORTSMEDICINE FOR THE WAITING ROOM


What is Osteoporosis? Osteoporosis is a disease in which bones lose minerals—mainly calcium—and become thin and weak. With osteoporosis, your bones become so brittle that a minor injury can break a wrist, hip, or spine. It often affects women after menopause when their bodies make less of the female hormone estrogen.

Osteoporosis can occur in younger women, too, if they stop menstruating for 3 months or more, are not getting enough calcium, or have an eating disorder such as anorexia. Doctors have seen premature osteoporosis in very athletic young women who exercise or diet to such an extent that they stop having their periods.

Fortunately, you can protect yourself. A three-pronged approached to avoiding osteoporosis includes exercise, calcium intake, and hormone replacement or other medication. These methods work best in conjunction with each other, rather than alone. If you are worried about your bone density, talk to your doctor.


[Figure]

Your bones, like your muscles, stay stronger with regular exercise. And having strong bones and strong muscles can keep you from getting osteoporosis. (But remember, exercise alone will not create miracles: Your hormones need to be at the right levels for exercise to help you.)

Bone loss is prevented best by exercise performed while you are on your feet—like walking, jogging, or playing tennis—and by resistance exercises like weight lifting and strength training. Whatever exercise you choose, you should do it regularly, ideally for 20 to 60 minutes three to five times a week.

It may be hard to keep up an exercise routine as you age, but exercise does not have to be elaborate to be effective. Taking a stroll after dinner, lifting some hand weights while you watch TV, or meeting a friend for a tennis match are all examples of bone-building activities. What's more, if you keep up your strength, flexibility, and coordination, you will be less likely to fall and break a bone—a real danger if you have osteoporosis.


[Figure]

Calcium is used by the body to form bones and teeth. It also helps nerves and muscles work properly and helps blood to clot. A shortage of calcium in your diet can lead to osteoporosis.

The recommended dietary allowance for calcium is

  • 1,200 mg to 1,500 mg a day for girls;
  • 1,000 mg a day for women 18 to 50;
  • 1,500 mg a day for women who are over 50, have irregular or absent menstrual cycles, or are pregnant or breast-feeding.

Counting Your Calcium

Food Calcium
(mg)
Yogurt (1 c, plain low-fat) 415
Milk (1 c, skim) 315
Orange juice (calcium-enriched, 1 c) 300
Tofu (calcium-processed, 4 oz) 260
Spinach (1 c, cooked) 245
Kale (1 c, cooked) 95
Almonds (1 oz) 80
Broccoli (1 c, cooked) 70

It's best to get your calcium from food (see box) because it's most easily absorbed by your body this way. But if you can't, ask your doctor about taking calcium supplements. Antacids containing calcium carbonate are inexpensive and easily absorbed if taken with a meal.


[Figure]

Extra Benefits. HRT can also help you avoid other problems associated with menopause—it reduces heart disease risk, improves mood and sleep quality, and lessens vaginal atrophy and hot flashes. But HRT is not right for everyone, so ask your doctor whether it makes sense for you.

Hormone replacement therapy (HRT) is a drug treatment that replaces the female hormone estrogen when your body is not making enough naturally. If you are not menstruating regularly, you are most likely low on estrogen. Progesterone is a hormone that is usually also given in HRT because it protects your uterus from cancer (if your uterus has been removed, you will not need the progesterone portion).

Hormone therapy cannot repair weakened bones, but it does prevent further bone loss, especially when combined with exercise and a calcium-rich diet. Treatment must continue as long as you are not making estrogen naturally. You may receive the hormones separately or combined in an oral contraceptive pill.



A Matter of Timing

No matter what your age, you can take steps to prevent bone loss.

Between 10 and 20 years old:

  • Now is the time to start laying the groundwork for strong bones by storing up on calcium. This will help you grow and prepare you for a healthy adult life.
  • Make proper nutrition and regular exercise a part of your life. Health is more important than weight. If you are dieting constantly, throwing up after you eat, using laxatives, or using diet pills, you very likely have an eating disorder.
  • Regular menstrual periods are important to prevent osteoporosis. See a doctor if you are older than 16 and have never menstruated, or if at any age you have begun to menstruate but have noticed changes in your period, such as longer cycles, skipped cycles, or no cycles for 3 months.

Between 20 and 35:

  • Because your bones will reach their peak strength during these young adult years, make sure you continue to get plenty of calcium and exercise.
  • Report any changes in your period to your doctor.
  • If you are pregnant or nursing, be sure to increase your calcium intake.

Between 35 and 50:

  • You may have begun to gradually lose bone. Getting enough calcium and exercise are important to keep bone loss to a minimum.
  • If your periods become irregular or if you develop signs of menopause such as hot flashes, talk with your doctor about estrogen treatment.

Over 50:

  • If you have gone through menopause, you may be losing bone at a rate of 1% to 6% per year. Replacement with estrogen alone or estrogen with progesterone is the single most important thing you can do to prevent osteoporosis. Ask your physician if hormone therapy—or other types of medication—is appropriate for you.
  • Remember, adequate calcium intake and exercise are still important. Try to walk, jog, play tennis, or perform a resistance workout for 20 to 60 minutes three times a week.

Prepared by Sarah L. Gall


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