Doctor’s Tip: Update on osteoporosis
Osteoporosis (brittle bones) often leads to fractures. About 20% of American women and 4% of men aged 50 or older have osteoporosis. Another 50% of women and 30% of men have osteopenia (pre-osteoporosis).
Osteoporosis causes over 1.5 million fractures annually in the U.S. White women age 50 and older who do not receive estrogen replacement have a 46% risk of sustaining an osteoporotic fracture during the remainder of their lives. Hip fractures are a major cause of disability and placement in long-term care facilities. Fractures in the vertebrae cause a bent-forward deformity of the spine that interferes with quality of life.
The November issue of Nutrition Action, published by the nonprofit Center for Science in the Public Interest, has an interview with Bess Dawson-Hughes, an endocrinologist and professor at Tufts University in Boston, who is former president of the National Osteoporosis Foundation. She notes that throughout life, bone is constantly being remodeled by cells called osteoclasts that absorb bone, and osteoblasts, cells that make bone.
There is a net bone gain until we reach our peak bone mass at age 25-30. At menopause, due to drop in estrogen levels, the balance is changed so the average menopausal women loses 2-3% of her bone density every year for five to eight years, after which she loses about 1% a year. Starting at around age 50, the average man loses about 1% a year for the rest of his life, due at least in part to a drop in testosterone levels. People who develop osteoporosis have a greater than normal rate of bone loss.
Osteoporosis is diagnosed by a DEXA scan, available locally. The National Osteoporosis Foundation recommends this test at age 65 for women and 70 for men, but earlier if risk factors such as a previous fracture are present. Abnormal loss of height is a red flag for osteoporosis: Most people lose 1.5 inches as they age, due to drying out and collapsing of the discs between the vertebrae. Loss of height beyond that is a sign of compression fractures of the spine, which often are painless. To estimate your fracture risk, go online to Sheffield.ac.ukFRAX and click on the calculation tool.
The most common risk factors for osteoporosis are: 1) aging; 2) deficiency of estrogen in women and testosterone in men; 3) heavy alcohol use; 4) smoking; 5) long-term proton pump inhibitors such as omeprazole; 6) long-term steroid (cortisone) use; 7) anti-testosterone prostate cancer treatment in men; 8) overactive thyroid or parathyroid glands; 8) low physical activity; 9) malabsorption diseases such as celiac disease; 10) early menopause; and 11) a Western diet. Of interest is that obesity is associated with stronger bones, because fat cells manufacture estrogen.
Why does a Western diet increase risk? Dr. Dawson-Hughes explains that the typical American diet, which is based on animal products and refined grains, is acidic, whereas a plant-based diet is alkaline. Bone is alkaline, so the body dissolves bone to neutralize the acid associated with a Western diet.
If you want to prevent or treat osteoporosis, eat a plant-based, unprocessed food diet and cut back on or avoid animal products and refined food. Adequate calcium is important throughout life and is best obtained through green leafy vegetables and legumes, including soy. Of interest is that people who drink more cow’s milk have a higher incidence of osteoporosis and fractures. Calcium supplements are controversial, but adequate vitamin D levels are important for strong bones, and many people need D supplements.
Weight-bearing exercise in the upright position most days of the week is important for bone health. Jogging, hiking, stair climbing and racquet sports are best. But if you have brittle bones, engage in safer activities such as walking. Dr. Dawson-Hughes also recommends muscle-strengthening exercises two or three days a week, which not only increase bone density but also make people stronger and therefore less apt to fall.
There are medications for osteoporosis such as Fosamax. They can have side effects, but if you are diagnosed with osteoporosis, the health risks from having a fracture outweighs risks of side effects from these medications. Postmenopausal estrogen is another way to prevent and treat osteoporosis, but risks must be considered. Medications are not recommended for osteopenia.
Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email firstname.lastname@example.org.
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