It’s a common misconception, but osteoporosis is not a normal part of aging. It is a risk factor, but by no means should you settle for poor bone health later in life. In fact, there is much you can do at any age to protect your bones.
Some risk factors cannot be changed: age, gender, menopausal status, family history, and body frame cannot be changed. Additionally, certain medications and other health problems may increase risk of osteoporosis.
That said, many factors are within your control to promote better bone health, such as eating a healthy diet with adequate calcium and vitamin D, maintaining a normal weight, engaging in weight bearing and muscle strengthening exercise, avoiding tobacco, and limiting alcohol.
It’s estimated that 34 million Americans have low bone density (osteopenia) and another 10 million have osteoporosis. Having a fracture can cause limited mobility, limited independence, and chronic pain; twenty percent of seniors die within a year of a hip fracture due to complications. Unfortunately, osteoporosis is usually a silent disease, and for many people the first symptom is a broken bone. It doesn’t have to be this way — not with regular screenings.
Various expert groups, such as the American College of Physicians, the National Osteoporosis Foundation, and the United States Preventive Services Task Force, have slight differences in who should be screened for osteoporosis. The National Osteoporosis Foundation recommends a bone density test (a duel energy x-ray absorptiometry or DXA test) for women over the age of 65 and for men over the age of 70.
Some individuals need testing at a younger age; examples include individuals over the age of 50 who have broken a bone, and women between the ages of 50 to 65 or men ages 50 to 70 who have on certain risk factors. Depending on results and risk factors, a repeat DXA test may be needed in two to ten years.
Diagnosis of osteopenia and osteoporosis from a DXA test is based on something called a T-score which compares your bone density to an average young person. Osteoporosis can also be diagnosed if you have a “fragility fracture” which is a fracture after a low impact fall.
Adequate calcium and vitamin D are key to bone health, and the best way to get them is through your diet. Dairy products, tofu, and certain green vegetables (such as kale or broccoli) are excellent sources of calcium; additionally, some cereals, breads, juices, and other foods may have calcium added to them. Vitamin D is naturally available in fatty fish such as salmon or tuna; it, too, is added to milk and other food items. Supplements are another major source of vitamin D.
How much calcium and vitamin D is needed? The Institute of Medicine recommends:
- Women under 50 and men under 71 need about 1000 mg of calcium per day
- Women over 51 and men over 71 need 1200 mg of calcium per day
- Most individuals under the age of 50 need 400 to 800 IU of vitamin D per day. People older than age 50 need 800 to 1000 IU per day. Note that higher amounts may be needed for certain individuals.
It may seem simple, but fall prevention is very important in individuals with osteoporosis or who are at risk for it. This includes removing throw rugs, being mindful of electrical cords, wearing sturdy shoes, avoiding slippery surfaces, and being mindful of household pets that may be underfoot.
Not all people with low bone density or osteopenia need treatment with prescription medications; health care providers can use a predictive calculator to help determine who may benefit from treatment. Individuals with osteoporosis should strongly consider taking a prescription medication for it. Choice of medication and duration of treatment are very individualized.
Written by Dr. Sarah Swarts, a board-certified endocrinologist at Samaritan Health Services in Corvallis. She treats patients for a variety of hormone-related conditions, including diabetes, thyroid diseases, and bone diseases. She is accepting new patients. For more information, please call 541-768-5140.
Reference: The National Osteoporosis Foundation