Bone up on bone health

A largely unknown epidemic affecting 54 million Americans, osteoporosis causes 2 million fractures a year.

Photo courtesy of toa555/Adobe Stock

By Dr. Maurice Cates

Bones are such a basic part of the human body that many of us take them for granted. It’s easy to imagine them as sturdy and lifeless, but in reality, bones are a type of living tissue that grows and changes. And they are crucial. Functioning like support beams in a house, 206 of them form the adult skeleton—which protects our organs, works with our muscles to enable us to move and contains the marrow that produces blood cells.

Yet because weakening bones don’t hurt, often we don’t even think about how to keep our bones healthy until one of them breaks or we’re diagnosed with osteoporosis, a disease that occurs when the bones become so thin and porous that they fracture easily.

As an orthopedic surgeon, I see many patients with fractures caused by osteoporosis. Probably 70 to 80 percent of the trauma-call patients I treat have suffered from an osteoporosis-related injury. A largely unknown epidemic affecting 54 million Americans, this condition causes 2 million fractures a year, according to the National Osteoporosis Foundation. Most patients (including the ones I see) are elderly, but osteoporosis can strike at any age, and good bone health needs to begin early in life.

The bones you have now are not the ones you had 10 years ago—you are constantly losing old bone and creating new bone. Up until the age of about 30, you make more new bone than you lose. After that, bone loss outpaces new bone tissue. This means that you have the most bone you’ll ever have at about age 30, setting the stage for your later years. This is why osteoporosis has been called a pediatric disease with geriatric consequences.

And those consequences can be dire. For example, hip fractures in older people are a major trauma to the body and decrease mobility, which can further lead to heart attacks, stroke and even death.

But here’s the good news: Low bone density and osteoporosis are treatable. Even if you are older and haven’t thought about how to take care of your bones until now, it isn’t too late. There are still things you can do.

Who’s at risk for osteoporosis

Obviously, age is a risk factor for decreased bone density and osteoporosis because the body doesn’t produce as much new bone after age 30. Being female is another factor because estrogen levels plunge after menopause, which in turn accelerates bone loss. This is why osteoporosis affects half of women over the age of 50 compared to a quarter of men that age. People with a family history of osteoporosis are more prone to the condition as well as people with low body weight.

Other risk factors include behaviors you can control. Smoking is the No. 1 habit to avoid if you want to have healthy bones; cigarette smoke decreases bone mineral density and increases levels of hormones that cause the bones to break down.

Drinking alcohol excessively can put you at risk because alcohol interferes with the body’s ability to absorb calcium and people who drink a lot tend not to eat well. A poor diet—especially one deficient in calcium and vitamin D, which are critical to bone health—will also put you at risk. Physical activity helps create new bone tissue and makes existing bones (and muscles) stronger, which is why having a sedentary lifestyle increases your chances of osteoporosis.

A lifelong pursuit

If you’re a parent, it’s important for you to start thinking about bone health from the time your kids are babies. From birth until your children reach about age 10, the most important thing you can do is to be sure they get enough calcium and vitamin D. They are the building blocks of good bones. Because children today do not consume as much dairy or spend as much time playing outside in the sunlight without sunscreen, many kids do not get the recommended daily dose of 600 IU of vitamin D.

Good dietary sources of vitamin D include fortified dairy products such as milk, fortified orange juice and breakfast cereals, egg yolks and fatty fish such as salmon and sardines. In addition, 10 to 15 minutes of sun exposure at midday, without sunscreen, is an excellent way to boost kids’ vitamin D levels, and during the winter, a vitamin D supplement is often needed. (It is possible to overdose on vitamin D, so be very careful with supplements.)

Another potential issue is the fact that many people who are health conscious are also vegetarian and raise their children accordingly. It is recommended that vegans take a vitamin D supplement and eat cruciferous vegetables such as turnips and mustard greens, kale and collards. Vitamin K, phosphorus, magnesium and fluoride are also important, so it’s critical to make sure your kids eat a balanced diet.

From age 10 through roughly age 20, young people produce four to six times more bone than at any other time of life. It’s important for them to make daily exercise part of their lifestyle and to continue getting enough vitamin D and calcium, through food and supplements if needed.

From age 20 through age 30, your body doesn’t produce as much new bone as before, but your bones will become stronger, and continuing to eat right and exercise is important. Weight-bearing exercise, which includes walking and running, is especially beneficial.

After the age of 30, the goal is to minimize how much bone you lose. This is another time in life to think about taking a vitamin D or calcium supplement. I’ve treated patients with fractures who have practically nonexistent levels of vitamin D, which supplements could have prevented. The recommended intake of vitamin D for men and women over 40 is 1,000 units. For calcium, it’s 1,000 mg, and for women over 50, that dosage increases to 1,200 mg. Do not take more than 500 mg of calcium at one time. Your body cannot absorb calcium without vitamin D, so take the two supplements at the same time. Look for supplements that have the United States Pharmacopeia symbol to be sure they are reliable.

Screening and medication

Women over 65 and men over 70 are at the highest risk for osteoporosis and should be screened. This is done via a bone mineral density scan—typically a dual-energy x-ray absorptiometry scan, which estimates the density of your bones and can indicate whether you have normal bone density, osteopenia (below normal bone density but not as severe as osteoporosis) or osteoporosis.

Some people should be screened early. This includes women who have gone through menopause early and people who take steroids, such as people with asthma or Crohn’s disease. Prednisone, a commonly prescribed steroid, is the No. 1 drug that causes loss of bone.

Osteoporosis is typically treated with a class of drugs known as bisphosphonates, such as alendronate. These drugs don’t cure the condition, but they do slow down further bone loss. Some people resist taking these medications because of what they have heard about side effects, such as osteonecrosis of the jaw. However, this side effect happens only at high doses and is very rare.

Moreover, the risk of side effects is much, much less than the risk of a major fracture. Consider that 40 percent of people who break a hip are unable to walk unassisted within the first year. A compression fracture in the back often results in chronic pain or disability. Pelvic and femur fractures can be disabling as well. Your odds of preventing these life-altering injuries with bisphosphonates are far greater than the chance that you will suffer a side effect. And if you cannot take bisphosphonates, other drugs, such as the hormone calcitonin, are available.

As always, talk with your doctor about what treatment is best for your body, given the condition of your bones and your risk factors. And remember, whether you’re 25 or 75, it’s not too late to improve the health of your bones.

For more information about osteoporosis, visit the National Osteoporosis Foundation website. You can learn more about bone density by visiting MedlinePlus, an online resource produced by the United States National Library of Medicine.

Maurice Cates, M.D., is a board-certified orthopedic surgeon with the Mid-Atlantic Permanente Medical Group in the Washington, D.C., area. He serves as the group’s regional director of musculoskeletal services. Cates sees patients in the Kaiser Permanente Frederick and Largo Medical Centers and performs hospital-based surgeries at Suburban Hospital in Bethesda, Maryland, and at Virginia Hospital Center in Arlington.