Louise Chang, MD
If you have osteoporosis -- or are at high risk -- odds are you're not getting the care you need.
A Stanford study determined that more than half of all people with osteoporosis remain undiagnosed. What's more, even high-risk patients -- such as those who have already had a hip fracture - often don't receive calcium and vitamin D supplements or antiosteoporosis drugs. While a surgeon general's report on bone health adds that most physicians don't even discuss osteoporosis with their patients after a fracture, data show that a women's risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.
Why is this the case? "I have no idea," says a baffled Michael Holick, MD, PhD, professor of medicine, physiology, and biophysics at Boston University Medical Center. "But the numbers are out there. Only one in four women between the ages of 45 and 75 will ever talk to a doctor about osteoporosis."
What's tragic about those numbers is that it's relatively easy and cost effective to take care of your bones -- but it can be devastating when you don't. Osteoporosis causes about 2 million fractures every year. If you're a woman older than 50, you have 50-50 odds of having an osteoporosis-related fracture sometime in your remaining lifetime (don't stop reading if you're a man: your chance of a similar fracture is one in four).
Here are some things you can do to help protect your bones without breaking the bank -- especially if you're at high risk for osteoporosis, or nearing an age at which you will be.
Get Cs and Ds: Calcium and vitamin D, that is. A study of postmenopausal women on osteoporosis treatment shows that 52% had vitamin D insufficiency -- even though they'd been told by their doctors to take calcium and vitamin D.
In 2010, the Institute of Medicine issued new recommendations for how much daily calcium and vitamin D most people need. Most adults, the IOM says, should be getting between 600 and 800 international units (IUs) of vitamin D every day, and between 1,000 and 1,300 miligrams (mg) of calcium daily (with the higher levels for postmenopausal women, adolescent girls, and women who are pregnant or lactating).
"To prevent skin cancer, we're avoiding sun exposure, which is a major source of vitamin D," Holick says. Fortified dairy products, egg yolks, fish, and liver contain vitamin D, but some people may need a supplement to ensure they get enough. There are many dietary sources of calcium, including not just a variety of dairy products, but fortified cereals and juices, dark leafy greens like bok choy and broccoli, and almonds.
Exercise: Here's the good news: The best exercise for maintaining your bone mass costs you nothing, other than maybe a good pair of shoes. It's walking, as little as 3-5 miles a week.
"The pounding on the pavement as you walk increases muscle tone and maintains bone density," says Holick. "No other type of exercise does this as well."
If you're looking to increase (not just maintain) bone density, you can't hope to increase your bone density through exercise -- not unless you stress yourself abnormally (think super weightlifter-type workouts) -- but it can help you keep the bone that you have. Jogging, stair climbing, and other types of weight-bearing exercise are also effective.
Strength training is the other half of the exercise equation. It maintains and possibly even improves bone mineral density, according to several studies, according to results from the Bone, Estrogen, and Strength (BEST) study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
You don't have to join a pricey gym to get strength-training benefits. A few inexpensive hand weights or a rubber tubing used for resistance exercises are all you need. A simple program with one or two exercises for each muscle group is fine. Ask your doctor for some sample exercises.
You can also order the National Osteoporosis Foundation's BoneWise exercise video from its web site (www.nof.org) (be sure to check with your doctor before starting any exercise program, especially if you've had falls, fractures, or other injuries).
Testing: Bone density screening is the best way to assess the health of your bones. But will your insurance coverage pay for it? The answer is yes and no, says Holick. "If you're 50 to 55 years of age and perimenopausal, bone density screening provides an important baseline, but insurance coverage is spotty."
Many insurers won't cover bone density screening for women under 65 (the age at which the National Osteoporosis Foundation recommends screening begin for all women) unless you have one or more additional risk factors. Be sure your doctor and your insurer know if you have any of these risk factors:
You can also do a simple at-home test of your own bone health using an online tool called FRAX, developed by the World Health Organization to evaluate fracture risk. Using information including your age, weight, height, and a few questions about your health history (like smoking and steroid use), FRAX predicts risk of having a fracture within the next 10 years.
If you already have osteoporosis, insurers generally cover prescribed medications such as bisphosphonates, although the monthly co-payments for a drug you will take for years can add up.
If these payments become a serious burden, or if you're uninsured, don't risk your bone health by dropping your medications -- explore these options:
Sources: Surgeon General's Report on Bone Health, 2004. Stanford study reported in Archives of Internal Medicine, July 26, 2004. Michael Holick, MD, PhD, professor of medicine, physiology and biophysics, Boston University Medical Center. National Osteoporosis Foundation. Journal of Clinical Endocrinology Metabolism, "Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy," June 2005; vol 9: pp 3215-24; National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); NeedyMeds; AARP Bulletin; Seniors Inc.; The Medicine Program. Institute of Medicine: “Report Brief: Dietary Reference Intakes for Calcium and Vitamin D,” November 2010.
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