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OSTEOPOROSIS - Shalini Bhargava

It can happen without warning � you bend over to pick up the morning paper and feel a searing pain in your side. Later you learn you've fractured a rib. If you're an older adult, your fracture may be the result of osteoporosis.

Osteoporosis, which means "porous bones," causes bones to become weak and brittle � so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. Osteoporosis can also accompany endocrine disorders or result from excessive use of drugs such as corticosteroids.

osteoporosis causes fractures� most of them in the spine, hip or wrist.And although it's often thought of as a women's disease,osteoporosis affects many men as well.

It's never too late � or too early � to do something about osteoporosis. Everyone can take steps to keep bones strong and healthy throughout life

Signs and symptoms

In the early stages of bone loss, you usually have no pain or symptoms.But once bones have been weakened by osteoporosis, you may have signs and symptoms that include:

  • Back pain
  • Loss of height over time, with an accompanying stooped posture
  • Fracture of the vertebrae, wrists, hips or other bones
Causes

The strength of your bones depends on their mass and density. Bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain less mineral, their strength decreases and they lose their internal supporting structure.

Scientists have yet to learn all the reasons this occurs, but the process involves how bone is made. Bone is continuously changing � new bone is made and old bone is broken down � a process called remodeling,or bone turnover.

A full cycle of bone remodeling takes about two to three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain. Not getting enough vitamin D and calcium in your diet can accelerate the process.

At menopause, when estrogen levels drop, bone loss in women accelerates to about 1 percent to 3 percent a year. Around age 60, a woman's bone loss slows but doesn't stop. At the same time, bone loss in men accelerates so that by age 65, men lose bone at the same rate as do women. As women reach older ages, they may have lost between 35 percent and 50 percent of their bone mass. Men may have lost 20 percent to 35 percent. Your risk of developing osteoporosis depends on how much bone mass you attained between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you lose bone during normal aging.

Three factors are essential for keeping your bones healthy throughout your life:

  • Regular exercise
  • Adequate amounts of dietary calcium
  • Adequate amounts of vitamin D, which is essential for absorbing calcium
Risk factors

Risk factors for osteoporosis include:

  • Sex.Fractures from osteoporosis are about twice as common in women as they are in men.That's because women start out with lower bone mass and tend to live longer. They also experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. From age 75 on, osteoporosis is as common in men as it is in women.
  • Age.The older you get, the higher your risk of osteoporosis. Your bones become weaker as you age.
  • Family history.Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.
  • Frame size.People who are exceptionally thin or have small body frames are at higher risk because they often have reserved less bone mass to draw from as they age.
  • Tobacco use.The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.
  • Lifetime exposure to estrogen.The greater a woman's lifetime exposure to estrogen, the lower the risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier-than-average age. But if you have a history of abnormal menstrual periods, experience menopause earlier than your late 40s or have your ovaries surgically removed before age 45 without receiving hormone therapy, your risk is increased.
  • Eating disorders.Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.
  • Low calcium.Long-term low intake of calcium, or medical conditions and procedures that decrease calcium absorption, can contribute to bone loss. Stomach surgery (gastrectomy) can affect your body's ability to absorb calcium. So can conditions such as Crohn's disease, Cushing's disease � a rare disorder in which your adrenal glands produce excessive corticosteroid hormones � and anorexia nervosa.
  • Sedentary lifestyle.Bone health begins in childhood. Children who are the most physically active have the greatest bone density. Any weight-bearing exercise is beneficial, but jumping and hopping seem particularly helpful for creating healthy bones. Exercise throughout life is important, but you can increase your bone density at any age.
  • Chronic alcoholism.For men, alcoholism is one of the highest risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.
  • Depression.People who experience depression have increased rates of bone loss.
Prevention

The following measures can greatly reduce your risk of osteoporosis. If you already have osteoporosis, these steps can help prevent your bones from becoming weaker. In some cases you may even be able to replace bone you've lost.

Get adequate calcium and vitamin D.
The amount of calcium you need to stay healthy changes over your lifetime. Your body's demand for calcium is greatest during childhood and adolescence, when your skeleton is growing rapidly, and during pregnancy and breast-feeding. Postmenopausal women and older men also need to consume more calcium. As you age, your body becomes less efficient at absorbing calcium.

Good food sources of calcium include skim, low-fat and whole milk; low-fat plain yogurt; cheddar and ricotta cheese; broccoli;paneer made from skimmed milk; and orange juice and other products, such as tofu, fortified with calcium.

If you find it difficult to get this much calcium from your diet because you can't eat dairy products, for example, try calcium supplements. Supplements are as effective as calcium from food, are inexpensive, and generally are well tolerated and well absorbed if taken properly.

  • Exercise.Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life. Combine strength training exercises with weight-bearing exercises. Strength training enables you to strengthen muscles and bones in your arms and upper spine, while weight-bearing exercises � such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports � mainly affect the bones in your legs, hips and lower spine.
  • Don't smoke.Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman's body makes and by reducing the absorption of calcium in your intestine. The effects on bone of secondhand smoke aren't yet known.
  • Consider hormone replacement therapy. Hormone replacement therapy can reduce a woman's risk of osteoporosis during and after menopause. But because of the risk of side effects, discuss the options with your doctor and decide what's best for you
  • Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation and reduce your body's ability to absorb calcium. There's no clear link between moderate alcohol intake and osteoporosis.
  • Limit caffeine.Moderate caffeine consumption � about two to three cups of coffee a day � won't harm you as long as your diet contains adequate calcium.

Exercise and osteoporosis: Staying active safely

Whether you already have osteoporosis or you're trying to prevent it, physical activity can help. Exercise can slow bone mineral loss, help maintain posture and improve your overall fitness. The key is to know which exercises to do and how to do them properly � and safely.

The types of activities and exercises that are best for you are based on your goals, overall health status, degree of bone loss and what you enjoy doing.

Getting started

If you already have osteoporosis, consult your doctor before starting an exercise program. Depending on the status of your condition, your doctor may or may not recommend certain movements. Your doctor may also wish to measure your bone density or assess your fitness level.

Next, set your goals. What do you hope to achieve from regular exercise? Your goals for being physically active may be associated with:

  • Increasing your ability to carry out daily tasks and activities
  • Maintaining or improving your posture and balance
  • Relieving or lessening pain
  • Preventing falls and fractures
  • Increasing your sense of well-being

Finally, think about what kind of activities you enjoy most. If it's an exercise you enjoy, you're more likely to stick with it over time

Choosing the right exercises

Often a combination of activities can help prevent or treat osteoporosis. All are designed to provide benefits while minimizing your risk of an osteoporotic fracture while you exercise. Exercises typically include:

  • Weight-bearing activities.These include activities you do on your feet with your bones supporting your weight. Walking, jogging and stair climbing are examples. They work directly on the bones in your legs, hips and lower spine to slow mineral loss. If you have osteoporosis, walking � preferably at least a mile a day � is generally the best weight-bearing exercise because it minimizes impact stress on your bones.
  • Strength training.Strength training uses resistance, such as free weights, weight machines, resistance bands and water activities, to strengthen your muscles. It can also work directly on your bones to slow mineral loss. If you have osteoporosis, you'll need the assistance of your doctor or physical therapist to design a strength training program that includes proper techniques and is appropriate for your degree of bone loss.
  • Back-strengthening exercises.These exercises primarily work on muscles rather than bone. Strengthening your back muscles may help treat osteoporosis by maintaining or improving your posture. That's because the stooped posture caused by osteoporotic compression fractures may increase pressure along your spine, which can lead to even more compression fractures. Exercises that gently arch your back � the opposite direction of a stooped posture � can strengthen back muscles while minimizing stress on your bones.

You can do weight-bearing activities every day. If you're strength training, aim for at least two, but no more than four, exercise sessions a week to gain the most benefit. You can do back stretches daily, but for back-strengthening exercises, follow the guidelines for strength training. Also, avoid working the same back muscles on consecutive days.

Staying safe: Avoid risky movements

If you don't have osteoporosis and you're otherwise healthy, exercises to prevent osteoporosis are generally safe. If you have low bone density or already have osteoporosis, a few precautions are necessary when you exercise or perform regular activities. Certain movements may be dangerous because of the stress they put on your spine.

  • Forward bending.Avoid activities and exercises that involve bending forward excessively at your waist because they increase the risk of compression fractures of your vertebrae � the small bones in your spinal column.
  • Heavy lifting.Avoid heavy lifting � especially when bending forward at the waist � which may include lifting loads of laundry, bags of groceries or exercise weights. Such lifting also increases stress on your vertebrae.
  • Twisting.Twisting movements can place unusual force on your spine. Golfing and bowling are two common sports that involve twisting and may be harmful. Talk with your doctor or physical therapist about whether you can safely participate in these sports.
  • High-impact activities.Activities that involve higher impact movements, sudden stops and starts, and abrupt weight shifts put too much stress on your spine and can lead to falls and knee injuries. Such activities include running, soccer, racket sports, volleyball and basketball.

Sometimes you can't avoid certain movements, such as bending forward or reaching overhead. But you can use caution and practice good posture and body mechanics to decrease your risk of injury.

Prevent Osteoporosis Now

Today is the day to begin preventing osteoporosis, an age-related disorder in which bones become gradually thinner, more porous and less able to support the body.

This condition attacks both men and women, but women usually suffer more severely because bone loss accelerates rapidly after menopause. By the time a woman reaches the age of 70, she may have lost as much as 30 percent of her bone density.

Prevention is the key

The following lifestyle-related factors may lead to the development of osteoporosis:

  • lack of exercise
  • calcium and vitamin D deficiency
  • prolonged use of drugs, alcohol, caffeine, high-phosphate soft drinks
  • smoking

The good news is that osteoporosis may be prevented by a combination of exercise and good nutrition. Here's how:

Get plenty of exercise:

Weight-bearing exercises can help prevent bone loss and may encourage bone growth. Specific exercises to twist, bend, stretch and compress bones are needed to strengthen the common sites at risk: the upper arm at the shoulder, the forearm at the wrist, the thigh bone at the hip, and the spine. This process is known as ''bone loading.''

Before beginning any exercise program, always consult your physician.If you're given the go-ahead, start slowly and build up over time. An ideal program should include bone-specific, aerobic weight-bearing exercise three days per week. Weight-bearing exercise includes such activities as walking and cross-country skiing.

Include a variety of exercises that will stimulate as many different bones as possible. Add upper-body muscle strength and endurance training two days per week.

Stick with your program and work up to working out at least 20 to 30 minutes a day, three times per week. Also, think about ways to increase your daily activity, such as taking the stairs or gardening.

Eat for stronger bones:

You can bolster your bone strength by eating a high-calcium, high-fiber, low-fat diet.

Did you know that two-thirds of your bone is composed of calcium? Here are the recommended dietary allowances (in milligrams per day) for calcium for various individuals:

  • 18-50 years: 800 mg
  • pregnant or lactating women: 1,600 mg for mothers under age 19, 1,200 mg for mothers over age 19
  • women over 50: 1,000 - 1,500 mg
  • men and women over 60: 1,000 - 1,500 mg

You need vitamin D to help metabolize calcium. The best source of vitamin D is the sun, but fortified milk products offer the same benefit without the risk of skin damage.

You can also get a good dose of calcium from the following sources:

  • nuts, seeds, beans and peas
  • fish with bones
  • green vegetables

Bones to last a lifetime

Bone-loading exercise and a balanced diet are important components for preventing osteoporosis. By taking care of your bones now, they will stay strong enough to carry you safely through a lifetime of health and activity.

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