Osteoporosis Prevention Can Start Well Before Menopause, Experts Say
Osteoporosis causes women to spend more time in hospitals than breast cancer. Here's what you need to know.
By Susan E. Matthews
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THURSDAY, October 10, 2013 —Osteoporosis may seem like one of the more minor health concerns women have to worry about, but a highlights just how important it is for women to be aware of the disease. For example, one in three woman over age 50 will have a bone fracture caused by the disease, and sprains from osteoporosis are the leading cause of hospitalization in women over 45 — even above breast cancer or heart disease.
“Osteoporosis doesn’t strike fear in your heart like the word ‘cancer’ does, or ‘heart attack’ does,” said Beth Kitchin, PhD, RD, director of the Tone Your Bones osteoporosis program at the University of Alabama at Birmingham, where she is also an assistant professor of nutrition sciences. She was not involved in the report, but found that it quantified what is a big health issue for women that’s often minimized. “One of the things I see is that people don’t view themselves as likely to get the disease, or that the disease is a bad thing to have.”
In reality, however, osteoporosis can be quite debilitating. For instance, the report notes that 20 percent of women who fracture their hips will die within a year of the fracture. This has to do with the fact that fractures often require surgery, which can result in a blood clot of infection, Kitchin noted. Additionally, the decrease in mobility can lead to a “general downward spiral of health,” she said.
For these reasons, it’s important for women to work to prevent osteoporosis and be aware of their risk. “In the early 1900s, women’s life expectancy was 49,” said Elissa Gretz Friedman, MD, co-director of Mount Sinai’s Women’s Health Program and a certified menopause practitioner. Now, women are living for 30 years past menopause, and because of the changes in estrogen that come with menopause, they begin constantly losing bone.
“Osteoporosis is not something that women are as proactive about as they should be,” Dr. Friedman said.
Women need to think about their bone health well before menopause hits, both doctors agreed. This means making sure to get enough calcium, a recommended 1,000 milligrams a day (a glass of milk has 300 milligrams), and enough vitamin D, between 800 to 1,000 milligrams, said Friedman.
Bone mass peaks for women at age 30, so it’s critical to pay attention to it even before menopause, she added.
It’s also important to exercise enough, so that you put enough “good stress” on the bones, according to Friedman. That helps them with their constant cycle of breaking down and reforming, and it also keeps the muscles around them strong enough to support the bones and prevent falls, Friedman said.
Once you hit menopause, it’s critical to check in with your doctor about all of the changes happening in the body, but it’s particularly important to make sure you know what changes are occurring in your bones. Bone density loss happens most rapidly in the first five years after menopause, Kitchin noted, so this is a critical time to still be providing your body with plenty of calcium, vitamin D, and exercise. It’s best to get these from your diet, because the body can absorb it better that way, but supplements can help if they’re needed, she added.
It could be helpful to check with your doctor to decide if you need supplements. A recent study that analyzed several former studies on vitamin D found that many people who take the supplements don't actually need them.
"Supplementation to prevent osteoporosis in healthy adults is not warranted," Clifford Rosen, MD, of the Maine Medical Research Institute wrote in a comment on the study. "However, maintenance of vitamin D stores in the elderly combined with sufficient dietary calcium intake (800–1200 mg per day) remains an effective approach for prevention of hip fractures."
It’s also important to know family history, as genetics play a part in each person’s risk of osteoporosis. For people at higher risk of the disease, there are medications they can take to help increase bone density. Even for women on medication, getting proper calcium and vitamin D is still critical, according to Friedman. Additionally, women who choose to take hormone replacements may reduce their risk of osteoporosis because the extra estrogen helps to reduce bone loss, Friedman said.
For women who know they have osteoporosis who are afraid of exposing their bones to sprains and breaks, Kitchin recommended physical therapy.
“It’s an underused strategy to help women, and it can teach women to improve balance, or use proper posture to put less pressure on your spine,” she said.
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