A day doesn’t go by that I don’t see Valerie Bertinelli or Sally Fields on TV advertising Boniva® or some other treatment for osteoporosis. This condition is a major health problem in older people, especially women, who often sustain fractures as a result of falls. There are over 1.5 million fractures a year attributed to osteoporosis in the US each year.¹

Normally, the bony skeleton is maintained by continual renewal called remodeling, removing old bone and replacing it with new bone.¹ The entire skeleton is replaced every seven years. To do this, our cells require calcium, and to absorb calcium from our diet, we also require vitamin D, which our bodies can manufacture in the skin, with exposure to sunlight.

In osteoporosis which means “porous bone,” bones are peppered with millions of microscopic holes, or pores, the result of continual bone resorption over time.  (Resorption is the process in which bone is broken down and calcium is released into the blood.)  The normal balance between bone resorption and new bone creation is lost, with bone loss overwhelming the formation of new bone.¹ This results in a net loss of bone volume and strength and bones that are brittle.

The bone that remains is normal bone; there’s just less of it. Think of Swiss cheese: the cheese itself is normal, but it’s shot throughout with lots of holes. Really advanced osteoporosis would be analogous to lacy Swiss cheese.

Osteoporosis is often confused with osteomalacia which looks similar on x-rays. However, in this disease, the volume of bone is normal, but its calcium content is reduced, causing the bone to soften.

The reasons for osteoporosis are many, but most often, it results from long-term inadequate calcium intake in the diet, inadequate vitamin D intake, or both. In youth, the metabolic balance of bone turnover favors the creation of new bone. The young are also more active and weight bearing exercise helps to stimulate new bone formation. Activities in the sun promote synthesis of vitamin D in the skin and high levels of sex hormones help to maintain a positive bone turnover, favoring bone creation. These factors result in the strong, resilient skeleton of youth.

After early middle age however, we gradually begin to lose bone. After menopause, as estrogen levels fall, many Western women develop osteoporosis. This bone loss is worse if the woman has borne children, unless she has deliberately supplemented her diet with calcium throughout her life. All these factors together make osteoporosis a “silent thief,” which slowly and silently steals bone over the years, resulting in a porous, weakened skeleton.  To protect yourself, you need to replace all the missing factors that promote bone renewal: calcium, vitamin D, weight-bearing (preferably impact) exercise, and hormonal balance.

Calcium requirements vary throughout life. Through 50 years of age, both the National Osteoporosis Foundation (NOF) and the American Academy of Orthopaedic Surgeons recommend 1000 mg per day. Over 50, the recommendation is 1200 mg per day.^1-4 Good dietary sources include dairy products (like milk, yogurt or cheese), Chinese cabbage, kale, broccoli, spinach, soy, tofu, fish, and almonds (which are especially high in calcium).⁴

To absorb calcium, we require vitamin D. About 20 minutes a day of unfiltered sunlight on the skin will fill this requirement, but oral supplementation is often needed. The NOF recommends at least 400 to 800 IU per day for those under 50; for those 50 and above, 800 to 1000 IU is recommended.^1-4 Too much vitamin D however, can result in kidney stones.

Regular weight-bearing exercise like walking, jogging, dancing, hiking, weight lifting and other resistance exercise, stair climbing, or racquet sports also help to stimulate bone formation provided there is adequate calcium and vitamin D.  Those activities that involve impact, like jogging, are more effective than those without, like swimming, or an elliptical trainer.

Avoid smoking and excessive alcohol intake, both of which increase bone loss.  Talk to your doctor early about osteoporosis, and ask about your options. If osteoporosis is suspected, your doctor may order a Bone Mineral Density test to see if you have the disease, and if so, to quantify how bad it is.

Unfortunately, it takes as long to replenish calcium as it took to lose it. So in advanced cases of osteoporosis where the patient is at risk of fracture, medications may be prescribed by your doctor.  These include bisphosphonates like Reclast® (zoledronic acid) and Boniva® (ibandronate) which increase bone density; hormones like calcitonin, parathormone, and estrogen (HRT or hormone replacement therapy); Evista® (raloxifene); or minerals like sodium fluoride (which replaces calcium in the mineral lattice structure of bone).

Prevention is far better than treatment, and there is no cure, at present. Think of your skeleton as a bank. If you make regular “deposits” of calcium and vitamin D in your younger years, you have an “account” you can draw from in old age to prevent osteoporosis and its resulting problems.

References

1. American Academy of Orthopaedic Surgeons: Osteoporosis Prevention; October 2007;AAOS.org.
2. National Osteoporosis Foundation: Five Steps to Bone health and Osteoporosis Prevention; 2002;NOF.org.
3. 2004 Surgeon General’s Report on Osteoporosis.
4. National Institutes of Health — Office of Dietary Supplements: Dietary Supplement Fact Sheet: Calcium; Dec. 4, 2008.

[Ed. Note: Dr. Bill is William Thomas Stillwell, MD, FACS, FICS, FAAOS, FAANAOS, FAAPGS, orthopaedic surgeon and President of Dr. Bill’s Clinic, Inc. He is the author of HOW TO AVOID KNEE SURGERY. Learn more by clicking here.]

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