When Brittle Bones Need Bulking Up

Linda Johnson broke six bones in six years during her 30s. One time, she fractured a rib when her husband picked her up; another time, she broke a toe after bumping it on a wall; yet another, she stepped off a curb and shattered her ankle. "My kids started to joke: `Don't touch Mom or she'll break,"' says the 49-year-old from Brentwood, Md.

By age 41, when she was diagnosed with osteoporosis, Johnson had shrunk an inch in height from spinal fractures, and had bones like those of a 78-year-old woman. She had to quit her job as a church organist because of the pain of sitting on a bench. Just sliding across the seat of her car was excruciating.

SILENT ROBBER. While osteoporosis is rare in someone so young, Johnson's case illustrates how debilitating it can be. Osteoporosis--literally, "porous bone"--more commonly strikes people who are over 50. Until recently, it was considered a natural part of the aging process. But it is now known to be a preventable disease in most cases. Organizations such as the National Osteoporosis Foundation (NOF) in Washington, have been teaching that proper diet, exercise, and drugs can keep this silent bone robber at bay.

Currently, 7 million to 8 million Americans have osteoporosis, and 17 million more are at risk for fractures. As baby boomers swing into late middle age and life spans increase, the number of cases could double, says NOF President Robert Lindsay. The ailment affects one of every two women and one of every five men over age 65.

What causes this crippler? Bones are constantly being remodeled as old, damaged bone is replaced by new material. The whole cycle takes about three months. Osteoporosis occurs when bone disappears faster than it is created. Bones become thinner and more brittle, to the point where bending over to pick up the newspaper, or even rolling over in bed, can cause breakage.

Like high blood pressure, osteoporosis is a furtive stalker. Too often, people are unaware that they have the disease until bones break. While osteoporosis doesn't kill, it can demolish one's quality of life. Spine fractures can cause the elderly to become so stooped they can only look at the ground. Paralyzed by fear of falling and wracked by pain, many osteoporotic people become depressed and isolated, says Deborah Gold, a medical sociologist at Duke University Medical Center.

Osteoporosis is more prevalent in women because, while estrogen protects bones, its sudden reduction 5 to 10 years after menopause dramatically speeds bone loss. By contrast, men rarely lose testosterone and when they do, the process is more gradual. Also, men have greater bone mass to begin with, so they can afford to lose more before a problem develops.

Women especially need calcium in their early years because total bone mass is reached by age 30. "Peak bone mass is like money in the bank," says Jane Kerstetter, professor of nutrition at the University of Connecticut in Storrs. "If you start off with more to lose, that's protection later on in menopause." Unfortunately, adolescent girls may not be consuming enough calcium to protect them in middle age. Many teenagers tend to diet or drink soda instead of milk. Also, young women who stop menstruating because of eating disorders or excessive exercise are at greater risk for osteoporosis.

DON'T SMOKE. Other factors can interfere with proper calcium absorption. Excessive caffeine, salt, and protein cause the body to excrete more calcium in the urine. Cigarettes, excessive alcohol intake, and certain drugs such as steroids used to treat asthma and arthritis also contribute to bone loss.

While adults should take in at least 1,000 milligrams of calcium a day, adolescent girls and postmenopausal women need 1,500 mg. The best sources of calcium are dairy products such as milk and yogurt. Canned sardines and salmon as well as leafy green vegetables such as broccoli and collard greens are also high in calcium.

For those who can't get enough calcium into their diet, there are vitamin supplements. Calcium carbonate, found in the antacid Tums, is the cheapest and most concentrated source. Since that may cause some people intestinal distress, calcium citrate vitamins, which have less calcium but are more easily absorbed, are an alternative, says Kerstetter. Strong bones also need vitamin D. Fifteen minutes' daily exposure to sunlight on the face and hands without sun block is adequate and in most climates not long enough to burn the skin. Most milk and calcium supplements are fortified with vitamin D, which comes in tablets as well.

Nutrition alone won't keep bones healthy. Weight-bearing exercises, such as jogging, walking, and aerobics have been shown to build bone mass, even in the elderly. Staying fit also promotes strong muscles, which help cushion and protect bones, says Ethel Siris, director of the Toni Stabile Center for the Prevention and Treatment of Osteoporosis at New York's Columbia Presbyterian Medical Center.

Physical therapists at clinics such as the University of Connecticut Health Center can teach osteoporosis sufferers how to bend, cough, sit, and walk in such a way as to protect fragile bones. When Linda Johnson realized she might live another 30 years with osteoporosis, she started with simple isometric exercises and worked her way up to an hour each week of aerobics and weight lifting. She has since been able to slip and fall without fracturing a bone for five years.

The third way to prevent and treat osteoporosis is with medication. Three drugs are now available for bones: hormone replacement therapy, calcitonin, and Fosamax. "Estrogen is the drug of choice for prevention," says Kristine Harper, medical director of Duke's Bone & Metabolic Diseases Clinic. However, estrogen can sometimes exacerbate such problems as endometriosis, liver disease, blood clots, and breast cancer.

For women who can't take estrogen, the nasal spray calcitonin, a natural thyroid hormone, prevents bone loss. "Calcitonin is the safest of the medicines," says NOF's Lindsay, "but it's the weakest." The most potent treatment on the market is Fosamax. But it isn't as easy to take. It can cause irritation of the esophagus, so patients have to take it in the morning with a glass of water and wait at least a half hour standing up before eating. Other drugs now being tested mimic estrogen's bone and heart protection without its negative side effects. Also in the pipeline are sodium fluoride and parathyroid hormone which may actually promote new bone growth.

UNCOVERED. The only way to know for sure whether you have or are at risk for osteoporosis is to get a bone-mass density test such as a Dual Energy X-ray Absorptiometry (DXA) or Dual Photon Absorptiometry (DPA) exam. These tests are painless and quick, but still relatively expensive at an average of $200 per test. And the costs are not always covered by insurance. Women who are nearing menopause don't need these tests if they're going on estrogen, but for those at risk who eschew estrogen, it might prove worthwhile, says Siris.

Even though there is a strong genetic component to the disease, certain cases of osteoporosis have no known cause. Still, for most people, healthy diet, exercise, and estrogen will help ensure that while sticks and stones may break their bones, osteoporosis won't.

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