Osteoporosis

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Osteoporosis

As you age, your bones erode a bit. That's normal. But some people lose so much bone that their skeletons become riddled with weak spots. That's osteoporosis, and it causes a lot of hip, spine and forearm fractures. At its worst, bones become so frail that they crack under the body's own weight!

Anyone can get osteoporosis, but women are more likely to get it than men. They have lighter bones than men, and they lose bone rapidly after menopause, because their bodies are producing less estrogen. But men aren't immune, especially if they drink heavily, smoke or have taken steroid drugs.

But your bones don't have to crack under the strain of this disease. You can slow, stop or even reverse bone loss. For women, medical treatment with estrogen replacement therapy (ERT) is the most effective way to accomplish this. But even if you choose ERT, there are natural methods to help it along. (And not surprisingly, they're the same tips and techniques that can help prevent osteoporosis in the first place.)

If you want to step lively and stall bone loss, here are the tactics doctors recommend.

Build those bones. "We suggest, as a minimum, that people follow the American College of Sports Medicine recommendations to exercise aerobically for 20 minutes a day at least three days a week," says Miriam Nelson, Ph.D., an exercise physiologist and research scientist at the U.S. Department of Agriculture (USDA) Human Nutrition Research Center on Aging at Tufts University in Boston. Exercise actually stimulates bones to lay down new tissue, she explains.

What's the best aerobic exercise for strong bones? "It's one you will continue doing, because if you don't do it for life, the bone-building benefits fade," explains Dr. Nelson. In her studies, walking won top ratings--20 minutes a day three or four times a week--but you may prefer running, biking, swimming or aerobic dance classes.

Stop Training for the Olympics An intense exercise training schedule that leaves a woman so lean that she stops having menstrual periods also robs her bones of necessary calcium. "This usually happens only with elite female athletes, but it can also happen with women who are obsessed with staying thin and who exercise several hours a day," says Christine Wells, Ph.D., professor of exercise science at Arizona State University in Tempe. The solution: "Aim for quality, not quantity, when you exercise. Train hard, eat well, and maintain a weight that normalizes your menstrual periods," Dr. Wells recommends.

Walk in water. If you've already had a fracture or two, your best choice of exercise may be walking in chest-deep water, working up to 30 minutes at least three times a week, suggests Sydney Lou Bormick, M.D., director of Osteoporosis Services at the Cooper Clinic in Dallas. The water will help support your body weight and take stress off bones and joints.

Make your "exercise equipment" a chair and the floor. To complement water walking, do some easy muscle-strengthening exercises in a chair or on the floor, suggests Mehrsheed Sinaki, M.D., a physiatrist in the Department of Physical Medicine and Rehabilitation at the Mayo Clinic in Rochester, Minnesota. Such exercises can include abdominal curls, shoulder blade squeezes and back extensions.

To do back extensions, lie on the floor on your stomach, with a pillow under your hips and your arms at your sides. Using only your back muscles, not your arms, raise your upper body a few inches off the floor. Hold for as long as comfortable, then relax downward. Work up to doing this six to ten times a day.

Chow down on calcium. Doctors agree that you should try to get 1,000 milligrams a day of calcium, even if you haven't reached menopause. And they suggest 1,200 to 1,500 milligrams a day for postmenopausal women who are not getting ERT.

Most women consume far less than those amounts. Reaching 1,000 milligrams through diet alone means drinking a quart of skim milk a day or eating two cups of low-fat yogurt or four cups of low-fat cottage cheese.

"Figure out, realistically, how much calcium you can get through your diet, then make up the rest with supplements," says Bess Dawson-Hughes, M.D., chief of the Calcium and Bone Metabolism Laboratory at the USDA Human Nutrition Research Center on Aging at Tufts.

Aim for maximum absorption. Spread your calcium supplements out over the day rather than taking them all at once, and take each one with a meal, Dr. Dawson-Hughes suggests. Most doctors recommend calcium carbonate, a relatively inexpensive source of calcium that's fairly well absorbed if taken in divided dosages and with meals.

Get enough vitamin D. For maximum protection, aim for 400 international units of vitamin D per day (twice the Recommended Dietary Allowance), especially if you don't get much sun, suggests Dr. Dawson-Hughes. "Here in Boston, we tell people they need a more reliable source of vitamin D than the sun, especially during the winter months."

A cup of milk contains about 100 international units of vitamin D, so four cups a day is ideal. But don't count on other dairy products, such as cheese, yogurt or ice cream, to fulfill your vitamin D needs. Unlike milk, these foods are not fortified with vitamin D.

Do not exceed the recommended dosage of 400 international units, however. Vitamin D is toxic in high amounts.

Graze far and wide. Bones are not made from calcium alone. They're an amalgam that includes zinc, boron and copper, among other minerals. "These trace elements are best gotten through a varied and broad-based diet that includes mostly unprocessed foods, such as whole grains, beans, fresh fruits and vegetables, fish and shellfish and lean meats," Dr. Dawson-Hughes says.

If you smoke, stop. "Smoking accelerates bone loss," Dr. Dawson-Hughes says. It speeds the rate at which the body metabolizes estrogen, virtually canceling out the bone-beneficial effects of ERT. "And smoking must have other bone-rattling effects, too, because it causes bone loss in postmenopausal women not taking estrogen and in men," she adds.

Monitor your medications. Some drugs can hasten bone loss, says B. Lawrence Riggs, M.D., president of the National Osteoporosis Foundation and professor of medical research at the Mayo Clinic.

Those most likely to cause problems: corticosteroids, which are prescribed for a variety of conditions such as rheumatic disorders, allergic conditions and respiratory disease; L-thyroxine, a thyroid medication; and furosemide, a diuretic often used against fluid retention associated with high blood pressure and kidney problems.

"Talk with your doctor about this possible side effect," Dr. Riggs suggests. "If you have other risk factors as well, your doctor may want to check your bone density and, if it's low, alter the dosage or stop the drug entirely."

Pass on the pop. Colas and some other carbonated soft drinks get their sharp taste from phosphoric acid, which contains phosphorus, a mineral that in excess amounts causes your body to excrete calcium.

Salt lightly. As with phosphorus, too much salt causes your body to excrete calcium. So go easy on the shaker, and check food labels. Avoid products with more than 300 milligrams of salt per serving.