Osteoporosis

Osteoporosis is an age-related condition that causes a loss of bone mass and increased brittleness in the remaining bone tissue. Like heart disease, the bone-thinning of osteoporosis sneaks up on you, says Ethel S. Siris, M.D., director of the Toni Stabile Center for the Prevention and Treatment of Osteoporosis at Columbia-Presbyterian Medical Center in New York City.

Osteoporosis currently affects some 25 million Americans. While both men and women develop the condition, it's about 10 times more common-and much more severe-in women. Postmenopausal women with osteoporosis account for the vast majority of the nation's annual 700,000 spinal fractures, 300,000 hip fractures, and 200,000 wrist fractures.

Women's bones are strongest around age 30. From then until menopause, you don't lose much bone. But in the 5 to 7 years after menopause, you lose 1 to 5 percent of your bone mass every year, Dr. Siris says. After that, bone loss continues, but slows.

For women, menopause is the turning point in osteoporosis. Your bones' ability to incorporate calcium from your blood depends on the hormone estrogen. As you pass through menopause, you produce less estrogen, and you can't absorb enough calcium to replace the bone you naturally lose.

But menopause isn't the whole story. There are many other risk factors for osteoporosis. For example, excessive alcohol and caffeine consumption can accelerate bone loss. And there are many drugs that rob your bones of calcium, according to the National Osteoporosis Foundation. They include glucocorticoids such as cortisone (Cortone), prednisone (prednisone Tablets), thyroid hormone such as levothyroxine (Synthroid), anticonvulsants such as phenytoin (Dilantin), and aluminum hydroxide-based antacids (like Maalox).

You can help protect your bones by maintaining a nutritionally well-balanced diet, exercising regularly, and not smoking. The following strategies will also help keep your skeleton strong.

Best Choices

Nutrition

Start with calcium. Most adults should consume 1,500 milligrams of calcium a day, according to the National Institutes of Health. The best way to get your calcium is from food. Calcium-fortified foods, such as breads, cereals, and certain fruit juices, are a good idea, Dr. Siris says. (For other good sources, see "Counting Calcium.")

Pair calcium with D. In order to absorb calcium, your body needs vitamin D, which is why milk is fortified with this nutrient. Unfortunately, just as you grow old enough for osteoporosis to become a significant health threat, you also start having trouble getting enough vitamin D.

The best food sources of vitamin D include fortified low-fat or nonfat dairy items and fatty saltwater fish such as sea bass, halibut, tuna, herring, and swordfish.

You can also get vitamin D by stepping outside. It takes only about 15 minutes a day of sun on your face for your body to produce enough vitamin D. But if you live in northern climes, that might be a problem in winter. And if you live in the Sunbelt, chances are you use a lot of sunscreen, which interferes with vitamin D synthesis. That's why it's prudent to eat plenty of D­rich foods.

Get more of the secret bone builders. When it comes to osteoporosis, you don't hear much about magnesium, manganese, vitamin K, and boron. But these nutrients are crucial to the health of your bones.

People with osteoporosis often have low blood levels of magnesium, says Joseph Pizzorno Jr., N.D. When you're deficient in magnesium, your vitamin D isn't as effective in moving calcium into your bones. Clinical nutritionist Shari lieberman, Ph.D., recommends getting the mineral from the following food sources: seeds, soybeans, wheat germ, seafood, and dairy items.

If you're low in manganese, your bones can't absorb calcium. Good food sources of manganese include nuts (especially hazelnuts and pecans), avocados, and oatmeal.

Vitamin K activates osteocalcin, a protein that holds calcium in place in the bone matrix. Vitamin K is found in abundance in leafy green vegetables, notably spinach, broccoli, green cabbage, and tomatoes, Dr. lieberman says.

"Boron seems to activate both estrogen and vitamin D," Dr. Pizzorno says. According to Dr. lieberman, the best food sources of boron are fruits and vegetables, particularly carrots, applesauce, broccoli, peaches, pears, and cherries.

Discover the phyto factor. There's solid research showing that compounds called phytoestrogens increase bone mineral density. Foods rich in phytoestrogens include tofu and other soy products (except soy sauce) as well as beans.

Build bone with berries. Blueberries, blackberries, raspberries, and cherries get their deep color from compounds called anthocyanins and proanthocyanins. Both are remarkable in their ability to stabilize collagen structures, Dr. Pizzorno says. Since collagen is a major protein structure in bone, eating plenty of these berries may increase your chances of preventing osteoporosis.

Be smart about sugar. Studies involving laboratory animals have shown that a high­sugar diet weakens bone. And one small study involving humans found that a high­sugar diet increases the excretion of calcium in urine. So trim as much sugar as possible from your menu.

Steer clear of salt. For every 500 milligrams of salt you consume, you lose 10 milligrams of calcium, according to Stephanie Atkinson, Ph.D., professor of nutrition at McMaster University in Hamilton, Ontario. Many health experts recommend limiting salt intake to 2,400 milligrams a day.

Embrace vegetarianism. Compared with the general American population, vegetarians have a lower risk of osteoporosis, Dr. Pizzorno says. Vegetarians consume less protein and less phosphorus, a bone-robbing mineral. And their blood is less acidic, so their bodies don't have to tap their bones' calcium stores to keep the acid-base balance of their blood where it should be.

Supplements

Compare carbonate and citrate. There are several different kinds of calcium supplements. Some should be avoided because they may contain the toxic metal lead. These include any supplements made from bonemeal, dolomite, or oyster shells. The two best calcium supplements are calcium carbonate and calcium citrate.

Dr. Siris recommends taking calcium supplements in divided doses throughout the day, but no more than 600 milligrams at a time. Get the dope on D. Because you may have a hard time getting enough vitamin D from foods alone, especially if you're over age 60, Dr. lieberman and most other experts recommend supplementing with 400 to 800 international units (IU) a day.

Add more magnesium. Even if you get a good deal of magnesium from your diet, "magnesium supplementation is as important as calcium supplementation," Dr. Pizzomo says. He recommends taking 500 milligrams of magnesium citrate a day.

Kick in some K. Dr. lieberman also recommends taking 80 micrograms of vitamin K a day. But do this only with a doctor's recommendation. Build your supply of boron. To be sure that you're getting enough boron, Dr. Pizzomo suggests taking 3 milligrams a day.

Exercise

Pick 'em up and lay 'em down. In one study, half of a group of 84 sedentary women over age 60 began taking daily 20- to 50-minute walks. The rest of the women remained inactive. After a year, the sedentary women showed significant bone loss, but the walkers did not.

Once osteoporosis develops, weight-bearing exercise can help slow the rate of bone loss, Dr. Simons says. "But extremely strenuous exercise-for example, training for marathons-is counterproductive;" she adds. "In premenopausal women, it can lower your estrogen level to the point where you lose bone. And in postmenopausal women, it increases the risk of fractures:"

Pump iron. Resistance training can also help increase bone mass, which is why the American College of Sports Medicine recommends it for prevention of osteoporosis. Even if you can't get out for a walk, a little resistance training, which is easy to do almost anywhere, can help preserve your bone mass.

Herbal Medicine

Get phytoestrogens from herbs. Several medicinal herbs contain phytoestrogens that can help prevent osteoporosis. Among them are Chinese angelica (dang gui), licorice, and black cohosh. Dr. Pizzorno suggests taking 1 teaspoon of each daily in tincture form.

Home Remedies

Quit smoking. Compared with women who don't smoke, those who do typically have 15 to 30 percent less bone mass.

Watch the alcohol. Alcohol has been associated with an increased risk of hip fracture, because drinking to the point of intoxication makes hip-fracturing falls more likely. But a little alcohol does not appear to increase risk of osteoporosis. Alcohol contains phytoestrogens that help prevent osteoporosis.

Can the colas. Two studies show a link between cola soft drinks and osteoporosis. Carbonated beverages other than colas showed only a slight association with fractures. Christiane Northrup, M.D., founder of the Women to Women health center in Yarmouth, Maine, and past president of the American Holistic Medical Association, urges women to avoid colas.

Be careful with caffeine. Caffeine increases calcium excretion. "But any increase in risk from consuming a few cups of coffee a day can be overcome by taking extra calcium;" says Alan Gaby, M.D.

Other Good Choices

Homeopathy

Count on Calcarea phos. Homeopaths prescribe several medicines to prevent and treat osteoporosis. But according to homeopath Dana Ullman, the primary medicine is Calcarea phosphorica. He recommends taking it for 3 to 5 days every month, in consultation with a homeopath.

Chinese Medicine

Strengthen your Kidney. Practitioners of Chinese medicine attribute osteoporosis to a decline in Kidney qi, says Efrem Korngold, O.M.D., L.Ac." Bones are ruled by the Kidney, and when the Kidney declines, the bones weaken. You treat osteoporosis by strengthening the Kidney."

Dr. Korngold prescribes herb formulas that contain drynaria root. The Chinese name for drynaria means "strengthen bone." One of Dr. Korngold's favorite formulas contains a combination of drynaria, Chinese angelica (dang gui), ginseng, astragalus, rehmannia root, poria fungus, and several other herbs.

Stimulate points to stop bone loss. Acupuncture treatment can help treat osteoporosis, Dr. Korngold says. If you're interested in trying acupuncture, you need to consult a professional acupuncturist. If you prefer a self-care approach, try acupressure instead. Apply steady, penetrating finger pressure for 3 minutes to each of the following points.

• Kidney 3, located in the hollow between your Achilles tendon and the inside of your anklebone
• Spleen 6, located four finger-widths above your inner anklebone on the back inner border of your shinbone

Ayurvedic Medicine

Open up to sesame. Sesame seeds are remarkably high in calcium. One cup contains 900 milligrams of the mineral. Vasant Lad, B.A.M.S., M.A.Sc., director of the Ayurvedic Institute in Albuquerque, New Mexico, suggests eating a handful of sesame seeds each day. The seeds make an excellent garnish for salads and fruit and vegetable dishes.

Medical Measures

These days, you don't have to wait until you break a bone or shrink a few inches to find out that you have osteoporosis. Doctors have several noninvasive ways to diagnose the disease. Chief among these diagnostic techniques is dual-energy x-ray absorptiometry (DEXA), an x-ray exam of your spine or hip that allows your doctor to calculate your bone mineral density. Other similar exams x­ray your forearm.

There are three drugs approved for prevention of osteoporosis: estrogen (premarin), alendronate (Fosamax), and raloxifene (Evista). And three are approved to treat it: estrogen, alendronate, and calcitonin (Miacalcin).

If you take estrogen, be sure to keep consuming calcium. In an analysis of 31 studies, Columbia University researchers discovered that compared with women who took estrogen and consumed less than 600 milligrams of calcium a day from food and supplements, those who took the hormone and consumed about 1,200 milligrams of calcium showed almost triple the bone mass.

If you opt for drug treatment, make sure that you understand how to take your medication and all the possible side effects that your treatment may cause.