Osteoporosis: The Silent Disease

Osteoporosis is characterized by the progressive loss of bone mass, which increases susceptibility to fractures, especially in the hips, spine, and wrists. It is considered a silent disease because most people won’t feel their bones getting weaker and will only discover the disease after experiencing a fracture caused by a minor fall or sudden movement. However, as the disease advances, structural changes occur, causing a permanent deformity of the spine known as dowager’s hump. This deformity causes muscle fatigue and pain, and limits activities of daily living. It is also associated with the loss of 15% of one’s height.

It is estimated that 10 million Americans are affected by osteoporosis; 80% of them are women. Women are more susceptible to osteoporosis than men because they generally have less bone mass than men, women’s calcium intake is usually lower, and menopause accelerates bone loss[1]. Also, women are more likely to engage in weight-loss diets than men, which tend to be low in calcium.

Who is at Risk?

Some populations are at increased risk such as older adults, non-Hispanic whites and Asians, women, and people with a slender build (thin and small). In addition, having a family history of osteoporosis or fractures can place you at higher risk. Some medical conditions (anorexia, bulimia, gastrectomy, and diabetes, among others) and medications (anticonvulsants, steroids, antacids, and diuretics) may accelerate bone loss. Lower levels of sex hormones in the blood (estrogen for women and testosterone for men) are also linked to osteoporosis.

However, there are other risk factors associated with personal lifestyle habits such as lack of physical activity, low intake of calcium and vitamin D, maintaining a very low body weight, smoking, alcohol consumption, and caffeine use. The good news is that by controlling those factors it is possible to prevent osteoporosis.

Prevention and Risk Factor Management

• Inactivity leads to bone loss. On the other hand, regular physical activity enhances peak bone mass during growth, slows the rate of bone loss with age, and reduces the risk of falls in older adults by improving muscle strength and balance. People with osteoporosis are advised to exercise in order to improve bone mass. However, it is important to avoid explosive movements, high-impact activities, and exercises that require twisting, bending, or that may compress the spine.
• Maintain a balanced diet that guarantees nutritional adequacy. Calcium is the most important nutrient for bone health, especially early in life when peak bone mass is attained. Also, adequate intake of vitamin D is required for calcium absorption. Other nutrients needed to maintain healthy bones are vitamin C, vitamin K, potassium, magnesium, and phytochemicals present in fruits and vegetables. Keep in mind that high intake of protein, caffeine, phosphorus, vitamin A, and sodium may have adverse effects in calcium absorption.
• Smokers tend to have lower body weight and may have lower levels of estrogen in the blood or experience menopause earlier than non-smokers. Thus, smoking increases the risk for osteoporosis.
• Alcohol decreases bone-building activity, impairs calcium absorption, and may increase calcium excretion. Also, alcohol abuse usually leads to poor nutritional status, which includes low calcium intake.
• The National Osteoporosis Foundation encourages women at the onset of menopause to talk to their health care provider about the need for bone density testing.

Bone-Healthy Lifestyle

• Eat three or more servings of calcium-rich foods such as milk, yogurt, cheese, and fortified beverages.
• Get moderate sun exposure (15 minutes per day) and/or consume vitamin D-fortified beverages such as milk.
• Engage in weight-bearing activities for a minimum of 30 minutes, three times per week. Walking, running, weight-lifting, and dancing are examples of weight-bearing exercises.
• Consume enough calories to maintain a healthy weight. Avoid getting too thin.
• Don’t smoke.
• Consume alcoholic beverages in moderation, if at all.

 References

Boyle, M. and Long, S. Personal Nutrition. Belmont, CA: Wadsworth Cengage Learning. 2010.

 “Fast Facts.” National Osteoporosis Foundation. Available at http://www.nof.org/node/40. Accessed in December, 2011.

Lutter, J. and Jaffee, L. The Bodywise Woman. Champaign, IL: Human Kinetics. 1996.

Thompson, W., et al, eds. ACSM’s Guidelines for Testing and Prescription. Baltimore, MD: Woters Kluwer and Lippinicott Williams & Wilkins. 2010.

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