When Younghee stopped HT at age 59, her doctor urged a bone-density test. “I didn’t think my mom needed a test because I knew she had been on HT and had a healthy lifestyle,” adds Dr. Chang. “But when I looked at her score and realized that her bone loss was significant, I understood why osteoporosis is called a silent disease.” The Changs learned the hard way that a dairy-packed diet, weight-bearing exercise, and calcium can’t guarantee you’ll escape brittle-bone disease. This is a message everyone should be heeding. “One in two women and one in four men age 50 and older will suffer an osteoporosis-related fracture,” says Judith Cranford, executive director of the National Osteoporosis Foundation.“We want people to know this means they could be at risk.” (Learn the signs of a fracture here.) For the latest on identifying and preventing osteoporosis, read on.
Sobering Stats on Bone Loss
The fracture statistics are frightening enough, but they don’t tell the whole story. The figures include an estimated 300,000 hip fractures every year, and recovery is painful and difficult: After a hip fracture, just 15% of patients can walk across a room unaided after 6 months; 25% require long-term care and may become disabled. While there are steps you can take to stop osteoporosis—and even help rebuild fragile bone—the key to long-term health is assessing how strong your bones are now.
Knowledge—And Testing—Is Power
“Healthy living is not enough,” affirms John Bilezikian, MD, director of the Metabolic Bone Diseases Program at New York’s Columbia-Presbyterian Medical Center. You need to be tested to know where you stand. If you have risk factors, such as a family history of osteoporosis, get a bone mineral density test (BMD)—a quick, painless measurement of the hip, arm, and other skeletal sites—earlier than age 65. That means getting checked at the onset of menopause or when you stop HT. Depending on the results of the BMD test, your doctor may recommend a more comprehensive dual-energy x-ray absorptiometry (DEXA), which measures the spine, hip, or total body. It’s also important to be aware of the side effects of medications you take regularly. Drugs can leach calcium from bones. Be wary of overuse of steroids; medications for thyroid problems; some drugs for rheumatoid arthritis as well as heart and gastrointestinal diseases; and antiseizure medications. “Constant dieting is a concern because you lose muscle and bone, not just fat,” says Robert Lindsay, MD, chief of medicine at Helen Hayes Hospital in West Haverstraw, NY. High-protein diets, in particular, can be a problem. “Avoid excessive protein intake—more than 60 g a day—since protein is acidic, and calcium is diverted from the bones to neutralize it,” Dr. Bilezikian warns. New screening methods coming up within 5 years will evaluate not just the amount of bone you have, as current tests do, but also its quality. That’s important because once you’ve had a fracture, you have a two- to fourfold risk of another fracture.[pagebreak]
Other Bone Boosters
Despite the many advances in osteoporosis screening, lifestyle changes are still your first line of defense: Stop smoking, limit alcohol to two drinks daily, and exercise 20 minutes or more three times a week (mix strength-training and weight-bearing cardiovascular workouts, such as bicycling or walking). Everyone over 50 should take 1,200 mg of calcium and 400 IU of vitamin D. At age 60, you should increase those amounts to 1,500 mg of calcium and up to 800 IU of D. Such measures may slow bone loss but won’t stop it. Only the new prescription drug Forteo actually builds bone, through a daily injection. But because it is 10 times more expensive than comparable medications, Forteo is reserved for severe osteoporosis. Far more common are Actonel and Fosamax, once-weekly pills that slow bone loss and reduce the risk of fractures within 6 months. Taken daily, Evista staves off bone loss and decreases the risk of future spine fractures by up to 50%. The daily-use nasal spray Miacalcin is prescribed for treatment, not prevention. “It’s the safest but also the weakest remedy,” Lindsay says. Not as widely available is kyphoplasty, a procedure only used in severe cases, in which a surgeon enters a collapsed vertebra and swells the osteoporosis-squashed cavity to normal size before filling it with a cementlike substance. Within 3 years, two new chemical cousins of Evista may become available. So may the once-yearly intravenous injection Zometa. All are in clinical trials. “We’ll see a lot of new bone-preserving drugs within the next 20 years,” Dr. Lindsay predicts. Ask your doctor about what else you can do to keep your bones strong and healthy. Alice Chang stresses that ignorance is not bliss. “Talk with your doctor before menopause if you think you’re at risk. The key is to get tested to diagnose osteoporosis before it is full-blown.”
Are You at Risk?
You could be at higher-than-average risk for osteoporosis if you:
Have a family history of osteoporosisWeigh less than 127 pounds or are taller than 5'7"SmokeDrink more than two alcoholic beverages a dayDon’t exercise
More from Prevention: 12 Ways To Break-Proof Your Bones
