Thursday, May 03, 2012
Posted by: Carole Cottet, WHCNP, ANP
Osteoporosis is a silent disease that is commonly seen in older, postmenopausal women. There are no symptoms until bones are so weak they break as a result of minimal trauma or, sometimes, they simply break without any trauma. There are, however, things you can do before menopause to help prevent osteoporosis.
Normal bones are in a constant state of renewal in which old bone is broken down and new bone is made to replace it. While we are young our bodies are able to make new bone faster than they break down the old bone. This allows us to grow taller and bones to mature. We reach our peak bone mass—the highest bone density we will ever achieve--by our mid-20s. In a healthy woman, bone density remains stable and little or no bone is lost until after menopause. When estrogen production stops after menopause, the balance between dissolving old bone and replacing it with new bone is disrupted. The dissolving speeds up and the rebuilding phase can’t keep up. Over time, this imbalance causes a gradual loss of bone density and may lead to osteoporosis. The higher peak bone mass you achieve in your 20s, the more bone you have “in the bank” and the less likely post-menopausal bone loss will lead to osteoporosis. It’s kind of like retirement savings; if you save enough money while you’re working, you can live on it without going bankrupt when you retire.
There are several things bone health specialists recommend that will help prevent development of osteoporosis. Children, teens and young adults need plenty of calcium and Vitamin D to help them achieve the best possible peak bone mass. Adult women younger than 65 need 1200 mg of calcium and 800-1000 units of Vitamin D daily. Women over 65 need 1500 mg of calcium and 1000 units or more of Vitamin D. These nutrients are needed for the body to be able to make new bone to replace the old bone that gets dissolved. Testing blood levels of Vitamin D is the most accurate way of determining how much supplementation is needed. Regardless of your age, avoiding smoking and excessive alcohol (more than two drinks per day) is important for healthy bones.
Exercise is also important. Being physically active with activities like walking, aerobic exercises and weight lifting stimulates normal bone metabolism and helps maintain normal balance between dissolving and rebuilding bone. Exercise also strengthens muscles, improves balance and reduces the risk of falls that may result in a fracture.
Because there is no pain or warning signs prior to a bone fracture, screening through a simple test called a DXA scan is important to detect osteoporosis before a fracture occurs. You should have a DXA bone mineral density test if:
Risk Factors for Fracture in postmenopausal women:
- Parent or sibling with a hip fracture
- Low Body Weight (BMI less than 21)
- Current tobacco use
- Consistently drinking more than two alcoholic beverages daily
- Rheumatoid Arthritis
- Digestive Disorders associated with poor nutrient absorption (Celiac Disease, Crohns Disease, Ulcerative Colitis, Bariatric Surgery)
- Type 1 Diabetes
- Hyperthyroidism or Hyperparathyroidism
- Height Loss of more than 2 inches
- Chronic use of medications associated with bone loss (glucocorticoids, anticonvulsants, anticoagulants)
- You are 65 or older.
- You are younger than 65, postmenopausal and have had a fracture.
- You are younger than 65, postmenopausal and have at least one risk factor for fracture (see box).
Your healthcare provider will recommend the screening frequency that’s right for you. This might be bone density testing annually or every 10 years depending on your results. In addition to calcium and Vitamin D, there are treatments available that strengthen osteoporotic bones and dramatically reduce the incidence of fracture. Your provider will work with you to determine the best treatment option for you.
Read more about osteoporosis screening at Women’s Healthcare Associates. Need to schedule an appointment? Contact one of our offices.
Carole Cottet, WHCNP is a nurse practitioner and board-certified Bone Densitometrist. She sees patients at the Peterkort office of Northwest Gynecology Center. Carole helps women maintain optimum health through the various stages of their lives, from puberty to menopause. She has a special interest in PMS, chronic vaginitis and menopause, and is a recognized leader in osteoporosis diagnosis and management.