#60 How to Preserve Bone Health Over Time

Osteoporosis means literally porous bones. Contrary to what many people think, bones are living. To understand osteoporosis and why women are prone to osteoporosis after menopause, you need to understand how your body produces bone. Your body produces two kinds of bone-related cells. Osteoblasts which create bone cells and osteoclasts which remove dead bone cells. Bone health is a combination of bone growth made by osteoblasts and bone uptake done by osteoclasts. When the rate of bone uptake exceeds the rate of bone making osteoporosis or bone thinning occurs.

Health conditions such as menopause, diabetes, vascular disease, heart arrhythmia, and COPD (chronic obstructive pulmonary disease) cause bone thinning, while medications like proton pump inhibitors (used to treat heartburn), steroids, serotonin and norepinephrine reuptake inhibitors (antidepressants) contribute to bone loss. Medications, like aromatase inhibitors, are life-saving therapy for a patient with breast cancer. All above are associated with low bone mass and promote an accelerated decline in bone density. Endocrine disorders including ovarian insufficiency, hyperthyroidism, and Cushing’s disease cause osteoporosis. Lifestyle factors like inactivity or smoking can cause bone loss. People with anorexia or bulimia don’t actually obtain maximum bone density and so are at an increased risk for bone loss with resulting fractures.

The person most at risk for osteoporosis is the thin, Caucasian, female smoker who is menopausal and inactive. Women generally have more trouble with fractures than men because women have smaller bones than men.  Smoking reduces the benefit of estrogen. Inactivity decreases bone size, so the less active a person is, the smaller their bones will be.

The Institute of Medicine recommends daily calcium intake of 1000 mg for women aged 19 to 50 and 1200 mg per day for those 50 and over. Food is the preferred source of calcium. Supplements should be used only if the calcium in your food is inadequate.

The recommendation for calcium intake refers to elemental calcium which varies depending on the supplement. Calcium carbonate elemental calcium is 40 percent whereas calcium citrate is 21 percent. For those who are Vitamin D deficient, the recommendation dose is 1000 international units (IUs) per day. The Endocrine Society and the American Association of Clinical Endocrinologists define a sufficient level of vitamin D more than 30 ng/ml (nanograms/milliliter). A level of 50 ng/ml is considered the safe upper limit. Habits to avoid include smoking and excessive alcohol intake.

If your doctor is concerned about bone loss, he or she may recommend a DXA (or DEXA) scan. This is a low-dose radiation scan which shows bone density. If your DXA scan shows loss of bone, it should be performed every one or two years at the same location and with the same machine.

Most medications used to prevent bone loss increase bone size by decreasing activity in the cells that carry the old bone cells away. That is, with the decrease in your body’s disposal of old bone cells, your skeletal structure becomes dominated by old bone cells, with fewer newer cells created. Medications for preventing osteoporosis actually increase bone size through the retention of old bone. Many medications for osteoporosis function this way. However, one of the side-effects of this type of medication is necrosis of the jawbone, a side effect generally not well-known.

If you choose to take medications for your osteoporosis, your doctor should present you with all the options and the side effects of each, as well as the option of no treatment. These medications change rapidly from year to year, so always check with your doctor for updates if you choose to take medications for your osteoporosis.