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Sunday, May 19, 2013
NetWellness receives many questions about osteoporosis. Osteoporosis is a condition of low bone mass that increases the risk of fracture. The normal architecture of the bone is disrupted making the bones more fragile. Increased susceptibility to fractures is the main concern for people affected with osteoporosis.
Osteoporosis a particular concern for women because women are more likely than men to have osteoporosis. There are two reasons for this: first, women never build as much bone mass as men do during development, and second, women lose bone mass when they experience a drop in estrogen levels during menopause. Estrogen slows the loss of bone mass by improving our absorption of calcium from the intestinal tract.
Various terms have been used to discuss osteoporosis. Below are three of them:
Postmenopausal osteoporosis refers to the bone loss that may result from the decline in estrogen at menopause. In this case, estrogen loss interferes with calcium absorption, and you begin to lose trabecular bone faster than the normal rate. You will also begin to lose parts of your cortical (the outer shell of the bone), but not so quickly.
Senile osteoporosis affects men and women. Here, you lose cortical and trabecular bone because of a decrease in bone cell activity that results from aging. Hip fractures are a late occurrence with this kind of osteoporosis. The decrease in bone cell activity affects your capacity to rebuild bone in the first place, but is also aggravated by low calcium intake and low vitamin D levels frequently seen in the elderly.
In secondary osteoporosis, an underlying condition causes bone loss. These conditions include chronic renal disease, hypogonadism (an underactivity of the sex glands), hyperthyroidism (an overactive thyroid gland), some forms of cancer, gastrectomy (removal of parts of the stomach which interferes with calcium absorption), and the use of glucocorticoids and anticonvulsants.
The following are behaviors and conditions that can contribute to bone loss:
Smoking - Research shows that smokers tend to go into earlier menopause. Older smokers have 20 to 30 percent less bone mass than nonsmokers. There may also be direct toxic effects of smoking on the bone.
Women with an early surgical menopause (removal of both ovaries) who are not on estrogen therapy - Losing estrogen earlier than normally expected increases your bone loss at a younger age.
Corticosteriods and antacids containing aluminum - These products may interfere with calcium absorption.
Diseases of the small intestine, liver, and pancreas - These conditions may prevent the body from absorbing adequate amounts of calcium and vitamin D from the intestine.
Lymphoma, leukemia, and multiple myeloma
Surgical removal of part of the stomach or small intestine - This affects absorption as above.
Hypercalciuria - This is a condition where one loses too much calcium through the urine.
Early menopause (before age forty) - The earlier you stop producing estrogen, the more likely you are to lose calcium.
Lighter complexions - Women with darker pigmentation have roughly 10 percent more bone mass than do women with fairer pigmentation because the former produce more calcitonin, the hormone that strengthens bones.
Low weight - Women with less body fat make less estrogen, which makes the bones less dense. They are also more vulnerable to fracture with falling because they have less "padding" on their body.
Women with eating disorders (yo-yo dieting, starvation diets, binge/purge eaters) - When there isn't enough calcium in the bloodstream through diet, the body will take what it needs from the bones. These women also have lower weight.
Family history of osteoporosis - Studies show that women who have a mother with a hip fracture are more prone to hip fracture themselves.
High-protein diet - This may contribute to a loss of calcium through the urine.
Women who have never been pregnant - They haven't experienced the same bursts of estrogen in their bodies as women who have been pregnant. The placenta actually improves vitamin D metabolism.
Amenorrhea (loss of menstrual cycles) in childbearing years - This condition typically affects women athletes who do endurance activities or ballet dancers with low body weight and intense excercising. Studies show that women with amenorrhea have 20 to 30 percent less bone mineral content than have those with regular cycles. The condition is associated with faster bone resorption seen with estrogen deficiency and low body weight as well as a potential negative effect from higher cortisol levels associated with physical "stress".
Athletes - Athletes have a low percentage of body fat needed for menstruation (see above), while excessive exercise releases B-endorphin, which researchers believe may suppress estrogen circulation.
Lactose intolerance - Since so much calcium is in dairy foods, this allergy is a significant risk factor.
Teenage pregnancy - When a woman is pregnant in her teens, her bones are not yet fully developed and she can lose as much as 10 percent of her bone mass unless she has an adequate calcium intake of roughly 2,000 mg a day during the pregnancy and 2,200 mg a day while breast-feeding.
Scoliosis (curvature of the spine) - This condition may predispose to osteoporosis by putting unequal stress on the spine.
In order to maintain optimal bone mass it is important to minimize sides effects from the above conditions. It's important to be aware of what you can do to reduce the risk of osteoporosis by controlling:
Being aware of the things that can not be controlled can make you more aware of your own risk of osteoporosis and can help guide you towards adopting preventative measures including:
Bone loss is best warded off by a healthy high calcium diet and regular exercise. Contrary to popular belief, both of these things are equally important, (taking calcium supplements is not enough on its own). For more information on osteoporosis talk with your healthcare provider.
This article is a NetWellness exclusive.
Last Reviewed: Dec 01, 2006
Margery Gass, MD
Formely, Professor, Clinical Obstetrics & Gynecology
College of Medicine
University of Cincinnati