Thursday, January 19, 2006

Osteoporosis -- The Silent Epidemic

Although you won't currently hear much about it in the press, there exists a disease that threatens almost 30 million Americans. Ten million Americans already have the disease. To make matters worse, it's a silent disease that typically doesn't show any signs or symptoms until the victim already has a full-blown case of it. What is the disease? In case you didn’t read the title, it’s osteoporosis.

The disease is so prevalent and severe that it causes over 1.5 million fractures every year, almost half of which involve the spine. In case you're rusty on your anatomy, the spinal cord runs through the spine. So that's not a place where you'd really want to have a fracture. In fact, it’s probably the last place.

Yes, I know, we tend to think that only frail elderly women suffer from osteoporosis, but that's not the case. In fact, over 2 million men in the U.S. already have the disease, and one out of eight men will eventually suffer a fracture due to the disease. And these are not necessarily benign, uncomplicated fractures. Because of frequent hip and spine involvement, many osteoporosis-induced fractures result in death due to complications.

Osteoporosis, which literally means porous bone, results when the formation of new bone is slower than the resorption of old bone. Bone is not at all an inert tissue like one might think. In fact, it's a very dynamic tissue - much like skin. When we're younger, bone formation virtually always exceeds resorption. That is until about age 30 when bone mineral density tends to decline.

Various factors affect how rapidly bone mineral density declines. Hormonally speaking, a decrease in estrogen typically corresponds to loss of bone mass. For that reason, the most drastic loss in bone mineral density in women occurs after menopause, when estrogen production virtually ceases. In men, declining testosterone levels can contribute to a loss of bone mass. While testosterone levels don’t drop as suddenly in men as estrogen does in women, levels do tend to gradually decline beginning between ages 25 – 30.

Certain medications can also decrease bone mineral density. One of the most common culprits is the long-term use of glucocorticoids, which are used to treat a variety of inflammatory conditions ranging from arthritis to inflammatory bowel disease. Numerous other medications have the same possibility to decrease bone mineral density like barbiturates, some anti-seizure medications, and even excess thyroid hormone.

One of primary factors that leads to osteoporosis is a diet that is chronically low in calcium and vitamin D. Though this is fairly common knowledge, nutrition surveys show that many people still don't even get half of the 1,000 to 1,500 mg of calcium recommended per day. Likewise, it is recommended that people consume 400 to 800 IU of Vitamin D per day. Because the skin makes Vitamin D when exposed to sunlight, less exposure to the sun necessitates a higher dietary intake and vice versa.

Being bed-ridden, or voluntarily choosing to spend your waking hours on your rear, will also decrease bone mass and increase ones chances of suffering osteoporotic fractures. Lastly, there are a couple of "sinful" behaviors that decrease bone mass: smoking and drinking. Now you have a couple more reasons to avoid these two vices.

Treatment and Prevention
When it comes to alleviating just about any ailment, it seems that our first instinct is to ask, "What can I take to make it go away?" Although medications to treat osteoporosis should only be used after or in addition to more natural means of treatment, there are some FDA approved medications that can effectively improve osteoporosis. Estrogen and calcitonin are hormone treatments while alendronate (Fosamax), raloxifene (Evista), and risedronate (Actonel) are synthetic pharmaceutical preparations.

A more natural way to treat osteoporosis, and one of the best ways to prevent it, is to ensure adequate dietary intake of the aforementioned nutrients calcium and vitamin D. As with any nutrient, it's considered ideal to get them from food. The best sources for calcium are, by far, dairy sources. This includes milk, cheese, and yogurt. In addition to dairy sources, some good sources of calcium are almonds, sardines, salmon, white beans, tofu, oranges, sweet potatoes, and most green vegetables like broccoli and turnip greens. As for Vitamin D, cod liver oil, egg yolks, and fortified dairy products are some of the best dietary sources; but don't forget the best natural source - sunlight.

In addition to vitamin D, which enhances calcium absorption, vitamins A, C, E, and K are vitally important in the formation and maintenance of bone tissue. Another nutrient that’s of utmost importance to bone formation is protein. I’m going to assume that you already know the importance of consuming adequate protein and already do so. So for now, I’m going to spare you the “eat more protein” lecture.

Let’s talk minerals for a moment. As already mentioned, calcium is vitally important in the formation of bone tissue. There are a couple of things you should know before you begin shoving calcium pills down your pie-hole. For starters, calcium absorption is optimized when consumed in smaller doses. Taking your daily requirement in one sitting will likely leave you deficient. Instead, spread your calcium intake out throughout the day. This applies to both calcium supplementation and calcium from food sources. So practically speaking, it’d be wise to take any calcium supplement with meals that are low in calcium. Don’t take your calcium with your cottage cheese. Instead, take it with a meal like meat and yams that is inherently low in calcium.
Other minerals that are essential to bone formation are phosphorous, magnesium, silicon, boron, zinc, manganese, and copper. Let’s discuss the most important of these: phosphorous. While phosphorous is absolutely vital for the formation of bone, too much phosphorous is the most common problem. Let me be more specific. Too much phosphorous in relation to calcium is commonly a problem. When too much phosphorous and too little calcium is consumed, the body will leach calcium from bones to correct this balance. Obviously it’d be a lot better to consume less phosphorus and more calcium in the first place than to have it taken from your bones! For the record, the optimal ratio of calcium to phosphorous is considered to be somewhere between 1.2:1 up to 2:1. That means that for every mg of phosphorous that you consume, you should consume between 1.2 to 2 mg of calcium. To keep this ratio in check, avoid processed meats and sodas which are high in phosphorous. Red meat is also high in phosphorous, but I believe that consumption of lean red meat is still advisable – though in moderation.

One of the best, but often forgotten, ways to improve bone density is to engage in weight-bearing exercise. Yep, good old-fashioned exercise, but not just any type of exercise will do. The more stress that the activity puts on the bony skeleton, the denser the bones will become. This is analogous to weight training stressing the muscles and them responding by getting bigger and stronger. Exercises like squats, deadlifts, and overhead presses are some of the best bone-density-building exercises around. As for cardiovascular exercise, opt for walking over bike riding for improved bone density.


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