12 Signs Your Bones Need Attention
The best way to approach your personal risk of osteopenia is to get a piece of paper and write down any of the following 12 signs (risk factors) that mean your bones might need attention. After you've made your personal risk factor list, check off those that you can control with bone-boosting changes, starting today. Talk to your doctor about the other signs or risk factors to see if further steps need to be taken to help prevent osteopenia and fractures.
Low body weight. Your weight influences your bone density. Some women maintain a low body weight through low-calorie dieting in order to look thin and so put themselves at increased risk for bone loss. For example, a woman who weighs less than 127 pounds is 10 times more likely to have lower bone density than a woman who weighs 150 pounds or more. The risk of bone loss increases when the percent of body fat becomes low. Women who diet excessively to maintain a low body weight often eliminate dairy products from their diet, losing their primary source of calcium -- a vital source of bone strength.
Genetics. Did your mother or grandmother have stooped posture or height loss? This increases your risk of bone loss. Your risk of osteopenia and fractures is strong if your mother or grandmother had bone loss or fractures. The genetic predisposition may account for up to 60 to 80 percent of bone mass, while environmental factors account for the remaining 20 to 40 percent. That's why it's important to ask about your mother's and grandmother's bone health history. Families often share lifestyle habits such as diet, lack of exercise, or smoking cigarettes. You can change all of this and by doing so rewrite your bone health future.
Race. While non-Hispanic white and Asian women over fifty years old have a higher risk of bone loss and non-Hispanic black women over fifty have a lower incidence of bone loss, some recent findings are cause for concern for all women. When large numbers of women were tested, it was found that low bone mass is much more common than once believed in all ethnic groups, including African-Americans. It is estimated that about 50 percent of white women over age fifty have osteopenia. And studies now confirm that 55 percent of Hispanic women, 65 percent of Asian women, 58 percent of Native American women, and 38 percent of African-American women have low bone mass and are at greater risk for fractures.
Age. The risk for bone loss increases with age. An estimated 90 percent of women over the age of seventy-five have experienced a bone fracture.
Low bone mass appears in about 50 percent of women in their 50s, 66 percent of women in their 60s, 86 percent of women in their 70s, and 93 percent of women over eighty.
Early menopause. The longer your body is exposed to estrogen, the lower your risk of bone loss and fractures. For instance, if you started menstruating late in your teenage years or if you experience menopause before your late 40s, your body produces less estrogen, putting you at higher risk for osteopenia.
Previous fractures. If you have had a fracture as an adult, your risk of more fractures is much higher. If you have a fracture in the spine (vertebral fracture), the risk is about 1 in 5 that you will have another one within a year if you don't take action. And a spine fracture can double your risk of a hip fracture! This is enough reason to have a bone density test and take lifestyle measures to reverse osteopenia.
Certain medications. The use of corticosteroid medications, such as prednisone or other cortisone derivatives, often leads to premature bone loss (these medications are common treatments for chronic conditions such as asthma, rheumatoid arthritis, and psoriasis). In fact, if you take these medications for more than three months, your risk for bone loss is high enough that experts recommend taking medication to prevent bone loss as well.
In addition, diuretics, antacids, chemotherapy, hormone therapy for cancer, lithium, and some medications for seizures can also sap the bones of calcium.
Lifestyle habits. Certain lifestyle habits such as smoking can lead to bone loss. On average, smoking doubles the risk of bone loss. The fastest-growing group of smokers in the United States are girls between the ages of twelve and eighteen. Younger women -- under forty -- often smoke in response to stress or to stay slim. Smokers also tend to have a higher consumption of alcohol, may be less physically active, often skimp on nutrition -- all of which can lead to early bone loss. Smoking cigarettes seems to have an anti-estrogen effect on the bones, and women who smoke tend to go through menopause at least two years earlier than non-smokers.
Excess consumption of alcohol can also lead to bone loss, since it reduces bone formation and interferes with the body's ability to absorb calcium. Drinking more than three alcoholic drinks per day can cause rapid bone loss. Moderate consumption by itself does not raise the risk.
Avoidance of dairy products. Calcium is the key mineral that makes up the dense structure of bone. The effect of calcium on bone health is most crucial during youth, when bones are growing quickly. In fact, it is thought that calcium deficiencies in childhood can account for a 5 to 10 percent difference in peak bone mass and can significantly increase the risk for hip fracture in later life. Some studies say that less than 25 percent of adolescent females are actually getting the calcium they need each day through foods or supplements. This deficit comes at a critical time in a woman's life -- just before bone mass peaks. During menopause, especially in the first few years, calcium has a less dramatic effect since the rate of bone loss accelerates during this time. Still, getting ample calcium through foods and natural dietary supplements is vital to ensure the body has enough bone-building ability.
Calcium must be replenished daily through dietary measures or supplementation or the body will be deficient. Although the optimal level of calcium intake has not been clearly established, it is recommended that daily calcium intake be at least 1,200 milligrams (mg) in premenopausal women and 1,500 mg in postmenopausal women. (See Step 3, page 60, for specific information on how to boost calcium in the diet. In Step 5, page 98, we give specific information on increasing calcium in the diet with natural dietary supplements.)
Vitamin D is usually categorized as a fat-soluble vitamin, although it actually functions as a hormone in the body. Vitamin D helps to activate calcium and phosphorus (another key mineral for keeping bones strong) into the bloodstream. This is especially important as menopause approaches. When the body is depleted of vitamin D or has an insufficient supply, the blood levels of calcium and phosphorus plummet as well. Your body turns to the bones for replenishing this mineral and bone loss increases.
Irregular menstrual periods. Amenorrhea (the absence of menstrual periods) and other menstrual irregularities are also associated with an increase in fracture risk (see Understanding the Female Athlete Triad, page 3). Amenorrhea can occur because of strenuous exercise, and is common in female athletes, especially gymnasts and others who train hard but keep their body weight low. Women with amenorrhea experience significant reductions in estradiol, the primary form of estrogen. In most cases, amenorrheic premenopausal women have lower bone mineral density, particularly in the spine, than women who have normal menstrual cycles. The young female athlete who appears to be in top physical condition often has the highest risk of osteopenia and fracture, particularly if she experiences an eating disorder and loss of menstrual periods.
Thyroid problems. Too much thyroid hormone can cause bone loss. This condition occurs when the thyroid is overactive (hyperthyroidism) or when excessive thyroid hormone medication is used to treat an underactive thyroid (hypothyroidism). A blood test called thyroid-stimulating hormone (TSH) can monitor hormone levels accurately and help women get the right amount of thyroid medication.
Rheumatoid arthritis. This type of inflammatory arthritis is most common in young women. It causes joint pain, swelling, and stiffness and can do permanent damage to the joints. Rheumatoid arthritis, as well as the cortisone medications often used for treatment, both raise the risk of bone thinning and fractures.
Excerpted from the book Reversing Osteopenia: The Definitive Guide to Recognizing and Treating Early Bone Loss in Women of All Ages by Harris H. McIlwain, M.D., and Debra Fulghum Bruce, Ph.D., with Laura McIlwain Cruse, M.D., and Kimberly Lynn McIlwain, M.D. Copyright © 2004 Harris H. McIlwain, M.D., and Debra Fulghum Bruce, Ph.D.
Harris H. McIlwain, M.D., a board-certified rheumatologist, is the founder of the Tampa Medical Group. He has served as chairman of the Florida Osteoporosis Board since its inception five years ago. Town and Country has twice named him one of its Best Doctors in America.
Laura McIlwain Cruse, M.D., and Kimberly Lynn McIlwain, M.D., are rheumatologists and board-certified internists in Florida.
Debra Fulghum Bruce, Ph.D., has written more than 2,500 articles and 65 books on various health topics.
For more information, please visit www.writtenvoices.com.