Osteoporosis: Not Just a Concern of the Elderly

by David Fitz-Patrick, M.D., Endocrinology

The importance of calcium is receiving increased attention as "baby boomer" women reach menopause. But the battle against osteoporosis, the "brittle bone" disease, begins long before middle age--and it’s a battle worth fighting. The bone deterioration of osteoporosis affects half of U.S. women over age 45 and 90 percent of women over 75. As many as 80 percent of the nation’s 25 million osteoporosis victims are women. Osteoporosis greatly increases a woman’s risk of breaking bones and suffering spinal compression fractures that cause serious back pain, loss of height and a hunched back. Osteoporosis causes about 250,000 hip fractures in the U.S. each year, resulting in a 20 percent risk of death from complications and a 25 percent risk that survivors will require nursing home care. Many women aren’t aware that the health of their bones in later years is affected by their life-long calcium intake. That’s because our bones, which release and replace calcium throughout life, build up density during childhood and the teenage years. Then, in early adulthood, calcium is deposited and released in equal amounts. When a woman reaches about 35, more calcium begins to be released than laid down--a process that accelerates rapidly when estrogen production declines at menopause. Consuming enough calcium through young adulthood helps create stronger bones, so the effects of bone loss later in life are less dramatic. This is especially important for women, whose bone mass is generally about 30 percent lower than men’s. "Enough" calcium is defined by the National Institutes of Health as 800 to 1,500 milligrams per day, depending on your age and whether you are pregnant or nursing. Dairy products are highest in calcium, and the mineral is also found in canned salmon and sardines with bones, soybeans and some vegetables, such as broccoli, spinach and greens. For example, a cup of skim milk has about 300 milligrams of calcium, a cup of plain, low-fat yogurt has 415 milligrams and a cup of bok choy has 252 milligrams. Calcium-fortified foods, such as orange juice, are also on grocery shelves. Many women may also benefit from taking a calcium supplement. Several types of supplements are available, and your doctor can help you choose the one best suited to you. Be aware that dolomite and oyster shell calcium supplements should generally be avoided because they can be contaminated with lead and arsenic. Also, large quantities of antacids taken for calcium supplementation can cause problems. Women with a history of kidney disease should check with their physician before taking any calcium supplement. Calcium supplements should be taken in small doses several times a day with a small amount of food rather than all at once or with a meal. A little bit of food will produce enough stomach acid to increase your calcium absorption without creating competition for absorption between calcium and the other minerals present in a full meal. Other measures that help prevent osteoporosis include hormone replacement therapy at menopause, which is perhaps the most effective means to prevent bone loss for women in this age group; regular weight-bearing exercise--walking is recommended because it doesn’t stress bones and joints the way jogging can; not smoking (smoking lowers estrogen levels, contributing to bone loss and earlier menopause); and limiting alcohol intake to two drinks per day. Provided as a public service by the Queen’s/HMSA Premier Plan and the Queen’s Physician Group. This column is intended for general information only. For personal medical advice, consult your physician. (This article first appeared in the Honolulu Advertiser on April 21, 1997.)
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