Osteoporosis Update

Loss of height of one inch or more may be an indicator of a vertebral fracture.That means one of the 29 “backbones” forming the spine might have a crack or be slightly crushed.These vertebral fractures are much more common than one would think and vertebral fracture is emerging as an important indicator of osteoporosis.

For many years it has been standard practice for doctors to recommend bone density evaluation (with “DEXA” scans, or dual-energy X-ray absorptiometry, a special type of X-ray) around menopause because estrogen is a potent bone-builder, and estrogen begins to wane at menopause, or even before menopause.According to the National Osteoporosis Foundation, 30 million American women (and 14 million American men) have osteoporosis today. This is a preventable disease, and if not prevented can seriously compromise quality of life, and, ultimately, longevity also.The DEXA scans measure bone density at several sites and give a standardized “score” to the bone density (called the T-score). A T-score of zero (0) is perfect.Anything below zero represents bone loss.A T-score of minus 1.5 (-1.5) means osteopenia (bone loss) and a T-score of minus 2.5 (-2.5) means osteoporosis, literally “holes in the bone.”Typically doctors will offer various bone building drugs to patients with T-score approaching or below -2.5.Drugs are more controversial in the T-score range from zero to -1.5.My approach is based on good nutrition and regular weight-bearing exercise.The best time to begin to prevent bone loss is in the pre-teen years when girls are approaching their final growth spurt. At least 1000 mg of calcium daily is required to lay down enough bone to last a lifetime. This must be complexed with Magnesium (at least 500 mg) and Vitamin D (at least 400 IUs).Vitamin D has received a lot of press lately and many researchers feel that Americans living further north than 40 degrees latitude (Eureka, Denver, New York City) are Vitamin D deficient. Sunlight passing through glass does not promote Vitamin D formation, and Vitamin D is not cumulative (so you can’t count on just 10 days a year on vacation to stock up on sunlight). Typically the way indigenous northern Americans prevented rickets was to eat plenty of fish oils.Cod Liver oil is one of my favorite ways to deliver Vitamin D and now Carlson and other fine purveyors of fish oils make delicious flavored oils that go down even a child’s throat smoothly!Make sure your fish oil is standardized for Vitamin D content.Strontium (up to 300 mg daily) and Boron (up to 3 mg daily) are other important bone building minerals.Weight bearing exercise works by putting mild stress on the long bones, which triggers bone-building activity.Walking, weight-lifting and rebounding are excellent choices for healthy bones.Jump-roping is my personal favorite as long as your knees and bladder can handle it.Aim for 1000 jump ropes a week. However, do not jump rope, or perform any other compression exercise, if you already have a compromised back: chronic pain, a herniated or bulging disc, sciatica, or a known fracture. Back to vertebral fractures the most likely reason you are shorter today than last year.Many vertebral fractures are not caused by much trauma, so often go undetected. However they are often the cause of chronic back pain. Fractures due to bone loss can occur in the hip, upper leg bone, lower arm bone and in the vertebrae. The vertebrae are, perhaps this will surprise you, the MOST common area for osteoporotic fractures.Fractures, even slight ones, in the back bones can lead not only to back pain, but decreased spinal mobility, reduced lung capacity, difficulty dressing, bathing, walking, and ultimately social isolation.Women with low bone mineral density (BMD) AND a single vertebral fracture run a 25 times higher risk of compromised quality of life than women with normal BMD and no vertebral fractures.Ask your doctor if you are a candidate for vertebral fracture assessment.If you do have this important risk factor for a future fracture, you are advised to become proactive about the bone building strategies mentioned here, reserving drugs, as always, for a last resort option.