Then you are looking through a glass too darkly. This ominous view of aging, which sees the deteriorated bones of osteoporosis as inevitable, is fast being replaced by the realization that women can prevent and even reverse bone loss. Thanks to better diagnostic tools, you don’t have to wait for a fracture to learn your osteo-status. And with drugs that don’t merely hold the line on bone loss but actually let bones rebuild themselves, you don’t have to join the 8 million American women, including 25 percent of those over 65, who are afflicted with the disease. What you do have to do is take some simple steps to prevent osteoporosis.
Begin with adequate calcium intake. The bones store about 99 percent of the calcium in the body, but calcium is also used by most other organs. If there isn’t enough calcium in the diet to satisfy those organs, the blood will rob the bones to get it. To avoid this, experts recommend a minimum daily intake of 1,200 mg of calcium for everyone, from the teenage years on. That’s approximately four cups of yogurt or milk, or six ounces of cheese, or a whole lot more of the best nondairy sources: 31/2 cans of sardines, three cups of dry-roasted soybeans or seven cups of collard greens. Since most Americans eat only half that much calcium, supplements that also include 400 to 800 mg of vitamin D are a good bet. (Vitamin D helps the intestines absorb calcium and encourages bones to grow.)
After eating all this good food, you might want to move a little, too. Regular weight-bearing exercise–jogging, jumping rope, walking briskly or lifting weights–can boost bone density 3 to 5 percent a year in those who previously didn’t exercise. Women who do exercise are already benefiting from stronger bones; to maintain your strong skeleton, all you need to do is take 30-minute walks or jogs three to five times a week. Just don’t exercise so much that you stop menstruating, which happens to some athletes. (This also occurs frequently in anorexics.) Losing your period means your body has virtually stopped producing estrogen, which leads to bone loss similar to that brought on by menopause.
Osteoporosis is often called the silent disease, because a woman feels no pain as her bones gradually thin to the point where even a slight bump or a fit of coughing can cause a fracture. Diagnostic techniques have been so poor that the pain from these breaks was often the first sign of a problem. No more. The best tool for diagnosing brittle bones is called a bone-mineral-density test; the new generation of machines includes the DXA, the most accurate. All the tests use sophisticated X-rays or sonograms to read bone density. A bone-density score of 1 or less is considered safe. Scoring between 1 and 2.5 could indicate a risk for the disease but doesn’t guarantee it; 2.5 or above indicates bone loss of 25 percent or more, the definition of osteoporosis.
Should you ask your doctor for a bone-density test? The key word here is “ask,” because many physicians seem to be somewhat in the dark about diagnosing and treating osteoporosis. According to the National Osteoporosis Risk Assessment, 80 percent of low bone mass and osteoporosis goes undiagnosed. “Women need to be proactive about this disease, and question their doctors and even provide information if need be,” says Dr. Aurelia Nattiv, director of the UCLA Osteoporosis Center. She suggests following the National Osteoporosis Foundation guidelines on who should get the test, which is now routinely covered under Medicare. In general, while bone loss is a universal fact of life, sex, race and size all influence how much bone a woman will end up with, how great her risk of osteoporosis is and therefore how much she needs the bone test. African-American women have denser bones than Caucasian, Hispanic or Asian women, for instance: a recent study of 48,000 women found that only 38 percent of postmenopausal African-Americans had bone loss that could lead to osteoporosis, compared with 50 percent and more among Caucasians, Hispanics and Asians.
Don’t panic if the test results make your bones look about as sturdy as butterfly wings. Several drugs, some old and some new, can halt and even reverse bone loss in women with osteoporosis. None of these drugs directly “builds” bones. Rather, they all reduce the body’s tendency to slough off old bone cells, so new cells gradually fill in the holes. While this might result in only a 2 or 3 percent yearly increase in bone mass, that small amount can reduce the likelihood of painful fractures–the real key to measuring the effectiveness of an osteoporosis drug. The pharmaceutical options:
Even with these new drugs, plain old-fashioned prevention works best. So drink your milk, eat your dark leafy greens and heft some weight now so your bones won’t be unbearable in the future.
