Forms and Instructions
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Osteoporosis is a condition in which gradual loss of bone mass causes bones to become thin, fragile and easily broken. Osteoporosis frequently leads to chronic pain and physical deformation. Though osteoporosis primarily affects women over the age of 65, attention to diet and lifestyle during the earlier stages of life can decrease a woman's chance of developing osteoporosis.
Bone is primarily composed of calcium and protein. Throughout life there is constant turnover within the matrix of bone. Old bone is removed by a process called reabsorption and new bone is laid down by a process called formation. During our younger years bone is formed at a faster rate than it is broken down and the bone matrix gradually becomes denser and stronger. Peak bone density is achieved during the early to mid 30s. Thereafter there is a shift in the balance of bone formation and reabsorption, and bone density gradually declines. Up until menopause these changes are usually minimal, but after menopause bone density declines more rapidly, especially in women who do not use estrogen replacement.
The first step in the prevention of osteoporosis is maintaining adequate calcium intake during the childhood, teenage and young adult years. Optimal daily intake is 800 mgs per day until age 10, and 1,200 to 1,500 mgs per day for teens and adults. Milk and other dairy products are the best sources of calcium, but other calcium rich foods and calcium supplements can be substituted. The metabolism of calcium into bone require vitamin D. When using calcium supplements it is best to choose those which also contain vitamin D. Regular weight bearing exercise also plays a role in maximizing bone formation and maintenance. During the premenopausal years adequate calcium intake and weight bearing exercise are important to preserve bone mass.
The major risk factor for osteoporosis is menopause, which occurs when the ovaries cease functioning. Whether menopause occurs naturally, or surgically by removing the ovaries, the dramatic drop in estrogen levels causes increased bone loss. Other risk factors include race (Caucasian and Asian women are at highest risk), slender build, family history of osteoporosis, alcohol use, sedentary lifestyle, diet low in calcium, and long term use of some medications (such as steroid, thyroid, and diuretic medications). Hereditary risk factors such as race, bone structure and family history are not modifiable but many of the other risk factors are. Making lifestyle changes to improve diet, increase exercise, stop smoking and avoid excessive alcohol use are important steps in modifying these risk factors and decreasing your chance of developing osteoporosis.
Post-menopausal estrogen replacement (HRT) is the most effective treatment to preserve bone density. The rate of loss of bone density is significantly decreased when HRT is used in conjunction with regular exercise and adequate calcium and vitamin D intake. Recommended duration of HRT treatment ranges from 5 to 10 years, but is frequently continued longer for women at high risk for, or already diagnosed with osteoporosis. For women who should not use or choose not to use HRT the use of Raloxifene (Evista) may be appropriate. Like HRT, Raloxifene also decreases the rate of decline of bone mass, but is not felt to be as effective as HRT.
Osteoporosis is not just a concern of elderly women, but should be a concern of younger women as well. With adequate calcium intake throughout the life stages, healthy lifestyle modifications, and HRT after menopause most women can significantly decrease their risk of developing osteoporosis during their elder years.
Christine Smith is a board certified OB/GYN. She joined Longmont Clinic in July 2001.
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