Osteoporosis, the 'Silent' Disease, Strikes One in Four Women Over 65, An Expert Warns
The South African-born gynecologist is a professor at the University of Florida College of Medicine and in 1980 founded the Center for Climacteric Studies in Gainesville. (Climacteric refers here to the women's mid-life years.) Notelovitz spoke with correspondent Sandra Hinson about the causes of and remedies for osteoporosis.
How does osteoporosis develop?
It is the result of severe or prolonged bone loss. A certain amount of age-related bone loss is normal, but with osteoporosis bones grow thin and porous due to an accelerated loss of calcium after menopause. If microscopic or more obvious fracturing occur, a person is said to have osteoporosis.
What are the symptoms?
One of the first visible signs is a gradual loss of height. This is caused by the spontaneous fracture and compression of the meshlike bones of the vertebrae, which often occur without pain. By the time a simple act such as lifting a chair causes acute back pain, the osteoporosis has achieved a very advanced stage.
How serious can osteoporosis become?
If unrecognized and untreated, it can progress until as much as 47 percent of the vertebral bone is lost. As more vertebrae fracture and collapse, as much as eight inches can be lost from adult height. The upper spine curves outward in the typical dowager's hump, the lower spine curves inward causing chronic back pain, and the fallen rib cage forces the abdomen to protrude, which can impair both digestion and breathing.
Which other bones maybe affected?
Weakening of the hard long cortical bones commonly results in wrist fractures, but more serious are fractures of the hip. Osteoporosis is responsible for some 270,000 hip fractures a year. About 30 percent of those patients will die within six months due to complications such as pneumonia, and fewer than half ever regain normal function.
Who is the typical osteoporosis victim?
A female, white or Asian, who has a slight frame, is menopausal and has a family history of osteoporosis.
Why are women at greater risk?
From age 35 to 50 both sexes experience a slight bone loss. Then a woman, from the time she enters menopause and for the next five or six years, begins losing bone twice as fast as a man. The process gradually slows down around age 65, once again becoming similar to that of men.
What role does menopause play?
Menopause marks the dramatic decline in the female sex hormones, estrogen and progesterone. Although estrogens do not directly affect the bone, they affect the body's hormonal control of bone formation and breakdown.
Does having a total hysterectomy place a woman at greater risk?
While 25 percent of the women who experience natural menopause are in danger of osteoporosis, 50 percent of women who have their ovaries removed before menopause are at risk unless they receive estrogen hormone therapy to prevent loss.
Why do overweight women tend to be less susceptible to osteoporosis?
Because the weight a fat woman has to support increases the stress to her bones, and as with doing exercises, it strengthens those bones. Also the more weight a woman has, the more estrogen she produces.
Which diseases contribute to developing osteoporosis?
People with diabetes, kidney disease, rheumatoid arthritis and overactivity of the thyroid, the parathyroid or the adrenal glands are at higher risk. This is also true of those who have had parts of their stomach removed or any intestinal bypass surgery.
Are there any risk factors that are within one's control?
Yes. I call them accelerators, factors that of themselves probably do not cause osteoporosis but that, if present, will make it more likely to develop. At the top of the list is lack of exercise. Second is an inadequate intake of calcium. Third are what we call bone robbers: those substances, such as alcohol and caffeine, which, if taken in excess, will leach calcium out of bones.
Why is exercise important?
Exercise is believed to be the only preventative measure that not only halts bone loss but actually stimulates the formation of new bone by placing stress on existing bone. Exercise also increases blood flow to bones, which brings in bone-building nutrients.
Which foods are rich in calcium?
Primarily dairy products, either whole milk or skim milk, cheeses and yogurt, sardines and other small-bone fish, green leafy vegetables and tofu. The problem is, it is almost impossible for people to consistently eat enough calcium-containing food to get enough calcium in their diet. Younger premenopausal women need between 800 and 1,000 milligrams a day [the equivalent of three eight-ounce glasses of milk]. Postmenopausal women need 1,400 milligrams. Since the average intake of calcium is about 450 to 600 milligrams per day, we believe that individuals should supplement with between 500 and 750 milligrams of calcium carbonate tablets. These should be taken mainly at night because the bones lose more calcium during sleep.
Can one take too much calcium?
Some people fear that large doses of calcium will lead to kidney stones, but quantities under 2,000 milligrams a day constitute a very small risk. Before working out a calcium program, of course, it's wise to consult your doctor.
Do you recommend other supplements?
Vitamin D is needed for the absorption of calcium. There is some evidence to suggest that one can have too much vitamin D, so researchers now recommend that one not exceed 1,000 International Units per day. All one really needs is 400 IU, and most people can get that from a half hour or so of sunshine per day or from vitamin D-fortified foods like dairy products or from one multivitamin tablet. Taking a special pill combining calcium and vitamin D is unnecessary in most cases.
Are there foods to be avoided?
Although phosphorus is an essential mineral, too much is believed by some researchers to lead to bone loss. Therefore, most preserved foods, red meat and cola drinks, which are high in phosphorus, should be consumed in moderation.
What are some other bone robbers?
Emotional stress increases the amount of calcium lost in the urine. It's been noted that women who smoke tend to have less bone than women of the same age who don't smoke.
How early should one start following guidelines to prevent osteoporosis?
The years between 20 and 35 are probably the optimum period to stimulate new bone formation by exercise and to avoid the "accelerator" factors by developing a healthy life-style. Between 35 and 50 the same regimen should be followed so that one enters menopause with the maximum bone mass possible. After menopause, exercise, diet and proper life-style should keep bone loss to a minimum.
What can people with osteoporosis do to lessen its severity?
Once a woman has a dowager's hump we can never straighten her again, but it's never too late to slow down the condition. These women also need to exercise, but they should be judicious about the type they choose. Walking and swimming have proved especially beneficial.
What new techniques are being developed to combat osteoporosis?
New screening techniques with machines called densitometers can diagnose osteoporosis in its earliest stages, when it is still reversible. Other than that, the greatest hope lies in prevention, prevention, prevention.