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Make No Bones About It


As a geriatrician, Diane Schneider, MD knows first-hand the devastating consequences of osteoporosis, the so-called “brittle bone” disease, on the elderly. In fact, breaking a bone can prove deadly. “Hip fractures are killers,” says Schneider. “One in three men will die within a year of breaking their hip, and one in four women. Few other diseases have such terrible odds.” Schneider believes osteoporosis and fractures are preventable. But frustrated by the lack of objective, well-balanced information, Dr. Di, as she’s known, has launched the Web site 4BoneHealth.org to educate people on how to build and maintain strong, healthy bones at every age. According to Schneider, “It’s never too early or too late to bone up on bone health.” Our interview with Schneider, along with tips on diet, exercise, and supplements is featured below.   ANDREA NAVERSEN


R&C: What is osteoporosis exactly and who is at risk?


DS: Osteoporosis is called the “silent thief” because it steals bone without any immediate consequence. Bone is lost silently and progressively, creating a fragile skeleton that puts you at risk for fracture. You may not even know you have a fracture — “silent fractures” occur in the spine and manifest by loss of height. Osteoporosis is the most common disease in older women and it also affects men. At age 50, 50 percent of women and 25 percent of men have a lifetime risk of fracture. One-third of hip fractures occur in men.


Osteoporosis is more common with advancing age and in those who’ve had a previous fracture, a family history of fractures, or a history of rheumatoid arthritis. It’s also more common among people who use oral steroids like prednisone, smokers, and those who drink three or more alcoholic beverages a day.


R&C: What can happen when seniors break bones and why can this be life-threatening?


DS: Hip fractures are the most devastating of all fractures. Men are more likely to die after hip fractures than women — 33 percent of men and 22 percent of women die within a year after sustaining a hip fracture. When you are older, you have less reserve in all of your body’s systems. When one system goes awry, a domino effect can occur, leading to overwhelming complications that your body cannot overcome.


R&C: What role does diet play in preventing osteoporosis?


DS: A balanced diet with good nutrition is important. Seniors often don’t get enough protein, which is important for muscle and bone.


R&C: What are important steps we can take at every age to keep our bones healthy and strong?


DS: The important components from day one are nutrition, adequate calcium and vitamin D, physical activity, and hormones to support and maintain healthy bones. At the time of menopause, women have increased bone loss due to the loss of estrogen that puts postmenopausal women at greater risk of osteoporosis.


R&C: I’ve read that calcium and vitamin D are important for healthy bones, but how do we figure out how much we should take?


DS: Calcium recommendations differ by age groups. The highest calcium requirements are during periods of growth, in preteens and teenagers (from ages 9 to 18), and in women during pregnancy and breast-feeding. In those age groups, figure on 1,300 mg a day. Adults from the age of 19 to 50 should consume 1,000 mg per day; those 50 and older, 1,200 mg per day. Keep in mind, these amounts are for total calcium intake, so that includes calcium from both your diet and supplements.


Vitamin D is a bit trickier because the main source of vitamin D is the sun. Even in sunny Southern California, we tend not to get enough vitamin D because of sunscreen and clothing. Few foods contain vitamin D, which are primarily oily fish like wild salmon, herring, and sardines. Some foods are fortified with vitamin D, such as milk, some cereals, breads, and yogurts. Supplementing with vitamin D will ensure you are getting sufficient vitamin D. The only way to find out if you have adequate vitamin D is to measure vitamin D, which is a common blood test. 30 ng/ml is the minimum level necessary to absorb the calcium you’re taking in through food or by supplements. The optimal level is being debated, but most experts suggest a level of 40 to 60 ng/ml.


R&C: We know the teenagers and young women in particular are concerned about body image and may diet to extremes to fit an unrealistic picture of ideal beauty. Why does this mean double trouble for bones?


DS: A growth spurt starts in preteen years and by age 18, approximately 95 percent of the skeleton is accrued in girls. With extreme dieting, the essential building blocks to make strong and healthy bones are missing. As a result, these young women do not achieve their optimal bone mass, putting them at high risk for fractures in the second half of their life.


R&C: Can some medications weaken bones?


DS: The most common medicines that increase bone loss and put you at risk for fracture are oral steroids like prednisone. Other drugs used after initial breast cancer therapy called aromatase inhibitors put breast cancer survivors at higher risk of osteoporosis, unless bone specific medicines are used to prevent the associated bone loss. Similarly, some medicines used to treat prostate cancer also put these men at higher risk of osteoporosis and fractures.


Recent research suggests the selective serotonin reuptake inhibitors (SSRIs) used in the treatment of depression, one class of oral diabetes drugs that includes Actos and Avandia, and proton pump inhibitors (PPIs) used to treat heartburn may increase fracture risk with long-term use.


R&C: Recently there’s been much in the news about a possible link between Fosamax and fractures. What are the facts?


DS: Recent reports have linked Fosamax with so-called atypical fractures of the thigh bone (femur) located below the hip. Cases of women taking the bisphosphonate class of osteoporosis medicines that includes Fosamax (generic alendronate), Boniva, Actonel, and Reclast have been reported at bone meetings and in the literature. Fortunately, these have been rare and unusual occurrences.


The FDA is investigating the issue. Their latest statement on March 10, 2010 was: “At this point, the data that FDA has reviewed have not shown a clear connection between bisphosphonate use and a risk of atypical subtrochanteric femur fractures.”


Stay tuned for more information. At this time, it is not known who exactly may be at risk, whether it is a pre-existing problem or as a result of treatment. Be reassured that “atypical fractures” occurring in the thigh below the hip are extremely uncommon. In the meantime if you have concerns about the medicine you are taking for osteoporosis, talk with your physician. If you are taking one of the bisphosphonates, seek medical attention if you develop thigh pain, which may be a warning sign prior to an atypical fracture.


R&C: Why did you launch your Web site 4BoneHealth? Isn’t there already tons of information out there about the importance of healthy bones?


DS: 4BoneHealth.org is providing an evidence-based resource for people of all ages and stages of bone health. We believe getting the facts increases awareness and education that will boost your bone health. A large gap exists between perception and reality in bone health. For example, everyone knows calcium is good for bones, yet according to the latest numbers published last month from a national representative sample, all ages and genders fall short. Only 15 percent of girls from 9 to 13, and 13 percent of girls from 14 to 18 had adequate intake of daily calcium. At the other end of the spectrum, at 71 years old and up, 31 percent of men and 39 percent of women had 1,200 mg of calcium each day combined from diet and supplements.


We are filling a current void with dynamic, up-to-date research-based topical information. Word of mouth is one of the most effective ways of spreading knowledge, and social media tools are currently the most efficient way to get people “talking.” 4Bone Health plans to reach out, one to one, with specialized information to targeted groups that are already using various social media tools like mommy bloggers, disease-specific Facebook groups, health bloggers, and disease forums.


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