Osteoporosis — What are your risks?

You might not think of bones as being alive, but they are. Every day, your body breaks down old bone and replaces it with new bone. As you get older, however, the ratio becomes unequal: more bone is lost than gained. If too much is lost, then you can develop the bone disease osteoporosis.

Osteoporosis can cause bones to become weak, brittle and prone to break. Due to loss of bone tissue, bones that were once dense and strong can be unable to withstand the stress of even normal activity, such as bending over or coughing. Osteoporosis-related fractures most commonly occur in the spine, wrist and hip. In addition to bone fractures, osteoporosis can cause bone pain, loss of height and a stooped posture. All of these symptoms can lead to feelings of anxiety and depression.

No one can say for sure which individuals will develop osteoporosis. But research has revealed what makes some people more likely than others to develop it. That’s why it’s important to be aware of the risk factors — and what you can do about them.

Bone health basics

Generally speaking, the risk of developing osteoporosis and being more prone to bone fractures depends on your bone health — the size and strength of your bones and the condition of your bone tissue. Bone health is a result of how well your skeleton developed during childhood and early adulthood, as well as your peak bone mass — the maximum amount of bone tissue you have. Most people achieve peak bone mass in their late 20s to early 30s. Bone health is also affected by how rapidly bone mass is lost as you get older.

Risk factors that can’t be changed

Some risk factors for osteoporosis, such as your age and family history, aren’t things you can control. But just because you’re at risk doesn’t mean you will get the disease. You can monitor your bone health for early signs of abnormal bone loss and take steps to prevent osteoporosis or to slow its development.

These are common risk factors for osteoporosis:

Age. The older you are, the more likely you are to develop osteoporosis and the more likely you are to break a bone because of it. After you’ve reached your peak bone mass, it’s normal to begin losing a small percentage of bone mass each year. This happens because new bone formation slows with age, while bone breakdown stays the same or increases. The internal structure of bones also begins to weaken, and the outer shell thins.

Gender. Women usually have lower peak bone mass than men do. Women also tend to live longer. So, in effect, women have less bone to lose but more time to lose it. In addition, during menopause, women experience a drop in estrogen levels, which usually accelerates bone loss. Osteoporosis is most common among postmenopausal women.

Ethnicity. Caucasians and Asians are at greater risk of osteoporosis; Hispanics and Native Americans appear to have an intermediate risk, while African-Americans have the lowest risk. These various levels of risk are based in part on differences in bone mass and bone density.

Genetics. Family history is a strong predictor of low bone mass. If your mother, sister, grandmother or aunt has osteoporosis, then you’re at greater risk. But remember that having a family history of low bone mass doesn’t automatically mean the same thing will happen to you. By taking steps to lower your risk, osteoporosis can be prevented.

Body frame size. Men and women with small body frames tend to have a higher risk because they usually have less bone mass to draw from as they age.

Health-related risk factors

Individual health circumstances, including health conditions and medications, can influence osteoporosis risk.

Childbearing. Pregnancy builds stronger bones by raising estrogen levels and increasing weight. Bone density decreases slowly during pregnancy and more rapidly while nursing a baby, but this bone loss recovers within six months after stopping nursing in most women.

Medications. Certain medications can accelerate bone loss and increase your risk of osteoporosis. If you take any of the following medications, then talk to your health care professional about what you can do to counteract their effects on bone health.

  • Corticosteroid medicines. Long-term use of corticosteroids, including prednisone (Rayos), cortisone, prednisolone (Orapred, Prelone, others) and dexamethasone (Maxidex, Tobradex, others), lowers bone mass. If you take one of these medications for more than a few weeks, then your doctor will likely monitor your bone density and recommend preventive measures.
  • Anticonvulsants. If you take a medication to control seizures (anticonvulsants) over a long period of time, then your liver begins to metabolize vitamin D in a way that causes a deficiency of the vitamin. If you take an anticonvulsant medication, such as phenobarbital (Lumina), carbamazepine (Carbatrol, Tegretol, others) or phenytoin (Dilantin, Phenytek, others), then your health care professional may recommend vitamin D and calcium supplements.
  • Thyroid medicines. When used in excessive quantities, thyroid medications such as levothyroxine (Synthroid, Tirosint, others) can cause high thyroid hormone blood levels that accelerate bone loss.
  • Diuretics. These drugs prevent fluid buildup in your body. But by doing so, certain diuretics can cause the kidneys to excrete too much calcium, leading to weaker bones.
  • Other drugs. Certain blood thinners, such as heparin, can cause bone loss when used over a long period of time. So can aromatase inhibitors, a class of drugs used to treat breast cancer, and drugs that are used to treat endometriosis and prostate cancer (gonadotrophin-releasing hormone agonists).

Medical conditions. Certain medical conditions can increase the risk of osteoporosis by slowing bone formation or speeding up bone breakdown. They include:

  • Endocrine disorders, such as hypogonadism, overactive thyroid (hyperthyroidism), hyperparathyroidism, Cushing’s syndrome and diabetes
  • Gastrointestinal disorders, including Crohn’s disease, celiac disease, lactose intolerance and liver disorders such as primary biliary cirrhosis
  • Rheumatoid arthritis
  • Absent or infrequent menstrual cycles in women of childbearing age

Gastrointestinal surgery. Surgery to reduce the size of the stomach or to remove part of the intestine limits the ability of these organs to absorb nutrients, including calcium.

Risk factors you can change

Although the risks may seem daunting, it’s important to realize there are some risk factors for osteoporosis that you can control. It’s never too late to do something about your bone health.

Low calcium and vitamin D intakes. A lifelong lack of calcium plays an important role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures. Because vitamin D is essential for calcium absorption, chronically low levels can contribute to osteoporosis. Some studies suggest that large portions of the U.S. population may have low levels of vitamin D. But the data is difficult to interpret, because the definition of what constitutes deficiency can vary. Still, it’s a good idea to have your vitamin D level checked if are in one of the categories of higher risk of deficiency.

Eating disorders. Severely restricting food intake and being underweight can weaken bone.

Lack of physical activity. Regular physical activity is key to preventing osteoporosis and fractures. Lack of exercise accelerates bone loss; whereas, weight-bearing exercises such as walking and resistance training can increase or at least maintain your bone density at any age.

Smoking. Here’s another good reason to quit — smoking is bad for your bones. Smoking interferes with the production of estrogen and testosterone, which are needed to build bone. Smoking also disrupts calcium absorption.

Alcohol use. Alcohol delivers a double whammy to your bones, putting a damper on bone building and stimulating the bone loss process. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

Source: Mayo Clinic

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Study: Vitamin D Supplements Won’t Build Bone Health in Older Adults

Steven Reinberg wrote . . . . . . . . .

Vitamin D supplements have long been touted as a way to improve bone health and possibly ward off the bone-thinning disease osteoporosis in older adults.

But a new study contends that claims of benefits from supplements of the “sunshine vitamin” fall flat.

A review of previously published studies found that taking either high or low doses of vitamin D supplements didn’t prevent fractures or falls, or improve bone density.

Vitamin D is found in very few foods. One of the biggest sources of the vitamin is exposure to sunlight.

“Vitamin D supplement use is common, particularly in North America,” where up to 40 percent of older people take them, said lead researcher Dr. Alison Avenell. She is clinical chair in health services research at the University of Aberdeen in Scotland.

“Most adults don’t need to take vitamin D supplements, although they are unlikely to do harm if taken in low doses,” she added.

Vitamin D supplements do prevent rare conditions, such as rickets in children and osteomalacia (softening of bones) in adults. People at risk of vitamin D deficiency include those with little or no sun exposure, such as nursing home residents who are indoors all the time, or those who always cover their skin when outside, Avenell said.

There’s also existing evidence that vitamin D helps prevent cancer or heart disease, she added.

“Preserving bone strength involves keeping active, not smoking, not being too thin, and taking medications for osteoporosis,” Avenell said.

Based on the new findings, Avenell thinks guidelines that recommend vitamin D supplements for bone health should be changed.

For the new report, Avenell and her colleagues reviewed 81 studies, most of which dealt with vitamin D alone, not in combination with the mineral calcium.

“Calcium supplements on their own have minimal effect on bone mineral density and fracture, and may increase the risk of cardiovascular disease,” Avenell said.

The only evidence that calcium and vitamin D together prevent fractures comes from a trial of older people with very low vitamin D levels in nursing homes. But calcium and vitamin D may also increase the risk of cardiovascular disease, Avenell said.

In addition, most of the studies covered in the new review included women aged 65 and older who took more than 800 IUs (international units) of vitamin D daily.

The new study found no meaningful effect of vitamin D supplementation when it came to reducing any fracture, hip fractures or falls.

This type of study, called a meta-analysis, tries to find common elements among previously published studies. This kind or research, however, is limited by differences in the methods and conclusions of the different studies analyzed by researchers, so the findings may not be consistent across the board.

A group that represents the supplement industry took issue with the findings.

“There is evidence that vitamin D is very helpful, especially when you have low levels,” said Duffy MacKay, senior vice president for scientific and regulatory affairs at the Council for Responsible Nutrition.

Over 94 percent of the U.S. population has vitamin D levels that are too low, he said. “Most Americans do not get enough vitamin D to meet their needs and supplements can fill that gap, but if your vitamin D levels are sufficient you don’t need to supplement.”

The benefit of proper vitamin D levels are seen over a lifetime and can’t be judged in short-term studies that look at any specific benefit, he added.

Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City, said this new study should convince doctors that vitamin D supplements don’t have a role in maintaining healthy bones, but they do have other benefits.

Previous research suggests that vitamin D, when taken in tandem with calcium, may help prevent certain cancers and protect against age-related declines in thinking and memory.

“What is important to keep in mind is that those with low vitamin D were not represented in this meta-analysis, and vitamin D supplementation — repletion, actually — is still necessary for those with low vitamin D levels, regardless of age,” Sood said.

The findings were published online in The Lancet Diabetes and Endocrinology.

Source: HealthDay


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Expert Consensus Finds that Higher Protein Intake Benefits Adult Bone Health

In seniors with osteoporosis, dietary protein intake above currently recommended levels may help to reduce bone loss and fracture risk, especially at the hip, provided calcium intakes are adequate.

A new expert consensus endorsed by the European Society for Clinical and Economical Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF) has reviewed the benefits and safety of dietary protein for bone health, based on analyses of major research studies. The review, published in Osteoporosis International found that a protein-rich diet, provided there is adequate calcium intake, is in fact beneficial for adult bone health. It also found no evidence that acid load due to higher dietary protein intakes, whether of animal or vegetable origin, is damaging to bone health.

The key findings of the extensive literature review include:

Hip fracture risk is modestly decreased with higher dietary protein intakes, provided calcium intakes are adequate

Bone mineral density (BMD), which is an important determinant of bone strength, appears to be positively associated with dietary protein intakes

Protein and calcium combined in dairy products have beneficial effects on calciotropic hormones, bone turnover markers and BMD. The benefit of dietary proteins on bone outcomes seems to require adequate calcium intakes

There appears to be no direct evidence of osteoporosis progression, fragility fractures or altered bone strength with the acid load originating from a balanced diet.

Professor René Rizzoli, Professor at the Division of Bone Diseases of the Geneva University Hospitals and Faculty of Medicine, stated:

Adequate intake of dietary protein, together with calcium, is needed for optimal bone growth in children and the maintenance of healthy bone at all ages. This message needs to be reinforced in view of currently circulating myths suggesting that too much protein causes ‘acid load’ and is damaging to bone health. In fact, in the elderly, we find that a common problem is not too much protein, but too little. This review of the literature confirms that a balanced diet with sufficient protein intake, regardless whether of animal or vegetable source, clearly benefits bone health when accompanied by adequate calcium intake. This is particularly important for seniors with osteoporosis, and individuals at risk of malnutrition due to acute or chronic illness, or recovering from an injury.”

Source: The International Osteoporosis Foundation

More Dairy is Associated with Higher Bone Density and Greater Spine Strength in Men over 50

Researchers from Hebrew SeniorLife’s Institute for Aging Research (IFAR), Wageningen University, Tilburg University, University of Reading, and Beth Israel Deaconess Medical Center (BIDMC) have discovered that higher intake of dairy foods, such as milk, yogurt, and cheese, is associated with higher volumetric bone mineral density and vertebral strength at the spine in men. Dairy intake seems to be most beneficial for men over age 50, and continued to have positive associations irrespective of serum vitamin D status.

In women, researchers found no significant results except for a positive association of cream intake in the cross sectional area of the bone.

Study participants included 1,522 men and 1,104 women from the Framingham Study, aged 32-81 years. Researchers examined quantitative computed tomography (QCT) measures of bone to determine associations with dairy intake.

Shivani Sahni, Ph.D., Director Nutrition Program and Associate Scientist at IFAR and senior author of the study said, “This study related dairy intake with QCT- derived bone measures, which are unique because they provide information on bone geometry and compartment-specific bone density that are key determinants of bone strength. The results of this study highlight the beneficial role of a combination of dairy foods upon bone health and these beneficial associations remain irrespective of serum vitamin D status in a person.”

The results of this study were published recently in the Journal of Bone and Mineral Density.

Source: Institute for Aging Research


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Mediterranean Diet Is Linked to Higher Muscle Mass, Bone Density after Menopause

The heart-healthy Mediterranean diet also appears to be good for an older woman’s bones and muscles, a new study of postmenopausal women in Brazil finds. The study results will be presented Monday at ENDO 2018, the Endocrine Society’s 100th annual meeting in Chicago, Ill.

The researchers reported finding higher bone mass and muscle mass in postmenopausal women who adhered to a Mediterranean diet than in those who did not. This way of eating involves a high intake of fruits and vegetables, grains, potatoes, olive oil and seeds; moderately high fish intake; low saturated fat, dairy and red meat consumption; and regular but moderate drinking of red wine. The Mediterranean diet has been linked to a lower risk of heart disease, diabetes, cancer and certain other chronic diseases.

Few studies, however, are available about the Mediterranean diet and its effects on body composition after menopause, said the study’s lead investigator, Thais Rasia Silva, Ph.D., a postdoctoral student at Universidade Federal do Rio Grande do Sul in Brazil. This information is important, she said, because menopause, with its decline in estrogen, speeds a woman’s loss of bone mass, increasing her risk of the bone-thinning disease osteoporosis and broken bones. In addition, menopause and aging reduce muscle mass. Silva said declines in skeletal muscle mass and strength in older people are major contributors to increased illness, reduced quality of life and higher death rates.

Silva and her co-workers conducted their study in 103 healthy women from southern Brazil, who had an average age of 55 and who had gone through menopause 5.5 years earlier, on average. All women underwent bone scans to measure their bone mineral density, total body fat and appendicular lean mass, which was used to estimate skeletal muscle mass. The subjects also completed a food questionnaire about what they ate in the past month.

A higher Mediterranean diet score (MDS), meaning better adherence to the Mediterranean diet, was significantly associated with higher bone mineral density measured at the lumbar spine and with greater muscle mass, Silva reported. This association, she said, was independent of whether the women used hormone therapy previously, their prior smoking behavior or their current level of physical activity, as measured by wearing a pedometer for six days.

“We found that the Mediterranean diet could be a useful nonmedical strategy for the prevention of osteoporosis and fractures in postmenopausal women,” Silva said.

Given the many health benefits of the Mediterranean diet, Silva added, “Postmenopausal women, especially those with low bone mass, should ask their doctor whether they might benefit from consuming this dietary pattern.”

Source: Science Daily