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The Quest for Healthy Bones
For: New Advice About Bone-Density Tests, July 2002

Fifteen years ago few people had heard of osteoporosis, an abnormal thinning of the bones that often accompanies aging. But now osteoporosis is a household word, and the vocabulary of anxiety has even been enriched by "osteopenia," bone thinning that can be seen on a scan but is not yet classifiable as osteoporosis. There are many ways to help your bones stay healthy.

But first see how you do on this true/false test:

1. Menopause is the time to start worrying about osteoporosis.
2. Both men and women can get osteoporosis.
3. All women should get regular bone-density scans starting at age 50.
4. All women over 65 need drug therapy to prevent thinning bones and future fractures.

Answers:

1. False. Ideally, the time to start thinking about osteoporosis is when you're an adolescent. Building bone and maintaining it is a lifetime proposition. In order to maximize bone density, adolescents and young adults, in particular, need a high calcium intake— 1,200 to 1,500 milligrams daily, as much as women over 50. Thus, in your thirties, when bone density begins to decline, you have a lot of bone to draw on—like money in the bank. Everybody, from early childhood throughout life, needs regular weight-bearing exercise, which helps keep bones strong. Nobody should smoke—tobacco use thins bone. But it's better to start thinking of your bones at menopause than never to think of them.

2. True. Men and women of every ethnic background can get it, though it's more common among women of European or Asian descent. Bone loss is part of aging, and it cannot be prevented indefinitely. But men lose bone more slowly than women and usually do not experience fractures until more advanced ages.

3. False, not all women. There's no evidence that low bone density at age 50 predicts fractures later in life. You and your doctor should decide when and whether you need a bone-density test, based on your medical history and risk factors for osteoporosis. The National Osteoporosis Foundation recommends screening for all women starting at age 65. But the U.S. Preventive Health Services Task Force (a consensus panel of physicians that makes recommendations for the government) has not endorsed routine bone-density screening for any age group.

4. False. Not everybody needs to be on drugs (see box below). You need to talk about it with a physician.

Figuring your risks

At menopause (or after surgical removal of the ovaries) women experience a rapid decline in estrogen production. Thus bone loss increases dramatically. It may take years for bones to become dangerously thin, leading to fractures. The risk rises with age after menopause. It's estimated that one-third of women over 65 will have one or more vertebral fractures. And of those who survive to 90, one-third of women (and 17% of men) will experience a hip fracture. Such fractures drastically reduce the quality of life and often result in disability or death.

And yet, menopause need not automatically be treated with drugs. Nevertheless, all women should discuss their bone health with a physician.

Here are some clues that you may have a higher-than-average risk for developing brittle bones:

• You smoke
• You are small-boned and fair
• Osteoporosis runs in your family
• You are a heavy drinker
• You don't get much exercise
• You have taken anticonvulsants or corticosteroids for long periods.
• You don't get enough calcium and other bone-building nutrients in your diet.
• You're a woman who has taken excessive amounts of thyroid hormones. Check with your doctor.
• You're a man with a history of low testosterone or are under treatment for prostate cancer.

If you fall into one or more of these categories, you and your physician may decide on a bone scan, and possibly drug therapy (see box below). But even if you take a bone-building drug, you still need to take the following bone-healthy steps. In fact, everyone should take these steps:

• If you smoke, quit.
• If you are a woman and consume more than one alcoholic drink daily, moderate your drinking habits. Two drinks daily are okay for men.
• If you are sedentary, you should begin an exercise program.
• Diet counts: low-fat and nonfat dairy products are important sources of calcium and other bone-building nutrients. So are fruits and vegetables.

It's important, too, to fall-proof your home to the greatest possible extent. Visit the website of the American Academy of Orthopedic Surgeons and click on "Prevent Falls" in the drop-down menu.

If you're a woman over 50 or a man over 65, you'll probably also need calcium supplementation to bring your total calcium intake up to 1,200 to 1,500 milligrams a day. Vitamin D is important for building bone: 400 IU, the amount in a multivitamin, should be adequate, though some experts recommend twice that amount, particularly for those over 65 and those with little sun exposure (sunshine causes your body to manufacture vitamin D).

UC Berkeley Wellness Letter, April 2001