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Not Just for the Elderly

Think osteoporosis just happens to little old ladies? Think again.

I thought I was a pretty healthy, fit 39-year-old woman until I got the results of my first bone-density test recently. When the diagnosis showed severe osteoporosis, I laughed it off as a lab mix-up. I eat right, take vitamins and exercise regularly. It didn't add up. My only apparent risk factor was prolonged amenorrhea that began five years before the test after some complications during childbirth sent my hormones into a tailspin and stopped my periods at age 34 -- or 15-plus years prematurely. Because a lack of estrogen can cause bone loss, my doctor thought it was a good time to check out my bone health -- even though I had no visible symptoms of osteoporosis.

Although most osteoporotic women are older than 50 and well into menopause, women in their 30s -- or even younger -- can develop the condition if they have a history of anorexia or bulimia (which may cause amenorrhea and low calcium levels as a result of vomiting, purging and poor nutrition); if they are athletes training hard enough to become amenorrheic; or if, like me, they simply have low estrogen levels. Because osteoporosis is usually asymptomatic, it can sneak up on women, many of whom aren't diagnosed until they actually break a bone. For this reason it's called a "silent disease."

The diagnosis that roared
But there was nothing "silent" about my diagnosis. The results of my second test came through loud and clear: Despite my age, I had the bones of an old lady. My doctor said the only other patient she had seen with a bone scan like mine had been an 82-year-old woman. My bones were 30 percent thinner than average, making my risk of fracture three times that of a normal woman.

To that end, my doctor said I'd have to give up anything that could put me at risk for falling or injuring my spine: skiing, ice skating, in-line skating, horseback riding, sledding with my daughter -- even abdominal crunches. The worst-case scenario? A nasty fall could paralyze me. I was shocked! But I was also incredibly grateful that I had found out before I hurt myself seriously, and in time to start the long, slow process of building back my bones. By avoiding risky behavior and by taking calcium supplements and prescription medication to adjust my estrogen levels and stimulate bone growth, I hopefully could keep my bones safe. The longer I went without these measures, however, the more bone I stood to lose. And if I waited too long, I might never be able to build back the bone I'd lost.

Osteo-what?
Ten million Americans -- 80 percent of them women -- currently have osteoporosis, or "porous bones." Another 18 million have low bone mass, or osteopenia, a precondition to osteoporosis which puts them at increased risk. With the first of the baby boomers now heading into their golden years, the National Osteoporosis Foundation expects the number to soar to 41 million in the next 15 years. Worried about breast cancer? Your risk of suffering an osteoporotic hip fracture alone is equal to your combined risk of breast, uterine and ovarian cancer.

Bone is a living tissue. Your body constantly breaks down and removes old bone while simultaneously forming new bone. Even well after puberty, your body adds more bone than it removes. Both men and women reach their peak bone mass sometime between the age of 20 and 30, when the balance starts to tip the other way and your body begins to lose bone mass at a faster rate than you can rebuild it. At menopause, consult with your physician to discuss risk factors and to explore what option is best for you. The drop in estrogen, which has a protective effect on bone, can make you lose as much as 20 percent of your bone mass in the first five to seven years of menopause.

Measuring bone
The most-reliable means of diagnosing osteoporosis is with a bone mineral density (BMD) test. The most-comprehensive test, using dual energy X-ray absorptiometry (DXA or DEXA), is a relatively quick, painless procedure that uses a very low dose of radiation (10 times less than you'd get on a round-trip, cross-continental flight) to measure the density of the hip and spine, where osteoporosis shows up first and is the most debilitating. Smaller machines using ultrasound to measure BMD in the extremities (typically the heel) are sometimes available at health fairs or in shopping malls, although experts debate their accuracy. One point is clear, however: If you have an ultrasound test that shows even marginal bone loss, talk to your doctor about having a DEXA scan as soon as possible.

You have osteoporosis if a scan reveals bone loss at any one site of at least 25 percent and osteopenia when results fall between 10-24 percent.

How to prevent osteoporosis
The best way to prevent osteoporosis is to make high-intensity weight-loading exercise a regular part of your workout, get enough calcium and -- once you're in menopause -- take hormone replacement or a drug that mimics estrogen.

The best preventive strategy for osteoporosis is to comply with existing guidelines for weight-bearing exercise set by the American College of Sports Medicine, according to Daniel Kosich, Ph.D., an exercise physiologist and consultant to Aurora Denver Cardiology and a Shape contributing editor. Ideally, your weight-loading regime should include vigorous resistance training (free weights, machines, elastic resistance, water resistance, body resistance). Kosich recommends eight to 12 repetitions maximum (to temporary muscle fatigue), performing one to three sets two to three days a week. Kosich says exercises which are particularly helpful for preventing osteoporosis include squats, lunges and leg presses. In addition to exercise, health guidelines recommend at least 1,000 milligrams of calcium every day.

Feeding your bones
Even the best exercise plan won't work if you're not getting enough calcium. The latest adult recommendation is at least 1,000 mg a day (1,200 after age 65), although most Americans consume only about half that. Milk and dairy products and calcium-fortified juices are a great source of calcium; so make sure you and your daughters get plenty -- because studies show mothers who don't drink milk tend not to serve it to their daughters, either. Supplements can also help. Calcium carbonate is the cheapest; taking it with food may improve absorption, but it sometimes causes gas and constipation. Calcium citrate costs a little more, but you can take it with or without food and it may cause less discomfort. Either way, don't take more than 2,500 mg a day or you may raise your risk of kidney stones. And don't take more than 500 mg at one time because your body can only utilize so much at once. The rest is merely flushed out of the body.

To absorb calcium, you also have to get the Recommended Dietary Allowance of vitamin D (between 400 and 600 IU). Like magnesium and phosphorus, two other bone-healthy nutrients, this vitamin can be easily obtained by eating a balanced diet containing vitamin-D-fortified foods, plenty of calcium through milk, dairy products and calcium-fortified foods and juices, and by taking a multivitamin.

Quit smoking and limit your alcohol, since both smokers and heavy drinkers have lower BMDs. Smoking may lower your estrogen levels, which results in bone loss, while heavy drinking interferes with nutrition. Some doctors also warn against consuming large amounts of protein, sodium, caffeine and soft drinks like colas that contain phosphorus because they can leach calcium from the bones, says Robert Rude, M.D., professor of medicine and an NIH researcher at the University of Southern California in Los Angeles. But with adequate calcium intake, he adds, that effect disappears.

Testy debate
Getting bone scans is important, especially for women with major risk factors like menopause, eating disorders or prolonged amenorrhea. And experts believe many more premenopausal women could benefit from scanning, so those who don't know they've already lost bone can find out early.

Bess Dawson-Hughes, M.D., chief of the Calcium and Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, wonders if earlier screenings might motivate women to take better care of their bones by quitting smoking, taking calcium or getting help for eating disorders.

By the time this article is published, I'll have gone for my next bone scan. (Bone grows so slowly that any change measured sooner than one year could easily be chalked up to mere standard deviation.) Having faithfully followed my treatment plan, I'm hoping to be able to hit the slopes sooner than later. Meanwhile, if you think you're at risk, don't even think of waiting until menopause to get a bone scan -- even if you're only in your 20s or 30s. By starting a prevention plan to maximize your bone density now, you can put enough bone in your body's bank so those inevitable withdrawals in later life won't leave you broke -- or broken.

7 major risk factors
Think you're safe because you're only 26? Suffer from one or more of the following and your bones could be two or three times as old as you are.

1. Eating disorders Since their nutrition is so poor, anorexics and bulimics deprive their bodies of calcium, bone's major building block. Anorexics often don't have enough body fat to menstruate, so their estrogen levels drop, too, increasing bone breakdown. This double whammy occurs when bone density should be still rising, so these women may never attain a normal peak bone mass, says Ethel Siris, M.D., director of the National Osteoporosis Risk Assessment research program.

2. Body size It is believed that thin women with small frames have lower bone mineral density, a measure of bone health.

3. Family history Researchers aren't sure osteoporosis is genetic, but it seems to run in families. Having a mother or sister with it puts you at risk.

4. Erratic periods/early menopause (whether from natural causes or a hysterectomy) "Having irregular periods shows a lack of progesterone, a hormone needed along with estrogen for bone health," explains Morris Notelovitz, M.D., Ph.D., a consultant in women's medicine in Gainesville, Fla., and author of Stand Tall: Every Woman's Guide to Preventing and Treating Osteoporosis (Triad Publishers, 1998). "Estrogen reduces the rate of bone loss, while progesterone, when in the presence of estrogen, stimulates new bone formation." Athletes beware: Rigorous training and low body fat can trigger irregular periods or amenorrhea.

5. Some diseases Conditions like hyperthyroidism, hyperparathyroidism and chronic kidney, lung and gastrointestinal disorders are risk factors.

6. Long-term use of certain medications "The No. 1 culprit is corticosteroids given to suppress inflammation," notes Laird D. Madison, M.D., Ph.D., of the Center for Endocrinology, Metabolism and Molecular Medicine at Northwestern University Medical School in Chicago. Steroid drugs prescribed for diseases like epilepsy, severe asthma, severe allergies and autoimmune diseases like lupus can also have an effect, says Madison, adding that nonsteroidal drugs prescribed for these diseases do not pose problems in terms of bone loss.

7. Excessive doses of thyroid hormone Normal replacement dosages for hypothyroid patients are perfectly safe, Madison assures, although superhigh doses prescribed by a doctor in certain rare circumstances can have an effect if prolonged.

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