By Matthew Haugen, MD
An estimated 26 million American women have low bone density, or osteopenia. Although osteopenia doesn’t represent as severe a bone loss as osteoporosis, it still poses a significantly increased risk of bone fracture. Many women don’t realize that the five- year survival rate following a hip fracture is equal to, and sometimes worse than, many cancers. Through risk assessment and modification as well as bone mineral density testing, a long term care plan can be made to reduce fracture risk by optimizing bone health.
Dual energy x-ray absorptiometry (DEXA), available at Women’s Care, is a safe, easy, and painless way to assess bone mineral density (BMD). The American College of Obstetrics and Gynecology recommends BMD testing for:
•All postmenopausal women age 65 or older regardless of risk factors.
•Postmenopausal women under 65 with one or more risk factors. Risk factors include, but aren’t limited to family history of osteoporosis, Caucasian race, history of prior fracture, smoking, early menopause before age 45, poor nutrition, low calcium intake, inadequate physical activity and high risk of falling.
•All postmenopausal women with fractures, to confirm the diagnosis of osteoporosis and determine the disease severity.
It’s critical to understand that BMD alone doesn’t completely define an individual’s absolute risk of fracture. BMD combined with age, history of prior fracture and risk of falling appear to be the most significant factors. Once BMD is known and risk factors are assessed, a long term care plan can be tailored for each individual to maximize bone health and decrease fracture risk. Current recommendations advise that everyone regardless of age obtain adequate intake of calcium and vitamin D. Regular weight-bearing and muscle-strengthening exercises reduce the risks of bone loss and osteoporotic fractures. Smoking cessation, moderation of alcohol intake and fall prevention strategies are also important. Depending on DEXA results and risk assessment, medications may be used to reduce fracture risk as well.
Understanding that there are multiple factors affecting your bone health and risk of fracture is important. Although many of these risk factors can’t be modified (age, race, family history), many can (diet, exercise, smoking cessation). Knowledge is power. Through knowledge of your BMD by a DEXA scan and assessing your own particular risks, your Women’s Care provider can work with you to create your own personal long term bone health plan. Don’t hesitate to ask about bone health strategies, risks and DEXA evaluation at your next appointment.
Calcium and Vitamin D: Essential for Strong Bones
Calcium slows the rate of bone loss, so if the amount of calcium in the bloodstream is too low, it’s taken from the bones to supply the rest of the body. Good sources of calcium are dairy products, leafy green vegetables, nuts, seafood, and juices and cereals that are fortified with calcium. A well-balanced diet is very healthy for bones.
Most women get only half of the daily amount of calcium they need from their diet. You may need to take calcium supplements. Here are recommendations from the National Institutes of Health:
It’s important to remember that your body can only absorb about 500 mg of calcium at one time. If you take more, try to divide it into two doses.
Vitamin D is needed for the body to absorb calcium. It comes from two sources: Through the skin after direct exposure to sunlight and from the diet. Experts recommend a daily intake between 400 and 800 IU daily for adults under 50, and 800 to 1,000 IU daily for those over 50. Vitamin D can be obtained from fortified dairy products, egg yolks, saltwater fish and liver. Or consider taking vitamin D supplements, which are included in most multivitamins.