The good news is that there’s plenty you can do—no matter how old you are—to bolster your bones and prevent osteoporosis. Why should women worry about bone health? A strong skeleton provides the foundation for an active lifestyle, essential to your ability to bike through wine country, tend your vegetables, and romp with your grandkids. Out of the million Americans who have osteoporosis, 80% are women. Throughout your life, bone cells called osteoblasts are continually adding new bone to your skeleton while cells called osteoclasts demolish old bone in order to supply the rest of your body with much-needed calcium. After bone mass peaks around age 30, you start to lose 1 to 2% of bone a year; the pace accelerates to 3 or 4% annually in the first 5 to 7 years after menopause, when declining estrogen offers less protection against the osteoclasts that break down bone. Moreover, osteoporosis is incredibly common. Your risk of developing it rises with age, especially in the first 5 to 7 years after menopause, when drops in estrogen may result in a 20% loss of bone mass. For women 50 years and older, the risk of suffering an osteoporosis-related bone fracture at some point is about 50%. What are the symptoms of osteoporosis? One of the scary things about osteoporosis is that it doesn’t have any obvious symptoms. It doesn’t hurt. But year after year, the bones get progressively weaker. You won’t suspect there’s a problem until you actually fracture a wrist, hip, or spinal bone or notice a substantial decrease in your height. While it’s normal to shrink about an inch in later adulthood, losing more height could be a sign of osteoporosis. In a study of more than 2,100 women, researchers at Ohio State University Medical Center in Columbus found that those who had shrunk 2 to 3 inches were five times more likely to have osteoporosis of the hip than those who had lost less than an inch. Women who had lost 3 or more inches were 10 times more likely to have the disease. Ask your doctor to start tracking your height yearly in your 40s, so you don’t miss a big clue. What causes osteoporosis? “Osteoporosis is a disease of heredity and lifestyle,” says Bess Dawson-Hughes, M.D., director of the calcium and bone metabolism laboratory at the USDA Human Nutrition Research Center on Aging at Tufts University in Boston. Estrogen deficiency in premenopausal women is a significant risk factor for bone loss, and once a woman reaches menopause, declines in the body’s estrogen cause the bones to lose calcium and break down at an accelerated rate. “Whether you get enough calcium and build adequate bone mass early in life or not, your body will start reabsorbing bone from your skeleton during your perimenopausal and postmenopausal years, which can lead to osteoporosis,” says Ethel Siris, M.D., director of the Toni Stabile Center for Osteoporosis at Columbia Presbyterian Medical Center in New York City. The good news? Even if you have risk factors for osteoporosis—such as a family history of the disease, a thin or small-framed body, a history of irregular or skipped periods, smoking or drinking excessive amounts of alcohol, not getting enough calcium, being inactive, or having taken steroids or other bone-thinning medications—the odds for preventing it can be very much in your favor. So what can I do to protect my bones? Do weight-bearing exercise. Walking, dancing, stair-climbing, skiing—any activity that forces your skeleton to support your weight speeds the work of bone-building osteoblast cells. Just a half hour of brisk walking boosted two measures of bone growth, according to one study. But avoid high-impact moves such as running or jumping if you already have osteoporosis or you risk fractures. Practice tai chi. Postmenopausal women who’ve practiced the slow, graceful movements of this exercise for years have denser bones—and even beginners slow bone loss as soon as they start, according to a research review at Harvard. Strengthen and tone your muscles. The stronger you are, the less likely you’ll be injured in a fall and break a bone. What’s more, lifting weights as little as twice a week reverses loss of mitochondria, giving you and your muscles extra energy, according to a study at the Buck Institute for Age Research in Novato, CA. A 16-week strength-training program has also been shown to cut arthritis pain by 43%. Bonus benefit: Muscle workouts boost your metabolic rate as much as 15%, so you burn more calories even when you’re inactive. Get enough calcium. This mineral is the main component of bone, and women need at least 1,000 mg a day—1,200 after menopause. Yet 64% of us don’t get enough, especially after age 50, when adult intake averages just 784 mg a day. Eat calcium-rich dairy foods and consider taking two 500 mg supplements a day. “Take doses separately–for example, one at breakfast and one at dinner,” says Kimberly Templeton, MD, an associate professor of orthopaedic surgery at the University of Kansas Medical Center. “The body can absorb only about 500 mg at a time.” Additional food sources include fat-free milk, which provides a third of the daily value for calcium, ready-to-eat cereals, and broccoli." Other components in food: phytic acid and oxalic acid, found naturally in some plants, bind to calcium and can inhibit its absorption. Foods with high levels of oxalic acid include spinach, collard greens, sweet potatoes, rhubarb, and beans. Among the foods high in phytic acid are fiber-containing whole-grain products and wheat bran, beans, seeds, nuts, and soy isolates. The extent to which these compounds affect calcium absorption varies. Research shows, for example, that eating spinach and milk at the same time reduces absorption of the calcium in milk. Take a test. Also crucial is getting screened for osteoporosis, because one of the scariest things about this bone-thinning condition is that it doesn’t cause symptoms and takes decades to develop. Ask your doctor when you need a bone mineral density test (some recommend them at age 65, some at menopause, and some even earlier if you’re at an increased risk). Common risk factors include a family history, broken bones as an adult, being Caucasian or Asian, a small frame, certain medications, or conditions that increases risk, such as inflammatory bowel disease or multiple sclerosis. What are some other natural remedies to boost bone health? Try yoga for better bone density. Yoga poses that strengthen the areas most likely to suffer from osteporosis-the hips, spine, and wrists - can help maintain bone density, says Lori Rubenstein, a senior instructor at the Yoga Therapy Rx program at Loyola Marymount University. Poses that focus on the spine can also help improve posture, preventing the hunched back that is typical in older osteoporosis sufferers. Good poses to try include the chair pose and cobra. Women who have small frames or family histories of osteoporosis are more prone to the disease—so if your mother or grandmother has been diagnosed, be doubly sure to add these poses to your repertoire. Go for a jog. When various activities were tested for their ability to stimulate bone growth, running scored three times higher than walking and other nonimpact exercises such as stairclimbing and stationary cycling, which had almost no effect. Hate running? Then try jumping jacks, tennis, swing dance, step aerobics-anything that’s higher impact than you’re used to and that varies your routine. However, women who have already been diagnosed with osteoporosis or who have a family history of the disease should consult their doctors before starting a high-impact exercise routine because the activity may increase their risk of fractures. Eat like a Greek. Omega-3s and monounsaturated fats are good for our hearts, but might they also strengthen our spines? Researchers from Athens, Greece, studied the diets of 220 Greek women and found that those who followed key components of the Mediterranean diet—they ate plenty of fish and olive oil and minimal red meat—had the greatest bone density. To eat like the Greeks, try replacing your regular fats and oils with 8 to 10 teaspoons of olive oil per day, incorporate 2 or 3 servings of fish (2 to 3 ounces each) per week, and limit weekly red meat consumption to 1 to 3 ounces (or 1 serving). Take your vitamins. Unless you get adequate vitamin D, about half the calcium you take ends up down the toilet. The vitamin helps your body better absorb calcium from food. Most people don’t get enough D from sources such as food and sunlight, and supplements are necessary (the vitamin is also linked to numerous other health benefits, including preventing cancer and heart problems). How much you need is up for debate, though; many experts advise that the currently recommended levels of 600 IU daily are too low and that we need 1,000 IU or more for optimal health. In addition, vitamin C, magnesium, vitamin K, potassium, and phosphorus are each linked to better bone health. You can get your recommended intake of these from a combination of a regular multivitamin and a diet rich in fruits and vegetables. What bone tests do I need? Bone density test. The 10- to 30-minute procedure uses an x-ray machine, known as DXA, that exposes you to a very low level of radiation. Having low bone density does not mean you will get osteoporosis, but it does mean you have a greater chance of developing it if you lose bone density in the future, according to the National Osteoporosis Foundation. Sometimes osteoporosis medications are prescribed for people with low bone density. Your doctor will weigh factors such as medical history (including whether you have broken bones in the past), lifestyle, and your risk of falling to determine whether the drugs are right for you. Research suggests the drugs may become less effective over time. Ask your doctor about getting tested if you have a family history of the disease, have broken a bone as an adult, are Caucasian or Asian, have a small frame, take certain medications, or have a condition that increases risk, such as inflammatory bowel disease or multiple sclerosis. FRAX score. The World Health Organization unveiled a risk assessment calculator, called FRAX, that goes beyond bone density to consider 11 other crucial factors in bone health, such as family history or taking skeleton-sapping medications. “It gives a much better sense of a woman’s true risk of getting a fracture, and it provides guidance about who needs treatment—and when," says Watts. The National Osteoporosis Foundation recommends medication for postmenopausal women if they have osteopenia and their FRAX shows a 10-year fracture risk above 20%. Ask your doctor to calculate your FRAX score, or go online and crunch the numbers yourself at shef.ac.uk/frax (click on “Calculation Tool,” then “US” and your ethnicity). How do I treat osteoporosis? Apart from upping your calcium and vitamin D levels and doing weight-bearing exercise, your doctor may also prescribe you meds to prevent further bone loss. To stop menopause-related bone loss, ask your doctor about drugs such as bisphosphonate, calcitonin, or raloxifene. There is also hormone therapy using estrogen to help maintain bone density. Where can I go to find out more? National Osteoporosis Foundation Mayo Clinic
