Fighting Osteoporosis:  The Simple Steps You Can Take to Keep Your Bones Healthy

Do you drink a lot of colas or coffee? Eat a lot of salt and processed foods? Love sugar? Red meat? Hate exercising?

If you're doing these things, you may be hurting yourself without being aware of it. You may be adding to your very real risk of the bone disease called osteoporosis.

Most of us have heard the frightening news: that osteoporosis is a real threat for women who go through an early menopause or suffer from premature ovarian failure. When your estrogen levels are low, your bones suffer the consequences. They become weaker, more brittle, less dense -- and more prone to fractures.

It's a difficult thing to come to grips to. Usually when we think of osteoporosis, we think of elderly women....not women in their 20s and 30s. But it's something that any of us going through early menopause have to think about.

I know all too well, because I didn't think I had to worry about osteoporosis. I had always done everything right -- I always ate a lot of calcium-rich foods, exercised regularly -- running, walking, Nordic Track and weights, and thought my bones were probably stronger than the norm. So, even after I was diagnosed with premature ovarian failure -- and even after I had read all the studies that showed that younger women with low estrogen often show rapid bone loss, I kept putting off getting my bone density checked.

Finally, two years after my diagnosis, I decided it was time.... Two months ago, I finally got a DEXA scan -- the test that measures bone density throughout your body. And I learned that my bones weren't nearly as good as I'd expected. In fact, I had osteopenia -- the precursor to osteoporosis --in my hip and my forearm. And it probably it had been worse before, since I've been on HRT for a year now.  This was a real warning signal to me. I'd done all the right things and I still showed bone loss.

Actually, though, I shouldn't have been so surprised....

The Osteoporosis Risk for Women In Premature Menopause

Women in early menopause -- whether naturally or surgically -- face a high risk of rapid bone loss. Here's a quick look at that threat of osteoporosis -- and the reason why it's vital to take care of our bones now -- before we lose a great deal of bone density.

A recent study conducted by researchers at the National Institute of Child Health and Human Development (NICHD) concluded that women with premature ovarian failure face a high risk for bone loss. Their findings:

- Two thirds of the women they studied had enough bone loss that they might be at risk for a hip fracture.

- 77 out of the 89 women they studied had osteopenia -- below normal bone density and a precursor of osteoporosis. Two of the women had full-fledged osteoporosis.

- Only ten of the women in the study had normal bone density for their age.

To make matters even more worrisome, about half of the women in the study had their bone density test within eighteen months of their POF diagnosis --and nearly half of this group already had osteopenia. While this particular study only looked at women with POF, the outlook is similar for women who are in premature menopause due to surgery or cancer treatment. Many studies indicate that if you had your ovaries removed, you experience significant bone loss in the first two years after surgery.

If you have premature ovarian failure and went through it before the age of 35, you're at an even higher risk of osteoporosis, primarily because peak bone mass -- the point at which your bones achieve their highest density -- typically is reached at age 35.  So premature ovarian failure may mean that your bones never attain their optimum strength -- which makes it all the more troublesome when you begin losing bone mass. As for early menopause after age 35, you may have attained peak bone mass, but you usually will have experienced significant bone loss if you haven't had periods for a long time -- and your estrogen levels remain low.

It's clear, then: When you have POF or early menopause -- naturally or surgically, bone loss is a very real threat-- and one that can occur rapidly. But -- and this is an important but -- osteoporosis is preventable. If you are aware of it now, and if you start taking care of your bones from this point on, you will be able to turn the odds back in your favor and keep the healthy bones you normally would have at this age.

Other Risk Factors for Osteoporosis:

Inherited Risk Factors

- Race -- It's a simple rule of thumb: In general, the lighter (or more transparent) your skin, the higher your chances of having low bone density. Asian women tend to have the lowest bone density, followed by white women. African Americans tend to have higher bone density and slower rate of bone loss

- Small Body Build-- The smaller and more fine-boned your frame, the higher the possibility of bone loss and fracture. . . . since you started out with less bone to lose.

- Low Weight -- Being too thin, that is, below normal weight -- increases your chances of osteoporosis. The reason? Fat cells produce estrogen, - so the fewer the fat cells, the lesser the amount of estrogen you produce -- and have produced.

- Family history of osteoporosis -- If your mother, grandmother, aunt or sister has or had osteoporosis, you are at an increased risk of having it yourself. According to recent scientific studies, this may be due to an inherited "osteoporosis gene" -- a gene that is supposed to stimulate the production of a protein that assists Vitamin D's job in bone-building. If this gene is defective, you generally have poor bone density.

Past Risk Factors

- No pregnancies -- When you get pregnant, your production of estrogen increases -- which helps your body absorb calcium and make stronger bones. If you've had no pregnancies --

- Skipped periods for a long amount of time because of excessive weight loss or exercise -- If you stopped having periods for an extended amount of time (six months or more at one time) due to excessive exercise, anorexia or bulimia, you stopped ovulating -- which means that your estrogen level dropped

- Low calcium diet (especially between the ages of 1 and 16) -- The formative years are important ones for your bones. If you didn't get enough calcium then, your bones may never have reached their optimal mass. . . . meaning you may have entered premature menopause with less bone mass than the average woman your age.

How Healthy Are Your Bones . . . Really?: Bone Density Testing

Whether or not you have any risk factors other than POF or early menopause (and, if you’re like most women, you probably do), there is one thing you should do if you want to take care of your bones now and in the future: Have your bone density measured. This is the only way you can actually -- and accurately-- determine how strong your bones are now, if you already have osteoporosis or osteopenia, and how aggressively you need to act to maintain healthy bones.

Because bone loss can be so rapid in women with EM or POF, it is a good idea to get tested when you are first diagnosed. This way, if you’ve already begun losing bone, you can take measures immediately. If you haven’t lost any bone yet, you have a baseline to measure against in the future -- and you can keep monitoring your bone density to be sure that you don’t start losing bone as you stay in menopause. Your doctor should suggest that you get tested, but if he or she doesn’t, be sure to ask for it. It’s too important to put off. And the results of the tests can be eye-opening, to say the least.

Bone density measurements can be taken of your heel, wrist, spine, hips, or total body. Some doctors may suggest you first get a screening test. In this case, you usually just have your wrist, arm or heel measured -- and if bone density appears low, then you get a diagnostic test, a scan of your hips, lower spine or total body. While this method is fairly common in the treatment of regular menopausal women, it may not be the best approach -- especially if you have EM or POF. According to a number of studies, you may have significant loss in your hips and spine even while showing normal bone density in your heel or wrist. So if you could be lulling yourself into a false sense of security by only having your wrist, arm or heel tested rather than your hips or spine -- and wind up losing precious time. Since the tests aren’t dangerous or complicated -- and since women with premature menopause are at high risk -- you’re best off opting for a thorough bone density test rather than a screening. At the least, many doctors recommend that you have bone density measurements taken of your hips rather than your spine, since spine measurements can be thrown off by medical conditions such as degenerative arthritis. At the best, you should have a total body measurement done.

There are a number of different types of bone density tests available. Most use a safe amount of low-dose radiation to measure the density of your bones in a relatively simple, quick, painless procedure -- one that can make a huge difference in your long-term quality of life.

The best -- and most accurate -- test is the Dual-energy X-ray Absorptiometery (DEXA). This is a state-of-the-art test that is able to measure even a 1 percent loss of bone. DEXA measures bone at the hip, spine, and/or wrist. (Again, though, it makes sense to have hip and/or spine, if not the total body tested, as opposed to just the wrist.) It’s an easy procedure. You lie on an examining table, fully clothed, while a scanner -- a mechanical imager that looks like a wand -- passes over your body, taking a picture of your bones. It’s sort of like being in a huge, super-duper computer scanner or photocopy machine. The amount of radiation used is minimal, about one-twentieth that of a normal chest X-ray -- and the results are extremely precise.

The DEXA prints out a picture of your bones, showing the density, and a computer measures your density (in grams of calcium per square centimeter) and "scores" your bones. You get two different scores, a Z score and T score. The Z score compares your bone density with that of an average woman of your age and body size. The T score compares it with an "ideal average woman" who is 30 years old and at her peak bone mass. By looking at your T score, your doctor can determine what percentage of bone you’ve lost in comparison to the ideal mass; by looking at the Z score, how you stand against the norm for your age. It does get a little complicated. Your score is given in terms of standard deviation from the mean.  For example, if you have a decrease of one standard deviation, you have about a 10 percent bone loss.

If you are more than one standard deviation below the mean peak value but less than two, you have osteopenia. And if you are 2.5 standard deviations or more below the mean, you have osteoporosis. It sounds a bit complex, but your doctor will explain the results to you in plain English, not medical-ese. Ultimately, you will wind up with one of three diagnoses: You have healthy bones still; you have osteopenia; or you have osteoporosis. In any case, you should get retested to see if you are losing bone mass, since this test only shows if you already have bone loss -- not if you are currently losing it.

The DEXA scan takes about ten to 20 minutes -- and costs between $150 to $300. DEXA machines are typically only found at larger medical centers. There are over 700 DEXA machines currently in use in the United States. To find one site near you, you can call the National Osteoporosis Foundation at 800-464-6700. There is one problem, though, that bears mentioning. Many insurance companies don’t cover DEXA, especially for younger women since, at quick review, their age doesn’t seem to warrant a bone density test. Check with your insurer and be prepared to fight, by showing that there is justifiable cause for getting the test. Remember, you are in a high risk group because you have EM or POF. The DEXA isn’t an unwarranted test in your case, but a prudent safeguard against a debilitating illness.

Aside from the DEXA, the other bone density tests that are sometimes used include:

Dual-Photon Absorptiometery (DPA): Like DEXA, DPA measures bone density in your spine or hip. It is a little slower than the DEXA, though, and isn’t as widely used.

Single-Photon Absorbtiometry (SPA): This test measures the bone density in your arm, wrist and/or hee, takes only about fifteen minutes and is relatively inexpensive. The big drawback with the SPA test? It doesn’t measure the bone density in your pelvis or spine -- both of which are often most affected by osteoporosis in women with premature menopause.

Peripheral Dual-Energy X-Ray Absorptiometry (pDXA): A mini-DEXA scan, this test is very cheap -- sometimes as low as $30. But it only measures the bone density in your arm, so isn’t the best bet when it comes to getting as accurate a picture of your bone health as possible.

Radiographic Absorbtiometry: Another test that doesn’t measure your spine or hips, this test only determines bone density of your hand -- using an X-ray to measure bone mass.

Ultrasound: Probably the easiest test of all, this measure the bone mass of your heel bone. But again, while many studies cite a correlation between heel bone density and density of pelvis and spine, there’s a chance you’ll get a good heel density reading -- while suffering from bone loss elsewhere. Many doctors recommend this test first, then, based upon the readings, decide whether you need a more complete bone density test. Again, though, you are probably better off getting a complete DEXA to begin with. It might take more time and cost more money, but your bones are worth it!

CAT Scan: Having a CAT scan to determine bone density has some definite pluses and minuses. On the plus side, a CAT scan is extremely accurate, and can measure both the total bone (the outer or cortical bone and the inner of trabecular bone) or the inner bone alone. The negatives? A CAT scan is generally much more expensive. In addition, you are exposed to much higher levels of radiation than in the other forms of bone density tests.

Ntx Bone Loss Assay: This osteoporosis risk assay is a follow-up test, one you would get after you’ve had your baseline DEXA or other X-ray test. Rather than go through another follow-up DEXA, you can determine if you’re still going through bone loss by taking this urine test. It’s a 24-hour urine test that measures bone loss by measuring a biological marker called Type 1 collagen in your urine -- and, unlike the DEXA, it’s extremely simple and not nearly as expensive. The only drawback -- it’s relatively new, and many doctors don’t offer it. . . or prefer the more-standard DEXA.

What You Can Do To Fight The Threat of Osteoporosis

Okay -- so women who are in early menopause or have premature ovarian faillure are at a higher risk for osteoporosis. What can we do about it?

One obvious answer is hormone replacement therapy. By replacing the hormones our body used to produce, we can strengthen our bones. Some studies indicate that replacing estrogen through HRT can cut your risk of fractures by 50%. As for progesterone, recent research has found that natural progesterone may actually help build new bone, not just stop bone loss. Finally, testosterone -- the hormone that many women in premature menopause have lower levels of, particularly those who've gone through surgical menopause -- also appears to both slow bone loss and help build bone density.

But while hormones certainly appear to help a great deal, they're not the only answer. In fact, there are several very simple things you can do to build your bones and fight bone loss -- whether you're on HRT or not. (One quick note: If you're not on HRT, it's even more important to be sure you're doing all you can for your bone health.)

Here are some easy tips that can help you

- Consider taking a calcium supplement. While it's a good idea to get your calcium through your diet, it's often one of those things that sounds easier than it is. The National Institutes of Health say you should aim at getting about 1,500 mgs of calcium a day. So if you think you might need more calcium than you're getting through your diet, it may make sense to take a calcium supplement. And, if you do take a supplement, it's a good idea to take it twice a day instead of in one dose, because your body can absorb only about 600 mg. of calcium at a time.

- Eat more greens. Greens -- like spinach, broccoli, even iceberg lettuce -- are high in vitamin K, one of the major bone-strengthening vitamins. In fact, according to research done at Harvard, eating a daily amount of iceberg or romaine lettuce can decrease your odds of hip fracture by up to 45%. Your best bet: trying to get 110 micrograms of Vitamin K daily. (To give you a rough idea of how to do this, here are the levels of Vitamin K in a half cup portion of different greens: cooked broccoli - 150 mcg.; cooked spinach - 324 mcg.; iceberg lettuce - 35 mcg., red leaf lettuce - 59 mcg.)

- And up your intake of other calcium-rich foods as well. Good bets are low-fat and nonfat dairy products, salmon, sardines with the bones, tofu, figs, tahini and almonds.

- Cut back on sodas, even diet sodas. The culprit here is phosphoric acid, which both diet and regular soft drinks contain. It is theorized that phosphoric acid leaches calcium from your system, increases calcium excretion in urine -- and robs your body of the calcium you need. 

- Steer clear of processed foods. Processed foods have a double whammy against them: they're often high in both sodium and phosphorus -- both of which increase calcium excretion.

- Keep an eye on how much coffee or other caffeinated beverages you drink. Caffeine acts as a diuretic, which increases the amount of calcium you lose in your urine. It may also reduce new bone creation and calcium absorption.

- Limit sugar and salt. These also appear to be "calcium robbers" -- and cause your body to excrete a higher amount of calcium in your urine.

- Keep your alcohol consumption on the moderate side. Three drinks a day or more affects your estrogen production, inhibits calcium absorption, and may cut down on your liver's ability to activate Vitamin D.

- Don't overdo the red meat. Yes, we've all heard that it may make sense to cut back on red meats because of their fat content -- but it also makes sense where your bones are concerned. The reason? Phosphorus again, which is found in red meat. In addition, some studies have found that excess protein in the diet may cause you to lose more calcium in your urine.

- If you smoke, try to quit. Yes, we all know the usual negatives about smoking....but it's also bad for your bones. Smoking interferes with your estrogen production and usage, which increases the loss of calcium from your bones.

- Be aware of the effect of certain medications on your calcium level. A number of different medications and drugs interfere with the absorption of calcium. Among them: Antacids containing aluminum, corticosteroids, certain diuretics called furosemides, bulk fiber preparations (like Metamucil) and thyroid hormone. Granted, some of these you can't necessarily stop taking. But if you do take any of these on a regular basis, you may need more calcium than many other women.

- Remember that, for calcium to work, you need to get other vitamins and minerals as well. Calcium alone doesn't do the trick. To get the most our of your calcium intake, you also need to other vitamins and minerals to help it along. These are: Vitamin D (which you get naturally from the sun. . . and which is often included in calcium supplements); magnesium (which is also often included in calcium supplements. The rule of thumb: You need a dosage equaling about half the calcium dosage you're taking); Vitamin K (which you can get through greens); boron, copper, zinc, manganese and silicon (which are usually included in multivitamins or multi mineral tablets).

- Last but not least: Exercise!!!! This will keep your bones strong, build their density, and fight bone loss. Walking, running, weight-training, stair-climbing -- anything that puts stress on your skeletal system is a great way of preventing bone loss and actually increasing bone mass as well. (An added bonus: it helps you keep your weight down AND minimize symptoms like hot flashes and mood swings.) Studies have shown that women who exercise regularly have a bone density about 10 percent higher than those who don't. So if you're concerned about osteoporosis, start moving!