My recent osteoporosis test result came back borderline low-normal. My doctor recommended that I adjust my diet and possibly take medication. What do you suggest?
Dear Anxiously Osteoporotic,
I understand your concern, and your doctor was probably not happy about the results either. There are options for you regarding diet, lifestyle and surgery.
Bones are living tissue, growing, and changing.
Osteopenia is low bone mass—a midpoint between having healthy bones and having osteoporotic disease. *It’s a warning!
Osteoporosis (OP): “Porous bones.” A systemic skeletal disorder characterized by micro-architectural deterioration of bone tissue leading to bone fragility.
Bone Density Screenings: Tests that determine level of bone mineralization and density. Usually measured are the hips, spine, wrists andor total body.
Computerized Tomography (CT Scan) uses X-rays and computer software to visualize and screen bones.
DEXA or DXA Scan: Dual-energy X-ray absorptiometry assesses bone density. It is considered a most useful and reliable tool.
Osteoporosis is a disease where bones have abnormally low density. Low bone density causes weak bones that can fracture easily with or without trauma. Furthermore, natural bone repairs inefficiently. Bone pain, disfiguration and difficulty with movement are common. Reduced bone density of the jaw can result in tooth loss. Quality of life diminishes.
Osteoporosis is called “the Silent Killer.” A person may be unaware of their disease until they experience a fracture. Anyone can fall accidentally, but with low bone mass it may be more prevalent and healing more difficult.
Note: There is currently no cure for osteoporosis. However, there are approved treatments to help reduce further problems and complications.
Who’s at Risk?
Being female * thin and small framed * advanced age (male and female) * genetics * early menopause * post -menopause * abnormal absence of menstrual periods * anorexia or bulimia * major depression in women * Irritable bowel disease/gastrointestinal disorders * low calcium in diet * certain medications (corticoid steroids, anticonvulsants, chemotherapy) * low testosterone in men * inactive lifestyle * cigarette smoking * excessive alcohol use * being Caucasian or Asian.
Ovaries produce estrogen (female hormone), which slows or stops bone loss. Reductions in estrogen interfere with bone health.
Corticosteroid medications interfere with: calcium absorption in the gut, production of male and female sex hormones, and causes muscle weakness. People who take steroids on a regular basis (asthma) are more prone to osteoporosis.
Secondary causes for osteoporosis include: hyperparathyroidism, hyperthyroidism, diabetes, malabsorption syndromes, rheumatoid arthritis, some cancers and neurological diseases such as multiple sclerosis and Parkinson‘s disease.
Caffeine reduces absorption of calcium from the gut. Coffee, caffeinated tea and chocolate (not white chocolate) all contain caffeine.
What to Do?
Calcium is critical for building and maintaining bones. It is the most abundant mineral in the body, stored mostly in bones and teeth. Foods high in calcium include dairy products, green leafy vegetables, fish and fortified calcium food products.
Calcium Supplements: If your diet is inadequate in calcium, supplements may be helpful such as calcium carbonate and calcium citrate.
Take calcium supplements in small doses (500mg or less) several times a day. Calcium supplements are absorbed well with food. Check supplement labels to ensure the product meets United States Pharmacopeia (USP) standards.
*Recommended Daily Calcium Intake:
0-6 months 200mg
6-12 months 260mg
1-3 years 700mg
4-8 years 1,000mg
19-30 years 1,000mg
31-50 years 1,000mg
51-70 years (male) 1,000mg
51-70 years (female) 1,200mg
70+ (male) 1,200mg
Vitamin D is needed for calcium absorption. You can get Vitamin D in three ways:
1. Exposure to approximately 15 minutes of sunlight daily.
2. Consumption of egg yolk, oily fish, liver, red meat and Vitamin D-fortified foods.
3. Use of Vitamin D supplements.
* Recommended Daily Vitamin D:
Infants-12 months 400 IU
Children/adolescents 600 IU
Men/women up to age 50 600-800 IU
Men /women above age 50 800-1,000 IU
* The Institute of Medicine recommends no more than 4,000 IU daily for adults. However, physicians may prescribe higher doses for people who are Vitamin D deficient.
Vitamin C: Helps prevent bone breakdown. Good sources include kiwis, citrus fruits, cruciferous vegetables and fortified Vitamin C products. If dietary intake is inadequate, take a supplement with 50-90 mg Vitamin C daily.
Vitamin K2: The protein “osteocalcin” plays a role in bone metabolism and is Vitamin K-dependent. Studies show Vitamin K intake improves bone density and bone health. Dark leafy and green vegetables, vegetable oils, chicken and beef are good sources of Vitamin K. Recommended intake for children under 12 years is 45 micrograms; for adults, 100-300 micrograms. People with certain medical conditions may require more, as recommended by their doctor.
2. Exercise: Regular exercise leads to greater bone mass, bone strength, and slows bone loss. Weight-bearing exercises such as walking, jogging, hiking, lifting weights, stair climbing, tennis and dancing are best for osteoporosis prevention and management.
Note: Swimming and biking are great cardiovascular exercises, but not effective for building bone density or for osteoporosis management.
3. Surgery: In osteoporosis surgery, a thin tube with orthopaedic bone cement is injected into the affected weakened vertebrae. There are two common surgeries: vertebroplasty and kyphoplasty.
Medications for Osteoporosis
1. Antiresorptive drugs slow the rate of bone breakdown.
a. Bisphosphonates - Alendronate (Binosto, Fosamax), Ibandronate(Boniva), Risedronate (Actonel, Atelvia) and Zoledronic acid (Reclast, Zometa)
b. Denosumab (human monoclonal antibody)
c. Estrogens-Evista (Estrogen Replacement Therapy-ERT), or estrogen and /or progestin medication
d. Calcitonin (synthetic hormone) hormone replacement therapy-(HRT)
e. Tibolone-selective tissue estrogenic activity regulator (STEAR)
2. Anabolic Drugs increase bone formation.
a. Monoclonal antibodies such as romosozumab (Evenity)
b. Synthetic versions of parathyroid hormone such as; Parathyroid Hormone 1-34 (PTH1-34, Teriparatide- Forteo) and (Alaloparatide-Tymlos)
* Medications are given orally (pill), by injection or intravenously (IV).
Side Effects of Bisphosphoneates and other Medications include:
Nausea-(oral med), Heartburn-Inflammation of esophagus-(oral med), Stomach pain-Indigestion-(oral med), Osteonecrosis (death of bone tissue) of jaw bone-(oral med), Headaches-(oral and IV meds)
Flu like symptoms sore muscles and joints-(IV med),
Kidney damage-most serious side effect – (IV med) and allergic reactions and others-(all meds).
Side Effects of Hormone Treatment include: Hot flashes, Leg cramps, Sweating and
Risks of Hormone Treatment include:
Breast Cancer, Strokes, Heart Attacks and Blood Clots.
Prescriptions for Osteoporosis are based on factors such as:
*Severity of disease.
* Ease prescriptions taken: daily (pill), monthly and/or yearly (injection or IV).
*Cost-check insurance for payment information.
Not all osteoporosis drugs are FDA-approved for all people. A drug approved to treat osteoporosis in postmenopausal women may not be approved for treating osteoporosis in men.
If you have a lower than normal bone density screening, do not take it lightly- It’s a warning! Give thought and attention to your diet and lifestyle. If you wish to prevent osteoporosis or improve your osteoporosis outcome, Nutrition Transformations, can help you. Diet and weight bearing exercises are as important as medication. Our specialized Osteoporosis diet plan and exercise program is effective. Call today for an appointment.
See our December blog “It’s That Time of Year Again” and if you have a question write me…I’ll answer….. Happy Chanukah!
Yours in good health,
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By Jenn Chapler MS RD CDN