If you have osteoporosis -- or are at high risk -- odds are you're not
getting the care you need.
A 2004 Stanford study determined that more than half of all people with
osteoporosis remain undiagnosed. What's more, even high-risk patients -- such
as those who have already had a hip fracture - often don't receive calcium and
vitamin D supplements or antiosteoporosis drugs. The 2004 Surgeon General's
Report on Bone Health adds that most physicians don't even discuss osteoporosis
with their patients after a fracture.
Will a vitamin D test tell me if I need more vitamin D?
That depends on whom you ask. As part of your regular blood test, your doctor can order a test for 25-hydroxyvitamin D (25-OHD).
The problem is not with the test. The problem is how to interpret the results. An expert committee convened by the Institute of Medicine in November 2010 concluded that "the cut-point values used to define deficiency, or as some have suggested, 'insufficiency,' have not been established systematically using data...
Why is this the case? "I have no idea," says a baffled Michael
Holick, MD, PhD, professor of medicine, physiology, and biophysics at Boston
University Medical Center. "But the numbers are out there. Only one in four
women between the ages of 45 and 75 will ever talk to a doctor about
What's tragic about those numbers is that it's relatively easy and cost
effective to take care of your bones -- but it can be devastating when you
don't. Osteoporosis causes more than
1.5 million fractures every year. If you're a woman older than 50, you have
50-50 odds of having an osteoporosis-related fracture sometime in your
remaining lifetime (don't stop reading if you're a man: your chance of a
similar fracture is one in four).
Here are some things you can do to help protect your bones without breaking
the bank -- especially if you're at high risk for osteoporosis, or nearing an
age at which you will be.
Get Cs and Ds: Calcium and vitamin D, that is. A recent
study of postmenopausal women on osteoporosis treatment shows that 52% had vitamin D
insufficiency -- even though they'd been told by their doctors to take calcium
and vitamin D.
The National Osteoporosis Foundation recommends 400 to 800 IU of vitamin D
every day, but Holick says that might not be enough now.
"To prevent skin cancer, we're avoiding sun exposure, which is a major
source of vitamin D," he says. "If you're doing that, you should be
making sure to get 1,000 IU of vitamin D daily." Fortified dairy products,
egg yolks, fish, and liver contain vitamin D, but you'll probably need a
supplement to ensure you get enough.
If you're postmenopausal, you should also be getting 1,200 milligrams of
daily calcium, and 1,000 milligrams if you're pre-menopausal.
Exercise: Here's the good news: The best exercise for
maintaining your bone mass costs you nothing, other than maybe a good pair of
shoes. It's walking, as little as 3-5 miles a week.
"The pounding on the pavement as you walk increases muscle tone and
maintains bone density," says Holick. "No other type of exercise does
this as well."
If you're looking to increase (not just maintain) bone density, you can't
hope to increase your bone density through exercise -- not unless you stress
yourself abnormally (think super weightlifter-type workouts) -- but it can help
you keep the bone that you have. Jogging, stair climbing, and other types of
weight-bearing exercise are also effective.
training is the other half of the exercise equation. It maintains and
possibly even improves bone
mineral density, according to several studies, according to results from
the Bone, Estrogen, and Strength (BEST) study funded by the National Institute
of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
You don't have to join a pricey gym to get strength-training benefits. A few
inexpensive hand weights or a rubber tubing used for resistance exercises are
all you need. A simple program with one or two exercises for each muscle group
is fine. Ask your doctor for some sample exercises.
You can also order the National Osteoporosis Foundation's BoneWise™ exercise
video from its web site (www.nof.org) (be sure to check with your doctor before
starting any exercise
program, especially if you've had falls, fractures, or other injuries).
Testing: Bone density screening is the best way to assess
the health of your bones. But will your insurance coverage pay for it? The
answer is yes and no, says Holick. "If you're 50 to 55 years of age and
perimenopausal, bone density screening provides an important baseline, but
insurance coverage is spotty."
Many insurers won't cover bone density screening for women under 65 (the age
at which the National Osteoporosis Foundation recommends regular screening
begin for all women) unless you have one or more additional risk factors. Be
sure your doctor and your insurer know if you have any of these risk
Being postmenopausal, and/or early onset of menopause
Family history of osteoporosis or fractures
Low weight/having a thin frame
Using corticosteroids for longer than three months
Late onset of menstrual periods
History of anorexia or bulimia
Excessive alcohol intake
Low intake of calcium or vitamin D
Taking certain medications, such as some cancer drugs, thyroid drugs, and
anticonvulsants-ask your doctor