Dear Doctor: I just turned 65, and even though I'm strong and healthy, my friends say I should be concerned about osteoporosis. What is it, and how do I know if I have it?
Dear Reader: Osteoporosis, which literally means "porous bones," is a progressive disease in which bone mass is lost. As a result, bones become thinner, more fragile and are at higher risk of fracture. People with osteoporosis most often break a bone in the hip, forearm or spine.
Although osteoporosis can occur in men and women of any age, post-menopausal women have the highest risk. This is due to the steep drop in the production of estrogen, a hormone produced by the ovaries, which protects against bone loss.
Risk of osteoporosis increases along with a person's age. A family history of the disease is an indicator of risk, as are alcoholism, cigarette smoking, anorexia and steroid therapy. Race also plays a role, with Caucasian and Asian women more likely to develop osteoporosis than other ethnicities.
To understand osteoporosis, let's first talk about bones:
Your skeleton, which supports and protects your body, is made up of living tissue. It's also a storehouse of essential minerals that are held within your bones. Throughout your life your bones go through a metabolic process called remodeling, in which old bone tissue is removed from the skeleton and new bone tissue is formed.
As we age, the formation of new bone tissue slows. In people with osteoporosis, the formation of new bone can't keep pace with the removal of old bone, which results in a net decrease in bone density. In addition to an increased risk of fracture, people with osteoporosis experience a loss of height, stooped posture and decreased mobility.
So how can you know if you have osteoporosis?
Since in its early stages osteoporosis typically does not have symptoms, a bone density test is needed for an accurate diagnosis. This is a painless scan in which low-level X-rays are used to reveal the proportion of minerals in your bones. During the test you lie on a padded table as the technician scans several areas, usually your hip, spinal column and wrist.
Treatment for osteoporosis ranges from lifestyle changes, such as adding an exercise plan and switching to a diet rich in calcium and vitamin D, to a range of medications that you would discuss with your doctor.
No matter your age, there are things you can do to keep your bones strong. Calcium is one of the building blocks of new bone, and to successfully absorb that calcium, your body needs vitamin D. Dairy foods, certain nuts and green leafy vegetables contain lots of calcium. Eggs, fatty fish and fortified milk contain vitamin D. Talk to your doctor about whether you need supplements of calcium and/or vitamin D.
Staying physically active strengthens both muscle and bone. Try weight-bearing exercises three to four times per week, and don't forget about balance and agility exercises, which can help prevent a fall.
Your bones hold you up, allow you to move and contain the marrow that produces about 230 billion red blood cells per day. We think your friends have a point here -- don't take your bones for granted.
(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)
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