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Bad to the Bone

By Jeanie Lerche Davis
WebMD Feature

Reviewed By Michael Smith

Chances are, 9-year-old Ali Brown doesn't know the word "osteoporosis." But she eats lots of cheese, munches a Flintstone vitamin every day (the plus-calcium variety), and gets tons of exercise -- inline skating, jumping on a trampoline.

Her mother doesn't like to admit it, but osteoporosis is low on her worry list. "Heart disease and breast cancer run in my family," says Jana Brown. "I tend to focus there."

Even adults have a hard time taking osteoporosis seriously.

There's no pain, no obvious sign that your bones are getting brittle. The first sign is often a fracture -- your wrist, spine, or hip breaks. Many of our grandmothers spent long years lying in bed with hip fractures.

Today: "A hip fracture is the No. 1 reason elderly people end up in nursing homes. Within the first year, 20% die," says Saralyn Mark, MD, endocrinologist and geriatrician, and medical advisor to the Department of Health and Human Services' Office on Women's Health.

Mark is a spokeswoman for the nationwide "Powerful Bones, Powerful Girls" campaign.

Her own mother has been battling osteoporosis for decades, Mark says.

"It's hard for her to walk ... she's fallen several times," she tells WebMD. Her mother's bones are so weak, she can't even carry her own purse. "She needs my dad to carry her purse at the mall. It's hard for her to sleep in bed because she's had a back fracture."

It all could have been prevented: "She was a smoker, didn't get much calcium, wasn't terribly physically active."

That's the grim reality of osteoporosis. "Quality of life can be severely affected," says Mark.

Here's another issue: What kids do now affects their risks later on. "I've said it before, it's a disease with pediatric origins and geriatric consequences," she tells WebMD.

Are Kids Getting the Message?

Only 14% of girls and 36% of boys age 12 to 19 are getting enough calcium, experts say. Yet as much as 98% of adult bone is established by the end of the teen years.

Those formative years are "the critical years," says Stephen I. Esses, MD, chairman of spinal disorders at Baylor College of Medicine in Houston.

"Kids need to be eating a good diet, getting enough calcium," he tells WebMD.

Exercise is also important -- "soccer, baseball, anything," Esses says. "It doesn't make any difference what the sport is, as long as they get into that mindset, where it becomes part of their lifestyle, that's what's important." Exercise builds up your muscles, which protect bones when you fall or sprain a joint.

Smoking is out of the question. "It's a major cause of osteoporosis," he adds. "Smoking is the worst thing you can do."

The best source of calcium for kids and adults is food, says Sheah Rarback, MS, RD, assistant professor of pediatric nutrition at the University of Miami Medical School. Rarback is also a spokeswoman for the American Dietetic Association.

"Dairy products are the richest source -- not the only source, but the richest -- plus they have vitamin D, which helps your body absorb calcium," she tells WebMD. Low-fat and fat-free dairy products (including yogurt and cheese), dark green vegetables, sardines, and salmon are all good sources. "Also, calcium-fortified juices, cereals, and soy products work very well." And a tablespoon of blackstrap molasses equals 3/4 cup of greens.

Calcium supplements come in two forms: calcium carbonate, which needs to be taken with food, and calcium citrate, which does not have be taken with food.

Unless a calcium supplement is in a chewable vitamin, they're too big for children, says Rarback. "That's why we always encourage kids to get their calcium from food."

Lifetime Prescription for Powerful Bones

Infants to Teens

Calcium. The American Academy of Pediatrics recommends the following amount of calcium for children:

  • 210 mg for infants up to 6 months old
  • 270 mg for infants 6 months to 1 year
  • 500 mg for toddlers 1-3 years
  • 800 mg for children 4-8 years
  • 1,300 mg for children 9-18 years

Exercise. Kids should be getting at least 30 minutes of exercise three or four times a week.

No Smoking.

Young Adults

Calcium/Vitamin D. By the time she's 25, a woman should be taking 1,000 mg of calcium in supplement form, says Esses. "Supplements are the best way for a female to be certain she's getting adequate calcium." If she becomes pregnant, her calcium intake requirements increase to 1,200 mg; it's 2,400 mg when she is breastfeeding.

Exercise. Thirty minutes, three times a week, is the minimum. Women should do weight-bearing exercise, especially walking, as well as strength-training exercises using hand weights.

No Smoking.

Life After 30

As you lose bone density, your risk of breaking a bone -- especially in the hip, spine, or wrist -- increases significantly. Bone loss can start when a woman hits her 30s, recent studies have shown.

Estrogen. Women should talk to their doctors about hormone replacement therapy, says Esses. "Although there is lot of controversy over hormonal supplementation, there's no question that HRT at the time of menopause is important in maintaining bone mass.

"Unless there are specific risk factors for taking hormones, like a history of cancer, there is overwhelming evidence that suggests [HRT] can be taken safely to prevent osteoporosis," he says.

Medications. For those who can't take hormones, there are other medications that can be used to protect bone mass. Medications such as Evista, Fosamax, or Actonel are effective in preventing or treating osteoporosis, says Esses.

Just don't wait too long to start. "I often see people who have had a hysterectomy and who were not given any estrogen, and 10 years later they've missed the boat," Esses tells WebMD. "You must start HRT within three years of whatever event, whether menopause or hysterectomy."

Calcium/Vitamin D: 1,000 mg

Exercise: 30 minutes, three times a week of weight-bearing and strength-training exercises.

No Smoking.

Older Adults

Bone Density Study. "Before they have a break, it would be worthwhile for females in their 60s to get a bone density study -- to see if they have osteoporosis," says Esses.

Medications. If bone density study shows deterioration, take osteoporosis-treatment medications.

Calcium/Vitamin D: For women, 1,500 mg a day. If she's on estrogen replacement, calcium intake should be 1,000 mg a day.

Although less common, men can also get osteoporosis and also need to watch their calcium intake. Men should be sure to take in 1,000 mg a day until age 65 and then 1,500 mg a day after that.

Exercise: 30 minutes, three times a week of weight-bearing and strength-training exercises. Even women in their 70s, 80s, and 90s can benefit from starting an exercise program, research shows.

Also, if women have a fracture, it's important that their osteoporosis also get medical attention, says Esses. "Here's a startling piece of information: nearly all patients admitted to hospitals with spine and hip fractures get sent home without treatment for their osteoporosis."

"It's never too late to strengthen your bones," Mark tells WebMD. "Bone is living tissue, it's always replacing itself. We can't give you what you missed; if you never built up much bone mass, you can't build it later. But you can strengthen what you've got."

Originally published May 20, 2002.

Reviewed by Michael W. Smith, MD.

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