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Bone Up!

Why it's never too early to prevent osteoporosis

Lights twinkled overhead and the smell of popcorn filled the air as Gail, 42, laced her skates and glided onto the ice. Today she'd put away her "to do" list of post-Christmas activities in order to savor some ice skating with her kids at the local rink. A good skater and athlete, Gail twirled on the ice, relishing their time together. Then, as she stood resting, inexplicably, Gail fell. She hadn't slipped, and no one had tripped her. Worse, she couldn't get up. As pain coursed through her body, Gail, a former nurse, knew there was only one explanation. A short time later, an emergency room x-ray confirmed Gail's suspicion: She'd spontaneously suffered a broken hip.

After surgery, Gail couldn't walk for 10 weeks and her hip was pinned for 10 months. She missed work, couldn't attend church, and had to drop out of her involvement with a women's Bible study as she slowly healed. How could this have happened? Gail seemed too young for this kind of thing. But at Gail's annual mammogram and check-up a few months later, the mystery was solved: A bone density scan revealed Gail already had experienced profound bone loss—30 percent in her hips, 25 percent in her spine.

Osteoporosis, the disease that thins bones, had caused Gail's hip to fracture.

Like Gail, thousands of women lose bone mass and don't even know it until they break a bone. That's why osteoporosis is called a "silent" disease; it progresses without pain or symptoms until a break occurs.

Osteoporosis affects 25 million people, and nearly one-third of all women in the U.S. will develop it severely enough to experience a fracture, severe back pain, or stooped posture. But osteoporosis doesn't happen overnight.

"Think of your bones as a savings account," says Dr. Laura Mackie, gynecologist at the Lakeside Renaissance Women's Center in Oklahoma City. "That's where you deposit calcium so you'll have plenty to draw on throughout your life."

Bone mass forms rapidly in infancy and slows a bit during childhood until puberty. Then, during the adolescent growth spurt, tremendous bone formation occurs so that by age 18, most of your adult bone mass is achieved.

Bone mass steadily accumulates until around age 30-35, when you should have about 3 pounds of calcium in your skeleton. From that point on, your body is less able to get the calcium it needs from food, so your bone mass slowly declines (which means bone is broken down faster than it's made) until menopause, when it declines even faster. From about age 35 on, if you don't get enough calcium—and most women from adolescence on don't—the body starts tapping into the reserves of your "account," weakening your bones.

Some people think only menopausal women need to focus on bonebuilding. Yet one of Dr. Mackie's patients, who was in her early 40s and small-framed, suffered a sudden foot fracture while out walking. A bone density scan showed she'd lost bone mass and wasn't doing anything to rebuild it—until she too was diagnosed with osteoporosis.

A little prevention is definitely worth a pound of cure!

Building strong bones should be a lifelong priority. But it's easy to get so busy with living that you neglect your own health needs. However, in the case of osteoporosis, a little prevention is definitely worth a pound of cure!

So what's your best defense? Building strong bones early in life and continuing healthy habits to keep your frame strong. Here's how to start:

Indulge in calcium-rich foods.

Eating a balanced diet rich in calcium, vitamin d, and other minerals needed to absorb calcium is the best prevention. Calcium is readily available in: skim milk (8 ounces = 300 mg); low-fat yogurt (8 ounces = 400-450 mg); cheese (1 ounce = 150-250 mg); broccoli or other dark green leafy vegetables such as kale, bok choy, and collard or turnip greens (1 cup = 100-190 mg); tofu processed with calcium-sulfate (1/2 cup = 250 mg); salmon (2 ounces canned = 125 mg); almonds (1 ounce = 80 mg).

You also can add other calcium-fortified foods to your diet, such as soy milk (1 cup = 200-400 mg), cereals, breads, and juices. Especially after age 35, most women need calcium supplements because it's hard to get enough calcium by diet alone.

Be aware of the needs of different ages.

Young women ages 13 to 19 need 1,200 to 1,500 mg of calcium, and women 20 to 45 need at least 1,000 mg daily. Pregnant moms need 1,500 mg, nursing moms need 2,000 mg, and women over 45, 1,500 mg.

Take your vitamins.

Healthy bones also need a consistent supply of nutrients such as magnesium, potassium, vitamins b-6, b-12, folic acid, and vitamins k and d. Vitamin d is easy to get if you're in the sun for just 15 minutes a day, or you can choose a multivitamin or calcium pill that contains vitamin d. Calcium plus vitamins d and k to help absorption are now available in soft chocolate or fruit-flavored chews.

Avoid these calcium drainers.

Everyone loses a certain amount of calcium daily through urine. However, excessive caffeine, salt, and animal protein markedly increase calcium loss. Some studies show that for every gram of animal protein you consume, you'll excrete 1 milligram of calcium. That doesn't sound like much until you realize your body only absorbs 10 percent of the calcium you eat. That means for every gram of animal protein you ingest, you need an additional 10 milligrams of calcium. And for every gram of salt you eat, you lose an extra 5-10 milligrams.

Colas (regular or diet) and processed foods that contain high levels of phosphorus also block your body's ability to absorb calcium. And sugar and the artificial sweetener aspartame are other no-nos. Too much of either causes your body to secrete high levels of insulin, which interferes with calcium absorption. So those supplements you take with your diet soda or your glass of milk end up in your urine.

While saturated fats also drain precious calcium, here's some good news: Olive oil and other essential fatty acids appear to be positively associated with bone mineral density.

Your chlorinated, fluoridated tap water is also a reducer of bone mass, so bone up on bottled water when you can.

Finally, limit your use of antacids. Calcium is absorbed through the hydrochloric acid found in your stomach. Antacids reduce that acid, so the calcium you may take with it has a more difficult time reaching your bones.

Exercise regularly.

Bones are strengthened by having muscles pull on them. Weight-bearing exercises such as brisk walking or jogging, in-line skating, tennis, or low-impact and step aerobics are best, but even walking several blocks a day will slow bone loss. Lifting free weights and using isometric machines also can build bone mass, even in women who've already experienced bone loss.

When adequate calcium is added to an exercise program, the effects of osteoporosis can be reversed. In her early 50s, Carolyn discovered from a bone density scan that she had osteoporosis and was at a high risk for fractures. But after a year of three-times-a-week aerobics classes and working out on weight machines twice a week, plus calcium and vitamin d and the proper nutrients, her bone mass increased and she is no longer at a risk for fractures.

Check into bone density scans.

If you have several risk factors such as a family history of osteoporosis, or you're thin, fair-skinned, small-boned, small-muscled, physically inactive, avoided milk or dairy products when you were younger, or had an eating disorder, ask your doctor about a scan that can detect early bone loss.

The bone density scan measures the density of your bone tissue. Just as a cholesterol test can help predict your risk of coronary artery disease, a bone density scan is a "risk predictor" to warn if you could get a fracture. The most accurate test is a dual-energy x-ray absorptiometry (dexa or dxa) test of your spine and hip that can detect even a 1 percent bone loss.

Don't let osteoporosis cripple God's plans for you. Take control—and "bone" appetit!

Cheri Fuller is the author of numerous books, including When Families Pray.

Are You at Risk!

You may be if you fall in these categories:

  • You're thin or small-boned
  • Have a family history of osteoporosis
  • Are postmenopausal
  • Use steroid medications such as prednisone
  • Don't exercise/lift weights
  • Strenuously exercise to the point of stopping menstruation
  • Are either Caucasian or Asian
  • Have a low-calcium/vitamin D diet
  • Smoke

Which Supplement Should I Take?

Just taking a calcium supplement won't prevent you from losing bone. The calcium must be absorbed. But calcium supplements exist in different combinations with different concentrations and absorption capabilities. How do you know which one to choose? Here's a quick breakdown.

Calcium Carbonate
  • Most widely available and least expensive form of calcium
  • Best absorbed with food
  • Most common form used in some antacids
  • Contains 40 percent elemental calcium
  • Best absorbed in the presence of stomach acid, so people on antacids (or with naturally low stomach acid) don't absorb it well.
Calcium Citrate
  • Second most common form found in supplements
  • Best-absorbed form of supplemental calcium—but only slightly better than carbonate
  • Can be taken on an empty stomach
  • Form most commonly added to calcium-fortified juices
  • Good source for those who take antacids or acid blockers
  • Contains 21 percent elemental calcium, which means you need to take more—or you could simply wash your supplement down with that calcium-fortified orange juice.
Calcium Lactate
  • Third most common form
  • Relatively well absorbed even when gastric acid is low
  • Could be better absorbed by pregnant women than other forms
  • Contains 13 percent elemental calcium
Calcium Gluconate
  • Relatively rare form
  • Expensive
  • Only contains 10 percent elemental calcium

Most labels list numbers for both "total" and "elemental" calcium. Here's what they mean:

  • "Total calcium" indicates the total amount of the calcium compound—both the calcium and its mineral carrier—found in the supplement. Only a portion of this calcium your body can use.
  • "Elemental calcium" is the calcium your body can actually absorb.

If the label doesn't list the elemental calcium, assume only a third of the total calcium is going to get from the supplement into your system. To further maximize absorption, spread your doses over the course of your day. And if you take calcium and iron supplements, take them at separate times. Calcium is best absorbed with food. Iron is best absorbed on an empty stomach.

One simple method for testing a particular brand of calcium supplement is to place it in a glass of white vinegar at full strength and check to be sure it breaks up within 30 minutes.

—Ginger McFarland Kolbaba

Read more articles that highlight writing by Christian women at ChristianityToday.com/Women

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