FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[EXERCISE AND CALCIUM CAN HELP PREVENT OSTEOPOROSIS]

Question: I'm a 64-year-old woman, and I'm concerned about osteoporosis. I don't think I have the condition, and I certainly would like to prevent it. I see many advertisements for calcium. Will it really prevent osteoporosis, and how much should I take?

Answer: Osteoporosis is a condition that causes weakened bones that can break when under mild day-to-day stress such as walking or getting out of the car. Each year in the U.S. about 1.3 million broken bones - or fractures as doctors call them - are attributable to osteoporosis, with most victims being 45 or older. Women, particularly Caucasian women, are afflicted more often than men. Since you are a woman over 45, you have good reason to worry about osteoporosis. Some additional risk factors for this condition, in addition to being a woman after menopause, are surgical removal of the ovaries before the normal age of menopause, being thin, smoking tobacco, and not exercising regularly.

Bones are made of stored minerals - mostly calcium - and several types of living bone cells. Some of these cells constantly dissolve existing bone, and at the same time, others lay down new bone. All bones, whether in an adult or a child, are continually undergoing this type of change. Until early adulthood the rate of "bone making" is greater than that of "bone destruction." Therefore, there is an increase in the total amount of bone - in other words, growth. Normally during adult years, the amount of bone formed is equal to that lost. This produces no net change in the strength of bones because the quantity of stored minerals and living bone cells remains constant.

Osteoporosis is a disease characterized by a loss of bone mineral content. This loss of minerals can be the result of diabetes, kidney disease, nutritional imbalances, the use of certain medications, or because of other poorly understood causes.

The loss of bone strength from decreased mineral content results in a crushing type of fracture in the vertebra in the region of the shoulders and low back. Other common locations for osteoporosis fractures are in the lower arm and also in the hip. Most of these fractures occur suddenly with only minor exertion. Sometimes this is no more than lifting a light object, jumping out of a car, stumbling over a curb, suffering a minor fall or even just riding in a car traveling a bumpy road. The fracture produces acute pain in the area of injury and is accompanied by much spasm in the surrounding muscles.

In order to build strong bones, the body needs calcium. The most common dietary source of it is dairy products. However, most adults don't consume sufficient milk and milk products to meet their calcium needs. So, the products that advertise their calcium content as a health benefit are correct. The average post-menopausal woman should have 1500 milligrams of calcium each day. This won't guarantee freedom from osteoporosis, but it certainly does reduce the risk of this dreaded illness.

Smoking has been shown to reduce the amount of bone. In an interesting Australian study of twins, the non-smoker Û or the one who had smoked at least 20 "pack years" (packs per day x number of years) less than the other twin - had 9 percent more bone at the hip. Regular exercise and estrogen replacement therapy also reduce the risk of osteoporosis dramatically.

So, the best way to prevent osteoporosis is to exercise regularly, consume adequate amounts of calcium, avoid use of tobacco, and if you are a woman, talk with your doctor about the benefits of estrogen replacement therapy.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.