Announcing: Stay Strong and Act Now to Prevent Osteoporosis

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Leading rheumatologist Dr. Jean Park recommends five measures to protect bones starting today.

Osteoporosis causes about 2 million fractures every year. One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her or his remaining lifetime. In the U.S. today, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone density, placing them at increased risk for osteoporosis and broken bones. Thirty years ago, it was generally thought that fragile bones and the fractures they cause were a consequence of normal aging. Today, we know that while gradual loss of bone mass is a fact of life for everyone, it's never too late to take steps that will protect our bones and the earlier we start, the better the chances of preventing osteoporosis.

“Bone is living tissue, comprising mainly calcium and protein,” says Dr. Jean Park, leading rheumatologist and osteoporosis expert with Somers Orthopaedic Surgery and Sports Medicine Group. “Healthy bone is always being remodeled; that is, small amounts are being absorbed in the body and small amounts are being replaced. If more bone calcium is absorbed than is replaced, the density or the mass of the bone is reduced. The bone becomes progressively weaker, increasing the risk that it may break.” Osteoporosis, which means "porous bone" develops when bone is no longer replaced as quickly as it is removed. The bones become so weak and brittle that a fall or even mild stresses like bending over or coughing can cause a fracture.

Healthy bones begin in childhood. Up to the age of 20, we are forming more bone cells than we are losing. As we age, rebuilding new bone slows down and bone density begins to decrease. According to the National Institutes of Health, the amount of bone growth that occurs during childhood and adolescence is just as important a factor in the development of osteoporosis as the loss of bone mass as we age. “Bones grow in size during childhood, gaining mass and strength,” says Dr. Park. “The amount of bone mass you obtain while you are young determines your skeletal health for the rest of your life. The more bone mass you have after adolescence, the more protection you have against losing bone mass later. Think of it as an investment in your bones when young that will pay dividends as you age.”

While there are factors that put some people at higher risk than others for osteoporosis, there are basic guidelines that will help children develop maximum bone mass and help adults slow its loss: get adequate calcium, get adequate vitamin D, exercise regularly, don't smoke, and avoid excessive alcohol consumption.

Calcium is the most important nutrient for reaching peak bone mass. Ninety-nine percent of the body's calcium is stored in the bones and teeth, making up a “bone bank.” Calcium is "withdrawn" from the bone bank daily to support a number of vital body functions and if sufficient calcium is not “deposited” each day via the diet, the bones become deficient in calcium and eventually weaken.
The amount of calcium we need to stay healthy changes over our lifetimes. The Institute of Medicine (IOM) recommends the following amounts of daily calcium from food and supplements:
<1 year     210 to 270 milligrams (mg)
1-3             500 mg
4-8             800 mg
9-18         1,300 mg
19-50      1,000 mg
51+      1,200 mg

Dairy products are one, but not the only, source of calcium. Almonds, broccoli, spinach, cooked kale, canned salmon with the bones, sardines and soy products, such as tofu, also are rich in calcium. Taking more calcium than you need does not provide any extra benefits and may be harmful. Estimate the amount of calcium you get from foods on a typical day then figure out whether a supplement is right for you.

Vitamin D helps the body use calcium and is just as important to bone health as calcium. The National Institutes of Health recommend 400-600 I.U. (international units) of vitamin D for children and 600-800 I.U. for adults. While sunlight is a good source of vitamin D, effective sunscreens -- which are required to reduce the risk of skin cancer -- prevent the production of vitamin D. Most infants and young children in the United States get enough vitamin D from fortified milk. But adolescents and adults often don't consume as many dairy products and may not be getting adequate amounts. And because vitamin D is available in only a few foods -- like oily fish, such as tuna and sardines, and egg yolks -- vitamin D supplements or calcium supplements with added vitamin D are a good option.

Exercise benefits the bones no matter when you start but the gain is maximized for those who start exercising regularly when young and maintain the habit throughout life. Both strength training and weight-bearing exercises are important. Strength training strengthens muscles and bones in the arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, and skiing — mainly affect the bones in the legs, hips and lower spine. Swimming, cycling and exercising on machines such as elliptical trainers can provide a good cardiovascular workout, but because such exercises are low impact, they are less helpful for improving bone health than weight-bearing exercise.

The precise medical causes have not been identified but researchers know that smoking and regular alcohol consumption in excess of two drinks a day also contribute to weak bones. Additional risk factors include family history, some medical conditions and certain medications that can weaken the bones.

The best way to assess the health of your bones is with a bone density test known as "DXA" (dual energy x-ray absorptiometry), a simple, painless, test that takes 5-10 minutes and uses very little radiation. The resulting "T-score" falls into three categories: normal density, low density (sometimes called osteopenia) and osteoporosis. For those with T-scores indicating low density or osteoporosis, medications are generally prescribed to increase bone density or prevent further loss and reduce the risk of fractures.

"Among the risk factors for osteoporosis, there are those you can control -- like diet, exercise, smoking and drinking -- and those you can't control -- like age, family history and medical conditions," Dr. Park concludes. "But it's relatively easy to take good care of your bones and it's never too late -- or too early -- to start. You can take steps to keep bones strong and healthy throughout life and prevent osteoporosis."

Somers Orthopaedic Surgery and Sports Medicine Group, founded in 1988, is one of the most comprehensive and specialized practices in the region. Highly trained physicians specialize in diagnosing and treating all orthopaedic, rheumatological, and pain management problems in adults and children. All surgeons are board certified and experienced, having completed rigorous training at the finest medical institutions in the country. The staff includes fifteen physicians, five physicians' assistants, three physical therapists and a supporting staff of over 100. The group's physicians perform all types of arthroscopic surgery, ACL reconstruction, minimally invasive joint replacement, computer navigation, revision joint replacement, sports care, spine surgery, fracture care, hand, ankle, and foot surgery. State-of-the-art facilities include digital radiology, MRI and ultrasound.

Dr. Jean Y. Park, a graduate of Case Western Reserve University School of Medicine, completed her residency training in internal medicine at University Hospitals of Cleveland and is board certified in internal medicine. Dr. Park furthered her training with a fellowship in rheumatology at New York University/Hospital for Joint Diseases and is board certified in rheumatology. As a fellow at NYU/Hospital for Joint Diseases, Dr. Park was voted "Fellow of the Year" for her excellence in teaching medical students and residents. She has published numerous scholarly research papers and was awarded an international scholarship from the Japanese College of Rheumatology in 2008. Dr. Park is a member of the American College of Physicians and the American College of Rheumatology.

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MELISSA CHEFEC
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