Our American healthcare system has been described as a sickcare system. The problem is that our current system is all about crisis management and patching things up after the fact. Hundreds of billions of dollars are spent on pills, hospitalization, and disability for problems we can prevent. Sadly, we do not spend enough of our time and resources on prevention, which is our most difficult job. It is up to us to make healthy choices. An ounce of prevention is worth twenty pounds of cure!
In the prevention of fractures, your goal is to decrease your risk of silent bone loss. But you will have to wait many years to reap rewards. “Feeling better” is usually not a big motivator. For me, if I do not exercise every day, my back talks back. For osteoporosis, you do not have symptoms to alleviate. Rather, it is all about having a healthy lifestyle that is good for your overall health and reduces the chances of major chronic diseases.
You may not believe that the simple choices you make in your lifestyle can be as powerful as drugs, but they often are. Although certain risks are genetic, your lifestyle plays a big role in the expression of your genes. You do have some influence over some aspects of the factors that you think you cannot change.
The goal is to modify the risk factors over which you have control. The challenge is to sustain your motivation to make comprehensive changes so that healthy changes become part of your regular routine, and ultimately, your lifestyle.
Age. Age is the strongest of all risk factors. The older you are, the greater your risk of osteoporosis. Regardless of your bone density, the older you are, the more likely it is that you will suffer a fracture. If two women have the same bone density, but one is fifty-five and the other is twenty years older, the seventy-five year old has a greater risk of fracture. Bone microstructure becomes more fragile with age, putting the older woman at higher risk.
You cannot change the aging process, so the goal is to minimize age-related changes.Sex. Women are definitely more likely than men to be at risk. More women than men sustain fractures because women start off with a smaller skeleton at peak bone mass. However, women do not have exclusive rights to osteoporosis. Men fracture, too. Osteoporosis is arguably the most understudied and underdiagnosed disease in men. One large research study, dubbed “MrOS,” is following six thousand men, age sixty-five and older, trying to fill in the gaps.
Race and Ethnicity. Race and ethnicity make a big difference. Caucasians are at the highest risk. Asians, depending on heritage, have similar risk to Caucasians. African Americans have the lowest risk, but that does not make them immune. In general, Hispanics tend to be at intermediate risk. These are broad categorical statements that need to be individualized for your particular family heritage.
Previous Fracture. Once you have had one fracture, the chances of a later fracture are markedly increased. Usually, the previous fracture refers to one after the age of forty-five. However, recent research indicates that children who fracture may be at higher risk to fracture as adults. They may have lower bone mass and never catch up. Fractures in younger adults are also linked to fractures later in life.
Height and Weight. While undoubtedly you have some control over your weight, it is included here with height. A calculation using both height and weight produces body mass index (BMI). BMI is related to bone density. In general, those with lower BMI have a lower bone density and are more likely to be at risk for osteoporosis. The reverse is true as well. Those with higher BMI have a higher bone density and are less likely to be at risk for osteoporosis. BMI may be used as a rough measure in place of bone density, if bone density is not available.
Height and weight are individual risk factors as well. Although we think of small, petite women as being at risk, a height of five feet eight inches or taller is a risk factor. Height is related to the force of a fall—mass that falls from a greater height falls faster and with greater force. When the force is greater than the flexibility of bone, the bone breaks.
Weighing less than 127 pounds puts you at higher risk. You are less likely to have the cushioning on your hips, which helps to distribute the forces in a fall. Being a little bit heavier is better, but too much weight is a problem and may be related to lower bone quality and density, as well as higher risk of fractures of the upper arm, ankle, and lower leg.
Family History. The health history of your grandparents, parents, and sisters and brothers is extremely important. Sharing your maladies might get boring, but knowing the problems and diseases that run in your family is the key to understanding your risk.
In addition, you should be sharing this information with the generation or two younger than you. Although younger people tend to think of themselves as immortal, learning about their health heritage may make a difference in their current health habits.
For instance, if you share with your twenty-five-year-old daughter that her great-grandmother became bent over with age, that her grandmother had a hip fracture, and that you have osteoporosis, she may be more likely to eat more calcium-rich food, take a vitamin D pill, stop smoking, and start exercising.
Do not forget about the men! If your father broke his hip, that is an even stronger risk factor for you than your mother fracturing because men are less likely to fracture. The hip fracture your father had after slipping on ice was not because he fell hard but rather because he had fragile bones. Men are less likely to be diagnosed with osteoporosis.
Other Illnesses or Problems. Other diseases may be the cause of bone loss and osteoporosis. Common to rare disorders make up a long list of diseases that can cause or contribute to osteoporosis and fractures. The following list gives some of the common conditions.
Common Conditions Tied to Osteoporosis
- Diabetes
- Breast Cancer
- Celiac Disease, also called gluten intolerance
- Crohn's Disease
- Depression
- Early menopause before age 45
- Epilepsy
- Hyperthyroidism (overactive thyroid)
- Rheumatoid Arthritis
- Ulcerative Colitis
Although you may have a problem that contributes to bone loss, you can make a difference in your long-term bone health. For example, if you are diabetic, better control of your blood sugars will make a difference for your bone health. Even though you may have other diseases, taking care of yourself and keeping those problems well controlled will minimize their effects on bone, and overall, you will be in much better shape.
Medicines. Some medicines that are helpful in treatments of other diseases have harmful effects on bone. Steroids, such as prednisone, are the most common culprit. Recent observations found medicines commonly used may weaken bones.
Common Medicines Tied to Osteoporosis
- Arimidex® (breast cancer)
- Actos® (diabetes)
- Lexapro® (antidepressant)
- Nexium® (heartburn and ulcers)
- Paxil® (antidepressant)
- Prednisone (multiple uses)
- Prevacid® (heartburn and ulcers)
- Prilosec® (heartburn and ulcers)
- Prozac® (antidepressant)
- Zoloft® (antidepressant)
Falls. Everyone falls. The risk of falls, and injuries from them, rises dramatically for those over age sixty-five. The majority of hip fractures are caused by falls. Falls may play a role in all other fractures, even those of the spine. Falls have multiple potential causes, and it takes a comprehensive approach to lower the risks. You need to “fall-proof” yourself and your home, which is where most falls occur.
Alcohol. As with everything else in life, we have supersized our alcoholic beverages. One “unit” of alcohol is the measure used in the new fracture risk assessment tool (see illustration on page 45). Three or more units a day gives you a black mark against your bones. The good news: One to two units of alcohol a day show a positive effect on bone and fracture risk. In fact, it is better for your bones if you drink moderately than if you do not drink at all.
Smoking. Of course, health reasons abound for not picking up cigarettes and cigars, and osteoporosis is only one of them. Smoking speeds up bone breakdown. In women, estrogen also tends to be lower when you smoke.
Sadly, our youth still view smoking as “cool.” According to the latest survey from the Centers for Disease Control and Prevention (CDC), 20 percent of high school students smoke. They are doing this harmful activity before their bones have reached peak bone mass, so they may not reach their “optimal level.”
Top Factors that Put You at Higher
Risk of Fractures
- Older age
- Being a woman
- Caucasian or Asian race
- Weight less than 127 pounds
- Previous fracture
- Mother or father had a fracture
- Steroids (oral prednisone)
- Smoking
- Alcohol (more than 2 drinks a day)
- Rheumatoid Arthritis
Stacking up the risk factors may cause fractures earlier rather than later; add aging and falls to the other insults and it spells even more trouble in later years. The goal is to lessen the risk factors you can control. Lessen the impact of other diseases on bone health by controlling them. Decrease to the lowest possible dosing necessary medicines that also impact bones. Connect your family history and your bone health. Simple lifestyle changes will lessen your risk and promote a healthier lifestyle.
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The Bare Bones
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