Nora Apothecary

Bone Density Evaluation & Osteoporosis Counseling

Sandra Justice, P.D., FACA
Did you know that Osteoporosis ……..
  • kills more women than cervical and uterine cancers combined?
  • is an epidemic?
  • affects 2 million American men?
  • is now considered a childhood disease?

While many consider osteoporosis a disease that affects the elderly, we now know that if you fail to build enough bone during growth and maturation and/or experience excessive bone loss thereafter you may be at risk much earlier in life. In the United States alone twenty-five million people have osteoporosis and the incidence is expected to double by the year 2020. The disease is responsible for 50,000 deaths each year.

Bone Composition

The interior of normal bone has a spongy, honeycomb-like structure. Contrary to a common misconception, bone is a living substance that is constantly being broken down and rebuilt in a process called remodeling. Specialized cells called osteoclasts remove old bone and create a cavity. Other cells known as osteoblasts fill in the cavity with new bone tissue. If more bone is removed than replaced bones become less dense, therefore weaker and more prone to fractures.

The Challenge

Osteoporosis is a silent disease that can progress without symptoms or sensation until a fracture occurs. Like heart disease, osteoporosis can develop undetected for many years. You may not realize you have osteoporosis until you fracture your hip, spine or other bones. At this point, you may have already lost a significant amount of bone. Most osteoporosis awareness programs recommend bone density measurement testing after menopause. Since bone mass begins to decline around age 35, it is prudent to seek evaluation at an earlier age. Below is a list of risk factors that may call for more immediate action.

  • Being female
  • A small, thin frame
  • Advanced age
  • A family history of osteoporosis
  • Early menopause
  • Abnormal absence of menstrual periods
  • Anorexia nervosa or bulimia
  • A diet low in calcium
  • Certain medications( i.e., steroids, anticonvulsants, excessive thyroid hormones, certain cancer treatments)
  • Excessive alcohol intake
  • Low testosterone levels in men
  • A sedentary lifestyle
  • Cigarette smoking
  • Malabsorption problems

The more risk factors you have the more likely you are to develop osteoporosis and the sooner you should seek evaluation.

Bone Density Scanning

The good news is osteoporosis can be treated and PREVENTED WITH EARLY DETECTION. A bone density scan is a simple and painless way to determine the mass, or density, of your bones. There are a wide variety of scanning techniques available today from those using X-ray technology to ultrasound. Unfortunately most insurance will not reimburse for this test unless you have signs and symptoms of osteoporosis (a fracture). The testing costs range from over $500 for the DEXA scan to $45 for an ultrasound measurement of the ankle. Testing is available through certain physician offices, clinics, hospitals, and pharmacies.

Steps To Optimal Bone Health

Adequate calcium and vitamin D intake, appropriate exercise, and in some cases, medications can work together to reduce your risk for developing osteoporosis. If you already have osteoporosis, these steps can slow or stop bone loss, increase bone density, and reduce your risk of fractures.

Calcium is important for bone health. It is also needed for heart, muscles, and nerves to function properly. If your daily calcium is low, calcium will be removed from the bones to perform these functions. Dairy products, fruits, vegetables, grains, fish, tofu, and calcium- fortified orange juice are good sources of calcium. Recommended daily calcium intake varies according to age from 210 mg/day for an infant to 1200 mg/day for men and women 51 or older.

If you are unable to consume enough calcium from food sources you can make up the difference by taking a calcium supplement. These compounds vary in the kind, purity and amounts of calcium available to the body. Read labels carefully and consult your pharmacist as to which product is the best for you and how much elemental calcium you are consuming. Calcium is best absorbed in small amounts (500mg) taken throughout the day. Drink plenty of fluids and consult your pharmacist about prescription and OTC drug interactions with calcium supplements.

Vitamin D aids in calcium absorption. Vitamin D is formed naturally in the body after fifteen minutes of exposure to sunlight. If you are homebound or in the winter you may need to supplement with at least 400 IU, but no more than 800 IU/day. Food sources include dairy products, egg yolks, saltwater fish and liver.

Exercise is an important part of an osteoporosis prevention or treatment program.
Weight-bearing and resistance-training exercise helps prevent bone loss and strengthens the bones, as well as improving balance, coordination and cardiovascular health. Check with your physician before starting an exercise program. If safety and weather prevent you from walking outdoors you may want to try “mall walking”. Some community centers and schools make their indoor track facilities available after school hours.

Medications can play an important role in osteoporosis prevention. The FDA has approved several medications for prevention and treatment including hormone replacement therapy, biphosphonates, SERMs and calcitonin. Your physician will evaluate your need for these products.

Avoiding Falls is an important way to prevent fractures. Changes in your environment can minimize the likelihood that you will fall. You can remove household hazards by anchoring rugs, avoiding slippery floors, using treads and handrails on staircases, installing grab bars and nonskid tape in the shower, and placing nonskid rubber mats near the sink and stove. Minimizing clutter, removing
loose wires, improving lighting in halls and stairwells, and using night- lights will also help you avoid falls. Wearing sturdy, low-heeled shoes and using extra caution when taking medications that cause drowsiness would be wise as well.

Additional Alternative Therapies

Nutritional support aids the absorption of essential vitamins and minerals and can slow bone loss.

  • Increase intake of complex carbohydrates, essential fatty acids (cold-water fish, nuts, and seeds), legumes, and soy. Isoflavones found in soy may slow bone loss and increase bone building activity. Recommended doses are 30 to 50 mg per day of soy to maintain bone mass.
  • Dark berries (blueberries, blackberries, cherries, and raspberries) contain anthocyanidins, which stabilize collagen found in bones.
  • Magnesium (200 mg two to three times per day) enhances calcium uptake, is necessary for hormone production, and protects the heart. Magnesium may actually increase bone density and may be a more important mineral than calcium for preventing osteoporosis.
  • Vitamin K (100 to 500 mcg per day) helps increase calcium uptake. Foods high in vitamin K include dark leafy greens. Vitamin K may interfere with the drug, Coumadin.
  • Boron (0.5 to 3 mg per day) helps calcium absorption. Women at high risk for breast cancer should use boron with caution.
  • Manganese (5 to 20 mg per day) helps produce the collagen foundation for calcium.
  • Zinc (10 to 30 mg per day) aids normal bone growth. Copper (1 to 2 mg per day) is needed with long-term zinc supplementation.
  • Chromium (200 to 600 mcg per day) should be used in patients with unstable blood sugars.
  • B-complex (50 to 100 mg per day) reduces the effects of stress. Elevated cortisol levels from stress increase bone loss. Take folic acid (1 to 5 mg/day), B6 (100 mg/day), and B12 (1,000 mcg/day).
  • Natural progesterone may be more effective at increasing bone density than synthetic progestins. Natural estrogen may have less carcinogenic activity for the uterus and breast. A physician should monitor blood levels of both. Natural progesterone and estrogen are prepared for individual patient needs by compounding pharmacists.
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