Danger of Brittle Bones_01

(Compilation)
People tend to think of their bones as an unshakable foundationa strong and solid support
system for the muscles and inner organs. However, our skeletal structure isn't solid at all, but
composed of living, growing cells. Our bones depend on a dynamic balance of available
minerals (such as calcium) and the hormones that control mineral absorption, to stay strong
and healthy well into old age.
Osteoporosis, the condition that turns so many older women, and some older men, into
smaller, shrunken, weakened versions of their former selves, is not inevitable. It is possible to
grow older and still stand tall, walk confidently, retain strong bones, and enjoy a great deal of
physical strength. Today, people can benefit from both increasing medical knowledge about
how to ward off this disease and some promising new medications that treat it.
Osteoporosis can often be prevented, or at least minimized, by simple improvements in
nutrition and exercise before bone loss begins, generally around age 35. For those already
affected by loss, medication therapy and other preventive measures can curb or even reverse
bone loss, and minimize the risk of disabilities.
Though 28 million Americans, mostly women, are affected by thining bones or outright
osteoporosis, surveys show that most (3 out of 4) women from ages 45 to 75 have never
spoken to their doctor about the disease. This is a missed opportunity, because there is now a
great deal medical science can do to help halt the progression of this disease. This chapter
outlines steps you can take to strengthen your bones and contribute to your better overall
health and well-being.

The Framework: Understanding Bones

Bone cells, which store 99 percent of the calcium in our bodies, are continuously breaking
down and building up, in a process called remodeling. The cells, which are interlaced with
nerves and blood vessels, both collect calcium molecules from the bloodstream and release
calcium back into circulation. The retained calcium adds to bone mass and keeps the skeleton
strong.
As we age, the balance of retained versus lost calcium tends to tip in the wrong direction, with
more calcium leaching out of our cells than is taken in. Losing a certain amount of bone mass
is therefore a natural result of the aging process. However, after menopause, lower estrogen
levels cause an accelerated rate of bone loss in most women, making them vulnerable to
osteoporosis.
In osteoporosis, the bones become progressively more porous, making them more likely to
break. Imagine osteoporotic bone as a honeycomb or Swiss cheese, and you can understand
how the slightest trauma can cause debilitating bone fracturestypically occurring in the hip,
spine, and wrist.
Since the loss of crucial bone mass usually occurs without symptoms or pain, osteoporosis can
go undetected for yearsuntil a fracture occurs. In young people, a broken bone usually heals
itself in a month or two, but in later years the process is slower and some fractures never fully
heal. A woman's lifetime risk of developing a hip fracture is equal to her combined risk of
developing breast, uterine, and ovarian cancer. Hip fractures leave many women permanently
disabled; and within 6 months following the injury, between 15 and 20 percent of patients will
die because of a hip fracture and its complications. One in 3 women over 50 suffers vertebral
fractures, which can lead to height loss and a stooped posture.

When the lifelong process called bone remodeling

slows, calcium leaches out faster than bone cells can
restore it. The result is an increasingly porous
skeletal structure given to tiny fractures you may
never notice. As the disease progresses and bone
density declines, major fractures of the hip, spine, or
wrist become ever more likely.

Hormones and Bone Strength

Our body balances the two processes of building new bone and removing old bone through the
actions of a variety of hormones, including estrogen. The steep decline of estrogen in women
after menopause seems to be an important reason why osteoporosis is much more common in
women than in men.
Estrogen plays a dual role in bone metabolism: It facilitates the absorption of calcium from the
blood into the bone and inhibits the loss of calcium from the bone. Bone density peaks in
women about age 35. After this time, and especially when estrogen levels drop after
menopause, bone loss exceeds new bone formation.
Normal estrogen levels help to ensure an adequate level of calcium in the blood, which, in
turn, influences muscle and nervous-system functions. As estrogen levels decline, calcium
blood levels can drop excessively, stimulating the production of another hormone called PTH.
This hormone, which is secreted by the parathyroid gland, then triggers the leaching of
calcium from the reservoir in the bones. This corrects the deficit in the blood, but does it at
the expense of bone health.
Bone loss accelerates after menopause, but varies considerably among individuals, for there is
a wide variation in blood hormone levels among postmenopausal women. A woman can lose
from one-half to 6 percent of her bone mass per year. This percentage may be even higher for
women who experience surgical or chemically induced menopause, in which the estrogen
supply is abruptly cut down. By the time a woman is 80, she can easily have lost 40 percent of
her bone mass.

Are You at Risk?

The risk of developing osteoporosis varies according to a number of factors, including sex,
race, weight, and family history. People who enter midlife with light, thin bones have a smaller
margin of bone mass that they can safely lose, and are therefore more vulnerable to bone
disease.

Risk Factors You Cannot Control

Gender. Women generally have lighter, thinner bones than men. At age 35, men have 30
percent more bone mass than women, and they lose bone more slowly as they age. In
addition, the decrease in estrogen production that occurs during menopause automatically
puts women in the high-risk group for developing osteoporosis.
Race. Caucasian and Asian women have lower bone density than blacks by as much as 5 to
10 percent. Until recently it was thought that Caucasian women were at greatest risk for
osteoporosis, but a recent large-scale study has found that Hispanic, Asian, and Native

American women are at least as likely to have low bone mass as Caucasians. And one-third of
African American women are also at risk.
Build. Having a delicate frame or weaker bones predisposes you to a higher fracture risk.
Overall muscle tone also plays a role in the likelihood of sustaining an injury.
Onset of menopause. Undergoing early menopause, naturally or surgically, increases a
woman's risk because she experiences reduced levels of estrogen for a longer period of time.
Due to the abrupt cessation of estrogen production that accompanies surgical menopause,
women whose ovaries are removed (69 percent in one study) tend to show signs of
osteoporosis within 2 years after surgery if nothing is done to prevent it. When medically
possible, doctors recommend keeping your ovaries intact in order to maintain estrogen
production, even if a hysterectomy (removal of the uterus) is necessary.
Heredity. Having a close relative with a diagnosis of osteoporosis or its symptoms (height loss
or multiple fractures) increases your risk. Body type, as well as a possible genetic
predisposition to osteoporosis, can be passed from one generation to the next.