Beyond Diet: Measures to Prevent Bone Loss
While diet and calcium intake are the foundation for maintaining bone density, they work in concert with other factors. Exercise, hormone therapy and medications all have their place in combating this disease. Your health care provider can discuss the options and combinations that would work best for you, depending on your risk profile and physical health.
Exercising as Prevention
You probably didn't hear it here first, but exercise is an absolute must for a healthy life — and a healthy passage through menopause. Exercise plays a particularly important role in protecting your bones. Studies have shown that weight-bearing exercise builds strong, healthy, resilient bones and can slow the progress of bone loss. Walking, one of the most popular forms of exercise, seems to be particularly helpful in encouraging new bone growth. Exercise not only helps maintain your bones' health but also keeps your joints and muscles flexible and strong. Those improvements alone go a long way toward helping you prevent fractures caused by falls.
Most health care professionals recommend thirty minutes of weight-bearing exercise — such as walking or other moderately intense physical activity — three days a week, as part of a total exercise program that also includes aerobic and stretching exercises. If you go with a weightlifting program, make sure you get the help and advice of your health care professional in planning a program that will offer you the maximum benefit and the minimum risk of strain or injury.
Exercise alone won't prevent osteoporosis. But if you combine a sensible exercise program with a well-balanced diet (remember those high levels of calcium and vitamin D) and avoid smoking and excess alcohol consumption, you'll go a long way to preserving your bone health, even after menopause.
Fact
In addition to weight-bearing aerobic exercise, weight training (also called resistance training) can slow down the loss of bone and even increase bone mineral density. It also shows some evidence of improving balance, possibly from better muscle tone, thereby decreasing falls. Check with your health care provider, and then take a class in free weights. It could make all the difference!
Using Estrogen for Bone Health
Diet, exercise, and nutritional supplements can all slow the bone loss your body experiences after menopause, but they can't stop it. However, most doctors agree that estrogen therapy can halt bone loss during this time and may actually contribute to bone growth. Estrogen helps to activate the vitamin D in your body to enhance its ability to absorb calcium. It also promotes the production of collagen in your system that aids in the development of bone strength and flexibility.
Menopause hormone therapy (MHT) has been shown to reduce bone loss, increase bone density in the spine and hip, and reduce the risk of hip fractures in postmenopausal women. If you are approaching menopause, talk to your health care professional about the benefits and risks of estrogen for the prevention of osteoporosis after menopause. MHT is also beneficial for the eyes, colon, and joints, so try to discuss all these benefits with your physician.
Alert
Some medications, such as corticosteroids, thyroid hormone replacement medications, and anticonvulsants, can contribute to bone loss. If your doctor prescribes these medications, be sure you have discussed your family health history and personal risks for osteoporosis.
Other Options for Slowing Bone Loss
If you are not a good candidate for MHT, and diet and exercise are not enough to keep your bones strong, you still have more options in the battle against bone loss. There are medications available that can slow the reabsorption of bones into your body, and are worth discussing with your health care provider.
Bisphosphonates
Bisphosphonates are anti-resorptive medications like alendronate (Fosomax) and risedronate (Actonel) used to slow down or block calcium loss from the bones. They are available in daily, weekly, or monthly dosages, and can be very effective in slowing bone loss. Other medications and supplements can interfere with their effectiveness, so it's best to take them in the morning before any other medications and with lots of water. They can have side effects such as irritation of the esophagus and osteonecrosis of the jaw, so discuss with your medical provider whether you would be a good candidate for these medications.
SERMs and “designer” estrogens
In addition to estrogen, some “designer” estrogens, including raloxifene and the bisphosphonates alendronate and risedronate have been approved by the Food and Drug Administration for the prevention and treatment of postmenopausal osteoporosis. Though these drugs don't share estrogen's other benefits, they may help to maintain bone density and represent a welcome alternative to estrogen for women who want a sound defense against osteoporosis, but who cannot or choose not to take estrogen in MHT (see Chapters 11 and 12 for a full discussion of HRT and its alternatives).
Fact
Calcitonin is the hormone your parathyroid gland produces to help control bone loss. The FDA has approved calcitonin, available in a prescription nasal spray, for treatment — not prevention — of osteoporosis.
Alendronate, risedronate, and raloxifene have been shown to reduce bone loss, increase bone density, and reduce the risk of fractures, just like estrogen. Raloxifene is among the newest of these designer estrogens, and it may offer some of the most attractive benefits. Raloxifene comes from a relatively new class of drugs called selective estrogen receptor modulators (SERMs) that prevent bone loss. According to the National Osteoporosis Foundation, early tests have shown that raloxifene increases bone mass and, after three years of use, can reduce the risk of spine fractures by about 50 percent.
Whether you choose to use natural estrogens, bisphosphonates, or designer estrogens to prevent postmenopausal bone loss, your doctor or health care professional is your best source of advice and information for making this important decision. But don't depend on either approach as your only solution for staving off bone loss. No matter what type of medications or supplements you take, a healthy diet and regular weight-bearing exercise are important components of your anti-osteoporosis arsenal.
Alendronate is an FDA-approved bisphosphonate that helps slow the breakdown of bone tissue that occurs in osteoporosis. It is available in both daily and weekly dose formulations.
Risedronate is a drug that inhibits the body's ability to reabsorb bone tissue, and thereby slows bone loss.
Calcitonin is not really a nonhormonal treatment for osteoporosis but rather a hormone produced by the parathyroid gland and helps slow bone loss by slowing bone reabsorption, in a process similar to the previous two drugs in this list. It is offered as an injection or nasal spray.
Raloxifene is an artificial hormone used as an alternative to estrogen. This medication has shown effectiveness in conserving bone mass, but does have a number of side effects, and is often a second choice to estrogen for women at high risk of osteoporosis.
