Bone Health Awareness
Bone health awareness in peri and post-menopausal women is crucial in the prevention of osteoporosis and bone fractures. Thirty percent of women with a hip fracture will die within one year. The number of women who have hip fractures exceeds all cases of heart attacks, stroke, and breast cancer combined. Lifestyle and screening play an important role in the prevention of osteoporosis.
Important lifestyle choices to prevent osteoporosis include adequate dietary calcium intake and vitamin D supplementation. Bone density falls when bone breakdown exceeds bone formation. Maintaining an adequate level of calcium in the blood will likely prevent removing it from the bones. The question is how much calcium does one really need? The previous recommendation of 1000mg/day for women ages 50 and under and 1200mg/day for women over the age of 50 has been challenged recently by many health authorities. Multiple studies have shown that supplementing at this level increases the risk of kidney stones and heart attack and does not prevent hip fractures. Obtaining calcium through the diet, however, does not pose similar risks. More recent guidelines suggest 500-700mg of calcium obtained through the diet is best. Foods high in calcium include broccoli, kale, bok choy, figs, oranges, sardines, salmon, shrimp, dairy products and fortified foods. Vitamin D, also essential for building and maintaining healthy bones, is best acquired through supplementation. Vitamin D is made in the skin through the exposure to UV light. The amount made decreases with age, use of SPF, and darker skin. To maintain vitamin D levels in the range required to maintain healthy bones 800-1000 IU daily is recommended. Other lifestyle choices which reduce the risk of osteoporosis include weight-bearing exercise, smoking cessation, minimal alcohol intake, and strategies for fall prevention.
To determine one’s risk for osteoporosis FRAX is frequently used. This algorithm considers age, sex, height, weight, medical history, smoking, alcohol use, medications, and demographics to determine risk of fracture. If the 10-year risk of a hip fracture is less than 3% and/or a general fracture less than 20%, screening with a DXA (bone density testing) is not necessary in women under 65 years of age. Women 65 and older have increased risk for fractures, osteoporosis, and high-risk scores and should have a baseline DXA test. This is in accordance with the most recent USPSTF guidelines.
Osteoporosis is treated with drugs that prevent the breakdown of bones. This class of medication has both risks and benefits and there is considerable debate about their safety and efficacy in early osteoporosis. Women who took hormone replacement therapy (HRT) in the WHI study between 1993-1998 demonstrated significantly reduced hip fracture rates compared to those who took placebos. This study also concluded that women who took HRT for 5-7 years did not demonstrate an increased risk of heart attacks or cancer in the 18 years of follow-up. HRT in post-menopausal women may be one of the most effective measures in preventing or delaying the development of osteoporosis.