likely to break. Older adults are at increased risk for signs or symptoms. Doctors often diagnosis people with

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1 Osteoporosis: Weak Bones That May Break Easy Read Volume # 18 Issue # 4 May/June 2008 Translated into plain language by Helen Osborne of Health Literacy Consulting Original article by Christina Skoski, MD Osteoporosis is a disease that causes bones to be weak and more likely to break. Older adults are at increased risk for osteoporosis as their bones lose strength, mass and density. This disease can be thought of as silent as there may be no warning signs or symptoms. Doctors often diagnosis people with osteoporosis only after they have broken a bone. Osteoporosis is a concern for people with lower-extremity amputations. One reason is that amputees are at increased risk of falling no matter whether they use prostheses, crutches, or walk unaided. Even amputees good at walking may sometimes stumble or fall, resulting in broken bones. Another reason that amputees are at risk for osteoporosis is that their bones can be under constant stress. The most common fractures are in hip, vertebrae (spine) and wrist bones. An amputee s mobility, Page 1 of 8

2 independence and quality of life can be affected when these bones break. This disease not only affects amputees but also non-amputees of all genders, ages, races and ethnic backgrounds. Post-menopausal women (whose periods have stopped) are at risk. Also, people who have a family history of osteoporosis, eat a poor diet, take certain medications, get little to no exercise, and smoke or drink alcohol are at increased risk for this disease. People should know their risk for osteoporosis and then make lifestyle changes to help prevent it. This article has facts about what you can do. Build your bone bank Many people think that bones are solid and lifeless. But in fact, they are always changing as bone tissue is built up, torn down, and built again. This not only helps heal broken bones but also is why drugs, diet and exercise builds strong bones. It may help to compare this to a savings account in a bone bank. The best time to build bone mass is when you are young (from teenage years to the 30s). Then, our bodies are good at building bone mass and making deposits to the savings account. Later, we make withdrawals when bones break down faster than they build up. Page 2 of 8

3 People with rich strong, healthy bones are better able to deal with bone mass withdrawals that happen as we age. You can help slow down bone density loss no matter what the balance in your bone bank account. Know your osteoporosis risk factors Some people are more likely than others to get osteoporosis. This depends in part on health history and lifestyle (such as diet and exercise). It helps to know your risk. Below are two lists of common risk factors for osteoporosis. One list is for women and the other for men. Talk with your doctor or other healthcare provider if you answer yes to some of these questions. Then discuss tests for osteoporosis and ways to treat it. Osteoporosis risk factors for women Check yes if you: Have a thin, small body frame. Are Caucasian or Asian. Of note, Hispanic and African-American women age 50 or older are also at risk for low bone mass. Page 3 of 8

4 Have broken a bone as an adult (or if someone in your family has had this happen). Eat a poor diet (such as not enough cheese or dairy foods), diet to excess, have anorexia or bulimia, or are diagnosed with malabsorption syndrome. Have low levels of estrogen (female hormone) because of irregular periods, early or surgical menopause, or are post-menopausal. Of note, the fastest decline of bone density happens during peri-menopause (when a woman s hormone level decreases even while getting her period). Take certain medications for asthma, arthritis, cancer, or other chronic conditions. These include steroids, anti-seizure drugs, some types of chemotherapy, antacids (with aluminum), and heparin. Lead a sedentary lifestyle with little to no weight-bearing exercise. Smoke cigarettes or drink a lot of beer, wine, or spirits. Osteoporosis risk factors for men Check yes if you: Are older, as bone loss increases with age. Weigh175 pounds or less. Page 4 of 8

5 Have chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, or other diseases that affect people who smoke. Take certain hormone-blocking drugs to treat prostate cancer. Have low levels of testosterone (male hormone). Ways doctors diagnose osteoporosis The only way doctors can diagnose osteoporosis for sure is with a bone mineral density (BMD) test. The most common is called DEXA which measures density of the hip and lower vertebrae. This test is noninvasive (nothing is put into your body). There are other tests to measure hands, heel and wrists but they are not as common or reliable. Medicare pays for BMD once every 2 years (more often for people at high risk). Ways to prevent and treat osteoporosis Your mother was right! She was helping you build strong bones when she said to eat breakfast, finish your milk, and go outside to play. In fact, studies show that diet, sunshine and exercise are the best ways to prevent and treat osteoporosis. Here are some more facts: Calcium. You need enough (adequate) calcium to build strong bones. The best way to get this is by eating a proper diet. That is why people who diet to excess or Page 5 of 8

6 have anorexia, bulimia or malabsorption syndrome are at greater risk for osteoporosis. Your body absorbs calcium best when it comes from nonfat or low-fat dairy foods such as skim milk, yogurt or cheese. Calcium is also in fortified cereals, orange juice, soy products, tofu, green leafy vegetables, canned salmon and sardines. Most people also need to take calcium supplements. This includes women who are post-menopausal. It is best to take calcium supplements with food in divided doses (not all at once). This is because your body can only absorb about 500 mg at one time. Talk with your doctor before you start taking calcium supplements. Make sure to tell your doctor if you have kidney disease or are prone to kidney stones. Here are the supplement amounts that the National Institutes of Health recommends: Men and women up to the age of 50 should take 1,000 mg of calcium each day. Men and women over the age of 50 should take 1,200 mg of calcium each day. Women who are post-menopausal and on hormone replacement therapy (HRT) should take 1,200 mg of calcium each day. Women who are post-menopausal women and not on HRT or over age 65 should take 1,500 mg of calcium each day. Page 6 of 8

7 Vitamin D. Vitamin D helps your body make use of calcium. One way to get Vitamin D is by being in sunlight for 15 minutes at least 3 times a week. But many people cannot do this. Maybe they live where there is little sunshine, or it is so cold and wet that they cover up with a lot of clothing. Some people do not get enough Vitamin D because they use a lot of sun block lotion (SPF 30 or greater). And amputees may not be in the sun enough because they are sedentary (not active) or have trouble moving around outdoors. To help, most people take Vitamin D along with daily calcium supplements. Exercise. Exercise not only makes muscles bigger and stronger but also helps build dense and strong bones. Any exercise is better than none. For instance, riding a bike or swimming helps increase stamina (energy) and heart health even though it does not build strong bones. Here are two types of exercise: Weight-bearing exercise. This is when your bones and muscles work against gravity. It includes walking, running, climbing stairs, dancing, and playing team or racquet sports. While you may not be a world-class athlete, maybe you can at least walk around the block each day. This advice is for amputees as well as everyone else. Page 7 of 8

8 Resistance training. This can be done by lifting free weights or working out at the gym with resistance machines. Many gyms have special programs for older adults and people with disabilities. All amputees should aim to have good balance and coordination. This helps people recover from a stumble. You can keep your joints mobile and tendons toned when you do activities such as yoga, tai chi and simple stretches. Inactivity is the bane of amputees. Help your bones by getting up and moving any way you can. About the author: Christina Skoski, MD, is a retired Clinical Anesthesiologist with 30 years experience and an active member of ACA s Medical Advisory Committee. She has been a hemipelvectomy amputee since she was a teenager. Translated from Osteoporosis. The silent disease Page 8 of 8