Archive for Osteoporosis
You may have heard in the new recently, that a recent study on Vitamin D did not show any benefit for bone health in post menopausal women.
I want to point a few things out however, before you stop your supplement, thinking it is not doing any thing.
- This study was done in a small group of women.
- It only last 1 year.
- It compared women taking 800 IUs of Vitamin D3, and those taking 50,000 IUs of Vitamin D3, and women taking a placebo.
The study did show there was greater absorption of calcium in the high dose supplement group, but it did not show any increase of bone density or muscle mass. Additionally, the sit-to-stand test was also unchanged.
It is important to understand that this study was only done for a year, and this may very well not be long enough to see a change of bone density. And it was done on a small sampling of women.
It is also important to understand that levels of Vitamin D above 30 ng/ml is felt to have benefit for muscles, brain, colon. You may not need 50,000 IUs, but I still adhere to a daily 2,000 IU tablet.
It does seem that small studies are released regularly with conflicting information. What is important to remember, is that we need strong bones that won’t break when we fall. We need strong muscles to give us strength, stability and balance; to help prevent us from falling.
We can accomplish this with a diet high in calcium and Vitamin D, supplement when our diet is lacking these important nutrients. And we can further help ourselves by exercising both aerobically for our hearts, and strength training for our strength and balance.
I know, as you stand in front of the calcium supplements your medical provider has urged you to start taking; your mind goes blank and confusion sets in.
It sounds so easy, “start taking calcium supplements daily”. “Ok” you say, that is one health action that seems easy for you to initiate. Until you stand before the mind boggling array of supplements available.
This post will hopefully make your decision easier.
The first thing to do is acquaint yourself with how to determine the amount of calcium you may be getting in your foods and beverages. This is easy if you are consuming something with a nutritional label on the container. Reading the nutrition label, you will see on the very bottom a percentage of calcium provided. This percentage is based on 1000 mg recommended by the FDA daily. Take that number and multiply by 10; that is the mg provided in that serving. For example, the yogurt I eat at lunch, Fage, lists 15% in the one serving container. So that provides 150 mg.
We menopausal women need between 1200-1500 mg a day. It is hard to get all that in the diet. For instance, milk provides a whopping 300 mg per 8 oz glass, but you would have to consume4-5 glasses a day to get the total recommended amount. That is a lot of calories, and most weight conscious women are not going to consume so many calories in milk.
Cheeses, especially the harder ones, provide a good amount of calcium. Greens also have calcium and this is harder to quantify. My ballpark estimate is a cup of cooked greens probably has 75 mg of calcium. Many foods and juices are now fortified with calcium, so this can be an easy way to get a good bone building serving of calcium(and Vitamin D). The NIH has a decent list of calcium content of foods for you to tally.
You get the picture, look at what you consume, add it up. The difference between what you get and what you need can be made up with supplements.
Ok, which supplement?
The most common forms are calcium carbonate, and calcium citrate.
Calcium Carbonate is the most common form of supplement, and the form used to supplement foods and juices that do not contain dairy or calcium naturally. It has the highest amount of elemental calcium, but is the hardest to digest. It requires more stomach acid to absorb, something that can be difficult as we age as stomach acid production can decrease for some people with aging. Additionally, if you take a heart burn medicine, you also may not absorb this form of calcium as readily.
Calcium Citrate is the second most common form. It is easier to absorb, but you do have to take more tablets as it has a lower percentage of calcium. You can take it on an empty stomach; and many supplements have the bonus of adding Vitamin D to it.
Calcium Phosphate has a high percentage of calcium but is not as easily absorbed as the above two. It is not as common and may produce more gas and constipation as other forms.
Many people like the idea of Coral Calcium, as it seem natural. It is basically a form of calcium carbonate derived from fossilized coral reefs. The manufacturers have made many health claims that have never been proven. Additionally, I have issues with using a resource that is endangered, as living coral reefs are.
Oyster shell calcium can also be a favorite as it is derived from a natural source. These forms have been found in some cases to contain high levels of lead and other toxic metals.
A new form of calcium supplement, KoAct, has had some mention in the medical press. It is a branded calcium collagen supplement that in a small study, showed improved reduction of bone loss as compared to an equivalent dose of calcium carbonate and vitamin D. Call me a sucker, but my recent bone density revealing osteopenia has me taking action. I am giving this supplement a try and have found it to be tolerable and not causing the common problems of gas and constipation.
As you try different supplements for tolerability, try to add some calcium in your diet. I usually suggest to my patients that they take a supplement containing 400-500 mg of calcium morning and evening. Then eat something with calcium mid day, like yogurt or cheese stick. If you eat cereal in the morning, use 8 oz of milk and drink it all. Then take your supplement at lunch and after dinner. You can easily switch it around, but you cannot take it all at once. Your gut can only absorb up to 500 mg of calcium at a time, so it has to be spaced out. When someone wants a specific recommendation, I will often suggest Caltrate twice daily. Its a good supplement of calcium citrate with vitamin D, is easily tolerated and affordable.
We need calcium for many functions within the body, including heart, blood vessel, and muscle function. What we don’t get in our diet, our body will take from the bones to fulfill this need. As we age, our bone making cells within the bone slow down. So you can see how a deficit can occur.
Take your calcium, and remain strong and mobile as you move through menopause and beyond!
Sleep is powerful medicine and as our sleep deprived society continues, research continues to reveal to us how lack of sleep is seriously affecting our health.
A recent study published in the Journal of Clinical Endocrinology and Metabolism supports the importance of sleep. A study performed in Taiwan involving over 1300 people diagnosed with Obstructive Sleep Apnea revealed that these patients had more than twice the rate of osteoporosis compared to an equal group without a diagnosis of OSA. All other potential contributing factors were eliminated or adjusted for.
Osteoporosis is a significant health risk for all aging women, and many men. It can lead to hip fractures and immobility, further declining our health. The reduced amount of oxygen distributed to the bones during the poor sleep associated with OSA was felt to be the causative factor.
Obstructive Sleep Apnea is a problems often associated with aging and the relaxation of supportive structures within the throat and mouth. This loss of support can cause obstruction of the breathing airway as we sleep, lessening the amount of oxygen that reaches our lungs and as a result, our blood stream. This lower oxygen can then cause the heart to work harder to deliver oxygen to our tissues for metabolism. Lower oxygen means less healthy metabolism, including in our bones.
The researchers of this study admit that although the exact mechanism of this increased incidence of osteoporosis is not known, there still appears to be a high association between OSA and osteoporosis that is important to keep in mind.
Helping to improve your life style to avoid both OSA and osteoporosis includes a healthy plant based diet to control weight, as well as ensuring consumption of calcium and Vitamin D. Smoking cessation helps improve the function of lungs. Exercising will do the same as well as control weight and help stimulate bone forming cells to lay down new calcium.
If you have OSA, or poor sleep that includes snoring; it is important to be evaluated and treated. This will decrease stress on the heart, improve lung function, improve sleep quality and energy; and now to help preserve healthy bones!
Do you feel you are a slave to pumping in those large calcium pills morning and night? Perhaps you forget them then worry about your bone health. If you can identify with this, I have good news for you. Recent studies and articles are questioning the safety of high dose calcium supplementation.
Several months ago, a study published and talked about in the news shows, make the claim that vitamins can cause heart disease. Perhaps you remember your favorite evening anchor person warning you to be careful about taking those vitamins. At that time, this study from Germany showed a relationship between increased heart attacks and consumption of high dose calcium supplement. It did not show the same events for calcium intake through foods rich in calcium.
Many of us want to maintain strong bones as we age and are in a quandary on what to do regarding calcium. Your may be lactose intolerant and cannot take dairy. Or, like me, you may not like greens. So what to do?
A recent study out of Sweden gives a different picture to the health of calcium supplements. These researchers looked at data from more than 60,000 women that had been enrolled in a different study. They took anywhere from 500 mg to 21oo mg of calcium. It was found that the highest percentage of death from heart events occurred with consumption of more that 1400 mg daily and less than 600 mg daily. Women taking more than 1400 mg of calcium daily from both supplements and through diet were found to have a higher risk of death from cardiovascular causes.
Now the big question is why heart disease can occur with something as benign as a vitamin or supplement like calcium tablets. Calcium can collect in walls of arteries and in cholesterol plaque which is also within the walls. This calcium deposition can make artery walls stiff, leading to problems with blood flow through them.
Calcium supplements create a dose of calcium absorbed at one time, theoretically flooding the system with calcium. What is not taken up by bones will have to go somewhere, and that may be the artery wall. Calcium consumed through food is generally not as high a dose, is absorbed more slowly as other nutrients and fiber can be associated with its absorption. This may have a different dynamic to the management of calcium. Researchers in the Swedish study postulate that too little or too much calcium throws off calcium homeostasis and therefor is not metabolized as well.
What should you do with this information?
I would glean from these 2 studies that consuming calcium a few hundred mg at a time, say 200-300 mg is safe. Perhaps do this 3, maybe 4 times a day. Try to get at least half of this through food. Do not take large doses in one sitting to get taking it out of the way.
Whether or not you have any osteopenia or osteoporosis, staying active with weight bearing activity as much as you can is wise. Take the stairs several times a day. Park one place and walk from store to store when doing errands, if safe to do so! Take vitamin D or eat Vitamin D rich foods.
Its’ hard figuring out what to do as we age. There seems to be conflicting information daily on what to and not to do. Sticking with whole, natural foods; and using some common sense and restraint with other unhealthy foods is a lose rule that is generally reliable to stick to!
The search for new and better regimens for treatment of osteoporosis continues with studies looking at different combinations of standard osteoporosis drugs. There has been some recent promising advancement with bone health. Recent studies have shown a significant increase in bone density with combined use of Forteo with either Prolia or Fosomax.
The usual standard treatment for osteoporosis involves use of bisphosphonates such as Fosomax, but many women cannot tolerate this due to problems with their stomach or esophagus.
Prolia is a medication used for women with severe risk of osteoporosis and has been used for many years to prevent metastatic spread of cancer to the bones. It works at building bones by inhibiting breakdown of bone, much as Fosomax or alendronate do.
The quandary has always been how to build bone by activating bone making cells. This is where Forteo is used. Forteo is an injection medication containing a synthetic form of the hormone PTH, which stimulates the bone making cells.
Recent studies have shown that when these drugs are used in conjunction with one another, significant increases in bone density are seen. All of these medications have significant side effects, so it is still advisable to work at preventing osteoporosis by diet and exercise.
Weight bearing exercise is beneficial at stimulating bone formation. Consuming adequate calcium, about 1500 mg a day is recommended. This can be done through supplements and calcium rich foods such as dark greens, almonds, salmon and dairy products.
Recent studies had advised that calcium supplements can cause heart attacks but recent re-examination of this data is refuting that finding. So it is now felt most likely to be safe to take those supplements if you are treating or trying to prevent osteopenia and osteoporosis.
Preventing and treating osteoporosis begins with working on you bone health. If you are doing all you can do and still losing the fight for healthy bones, talk to your provider about these options if you are at risk for osteoporosis. You can click on this link to use a tool to calculate your risk for developing osteoporisis.
Medical recommendations from the experts can sure get confusing!
First, in an effort to decrease breast cancer mortality,we are urged to get our mammograms yearly. Then, a government over-site group says, well maybe not yearly and not starting at 40. Now we can add calcium supplements to the dilemma on how to stay as healthy as possible while we age!
We’ll save the mammogram discussion for another time, but what do we do about keeping our bones strong and healthy as we age? You may also be wondering how on earth a calcium supplement can be dangerous!
Most of the information we have regarding this issue comes from the Women’s Health Initiative. This was a very large study including peri and post menopausal women that is still ongoing in terms of collecting data. The most well known reason for the study was to prove that taking Hormone Replacement Therapy would decrease the risk and occurrence of cardiovascular events such as MI and stroke. As most readers are aware, this was not only not proven but HRT was found to increase risk of heart disease in a subset of women.
In addition to effects of HRT, many other lifestyle issues were looked at. One of these was the benefit of calcium supplements and dietary calcium on bone health; as well as possible effects on cardiovascular health. A recent analysis of this data performed by a research group in New Zealand, raised the concern that calcium supplements were associated with an increased risk of MI. They found that women within the study who took upwards of 2,000 mg of calcium in form of supplements, had an increased risk of heart attack by 13-22%!
A more recent study published last week looked at data from a German study of women aged 34-60, confirmed this increase in risk. Their analysis suggested calcium supplements increased risk of MI by 86% whereas increased dietary calcium lowered risk of MI.
It is this recent study that had news media talking about risk of supplements and whether women should take them or not. Now to the question of how a calcium supplement could be harmful to you.
It is felt that when a woman takes a calcium supplement in the 500 mg range, as most of them are, there is a flooding of calcium into the blood stream. This causes a quick boost in available calcium, however the body is not designed to utilize this much calcium this quickly. The bones cannot soak it up that fast, so where does it go? Some is excreted in urine, but a significant portion can be deposited in areas of inflammation along to blood vessel walls, helping to form plaque. It is this plaque that can block the flow of blood through the blood vessel, think debris that forms in the pipes of your sink. That plaque can eventually rupture, causing a heart attack or stroke if the blood vessels involved are supplying the heart or brain.
When you consume small amounts of calcium throughout the day in your diet, you do not get the flooding effects. First, most of us don’t consume that amount of dairy in one sitting. Additionally, when consumed with food; there is fiber which slows the absorption. It is true that people that over consume dietary calcium by drinking gallons of milk a day, have some of these same problems. But that situation is rare.
How much calcium do we need? Menopausal and post menopausal women need 1200-1500 mg of calcium daily, preferable spread through the day and with Vitamin D3 added at some point.Here are some ways of getting calcium:
- 8 oz of skim or 1% milk provides 300 mg, higher fat content the less calcium available.
- 8 oz of yogurt provides 150-300 mg depending on brand
- 2 oz of cheese 150-300 mg or so, depending on the cheese
- greens such as collard, spinach, kale, bok choy and broccoli; usually 1/2 cup, 100-150 mg.
- almonds 1 oz (15 almonds) 75 mg.
- soy beans or white beans, 1/2 cup provides 100 mg.
There are many items that are calcium fortified and these are probably fine as the amount is not usually over 300 mg per serving.
To figure out how much calcium is in a serving of packaged or bottled item, you look at the nutritional label. This will provide the calcium in a percentage. The percentage is based on 1000 mg per day average recommendation of calcium intake for all people. So if your package of cheese states 2 oz of this cheese provides 35% of recommended daily calcium; you multiply that by 10 (just add a zero to the number) and that is the mg amount. In this example, 35 x 10 is 350; so 350 mg of calcium is provided in 2 oz of this cheese.
So what does someone do who doesn’t like or is intolerant to dairy? In this situation, it would be best to increase consumption of greens, as well as add tofu and almonds. One could perhaps utilize some to the calcium fortified cereals, breads and drinks.
It is important to realize that the trade off for lack of calcium consumption, for whatever reason, is possible crippling bone disease in later years. Look at your diet, add up the calcium you consume and figure out ways to safely increase this consumption if necessary.
Osteoporosis is most often thought of as an illness for older, menopausal women; and this is certainly when it is most often discovered. It can, however, be an illness that comes to fruition after a life time of dieting and strict attempts at weight control.
There are many more young women who are athletic, as compared to past generations; which is a good thing. As athletic scholarships to colleges have become available to young women, the growth of women’s sports and numbers of female athletes have grown exponentially in the past 20 or so years. While this has led to more opportunities for young women, there is a potential medical problem developing called the Female Athlete Triad. This is a condition recognized by the sports medicine community that involves diet restriction, amenorrhea (lack of menses); potentially resulting in osteoporosis or osteopenia.
Currently, there is a push to do a better job by athletic departments, of screening and educating women athletes regarding diet and nutrition.
This lack of bone density is a problem not only because of potential fractures at a young age, but also the impact on the future older skeletal system. The bone density acquired by age 30, is often the bone density sustained through the remainder of adulthood until menopause. So if you arrive at menopause with osteoporosis, your chance of a hip or back fracture is much higher as your bones are surely to become more osteoporotic.
You may wonder why these young women have inadequate bone density at their age, especially since they are athletes. Many people cannot tolerate, or cannot adequately digest milk. Additionally, eating disorders among High School and College age women are very common; and body image can become overly important even for women athletes. Milk is often avoided due to the caloric content, which robs young women of a calcium dense source. The rigors of varsity sports are sometimes not adequately balanced by healthy nutrition, especially if not supported by coaching staff.
We women often don’t become concerned with these issues until we are post menopausal, and realizing a fall may be much more serious than the embarrassment alone.
It is important that we educate and become good role models to our daughters, granddaughters, nieces and others.
Talk to the young women in your life that calcium is important, and necessary for strong bones; and best obtained through dietary sources.
Support young women athletes you know and encourage them to be comfortable with their bodies. Encourage them to work to improve strength and stamina in their sport; and not to focus on being slender.
We all want to look and feel good, but there are too many mixed messages in today’s multimedia world. It can be difficult for young people to sort it all out, and keep a healthy reality in mind.
Last week there was quite a bit of discussion in the various new media groups regarding osteoporosis and medications. The short version pushed by the news media was that medications for osteoporosis can cause fractures of the thigh bone.
While these sorts of fractures can occur and are no laughing matter, this simplification is not exactly accurate.
Our bones are made up of many living cells, some that make bone and some that break down old bone. This is meant to be a balance that maintains our bones as healthy with new, strong bone. Estrogen helps to stimulate the bone making cells; Vitamin D helps us to absorb the calcium we need for these bone making cells to make strong bone. As we move through menopause, the lower levels of estrogen cause these bone making cells to slow down. Meanwhile the bone destroying cells continue at their steady rate, breaking down the old bone. What you end up with is more in the loss column and less is the new column; like a business that pays out more in bills than it takes in as revenue.
Moving on to the medication for osteoporosis; drugs like Fosomax, Reclast, Actonel to name a few. This class of osteoporosis medications work by slowing down the destruction phase of bone remodeling, allowing a balance between destruction and formation to be achieved once again. When these medications were first released, they did represent a tremendous help to many women with osteoporosis. After all, there was not much treatment available other than supplements and vitamins. These medications were felt to be life changing for women at risk for a hip fracture. What has come to life, however, is the knowledge that these drugs can affect bone in different parts of our bodies, differently.
When taken for more than 5 years, some women are at risk for a fracture in the thigh bone. This is normally an area not affected by osteoporosis, unlike the wrist, spine and neck region of the upper thigh nearest the hip. For reasons yet unknown, the mid portion of the thigh is weakened by these medications in a very low percentage of women; thus resulting in painful fractures. Additionally, in rare instances, these medications have been shown to decrease blood flow to the jaw bone, resulting in osteonecrosis or bone deterioration.
When reading or listening to reports such as this, it is no wonder we are hesitant to start medication. After all, we can’t feel osteoporosis until it is too late and we sustain a fracture.
What do we do?
Don’t stop your medication until you talk with your medical provider. Discuss your risks of osteoporosis and make sure you understand all that you can do to improve your bone density. You are most likely safe to take these medications for 5 yrs, then stop to let the bone destroying cell have a chance to get rid of old bone.
Get your bone density study done at a reputable radiologic facility with an approved DEXA scanner.
Do weight bearing exercise daily, this stimulates bone making cells.
Get the proper amount of calcium and Vitamin D to make sure the bone you are making is strong bone.
When you listen to the lay press discuss these issues, make sure you understand that while they feel they are relaying important information to consumer; they are also selling stories. Talk with your medical provider before assuming the worst case scenario.
In this segment I review the dietary needs of a menopausal woman to meet the demand for protein, calcium and other minerals and Vitamin D3 to keep bones strong. I also recommend exercise to stress the bones so the body will strengthen them. This does not have to be vigorous but it does need to involve use of large muscle groups long enough on a regular basis. Look at the video – I have hosted it in an unlisted status on YouTube. You have to click on the link below to find it. It is “Unlisted” on YouTube. Only people that have the URL – that would be members of my site and their friends ( that I hope will also become members since the gift of membership will end this year). Enjoy the last part of this 3 part series and then leave me some comments and questions below. I am interested in knowing if you have had a bone density scan? How about a fracture of your arm or leg or spine since turning 50? What questions do you have? How could I do this better?
Here is the link Menopause and Osteoporosis part 3