By Bonnie Miller Rubin, Chicago Tribune reporter
August 1, 2012
The best way to reduce risk for osteoporosis — a thinning and weakening of the bones — seems to be the subject of ongoing debate. This month brought a fresh round of questions after a report published in the New England Journal of Medicine suggested that vitamin D is the key ingredient to preventing and reducing broken bones. Dr. Sonali Khandelwal, a rheumatologist and co-director of the Osteoporosis Center at Chicago's Rush University Medical Center, gave us some answers.
Q: A bone mineral density test screens for osteoporosis. How often should women get tested? It seems like there's little consensus.
A: For women going through menopause, we recommend to get one as a baseline, then follow up every two years. Women who are premenopausal or have risk factors like malnutrition or a family history of osteoporosis should do the screening earlier. The frequency is a little subjective ... but we do know thatpost-menopause seems to be the time when bone density will decline the most.
Q: How are test scores reported?
A: As T-scores, which compare the patient's bone density with that of a healthy young woman. A T-score of -1.0 or higher is normal. between -1.1 and -2.49 indicates moderate thinning — or osteopenia — and T-scores of -2.5 or less indicate osteoporosis.
Q: So what do you make about this analysis of multiple studies, showing that those who took 800 units daily of vitamin D were 30 percent less likely to suffer fractures than those who didn't?
A: There's a lot of controversy regarding adequate amounts of vitamin D. My current recommendations, based on NOF (National Osteoporosis Foundation) recommendations, are that post-menopausal women need 800 to1,000 units of vitamin D daily, while pre-menopausal need 400-800 units. Vitamin D is vital for bone health, calcium absorption and muscle strengthening.
Q: So, is the key vitamin D, not calcium? Should everyone be on supplements?
A: It's hard to make blanket statements ... but in general, yes. Vitamin D — unlike calcium — is difficult to get from diet alone. It's needed for the body to absorb calcium and thus an integral part of bone health.
Q: Have I been wasting my time, chomping on calcium chews all these years?
A: No, that is wonderful. But you still need the vitamin D.
Q: If you've been on Fosamax and other biophosphates, is it important for your doctor to give you an occasional drug holiday?
A: Of late, the idea of taking a break has become more important. ... We know that over the long term, these drugs can slow bone remodeling, meaning that the overall bone turnover is reduced or even stopped, thus making individuals at risk for atypical fractures. When to pursue a drug holiday or continue therapy becomes a case-by-case scenario, depending on an individual patient. ... Individuals who have been on long-term therapy or for whom there is a concern, we often use Teriparatide, the only FDA-approved osteo-formative agent.
Q: If you do take a break, how long before you resume the drugs again?
A: Again, there's no consensus, but resuming therapy would be based on repeat bone-density measurements and evaluation of the patient's risk factors.
Q: All these concerns seem to only afflict women. Do men have to worry about thinning bones?
A: About 2 million men are affected with osteoporosis, compared to 8 million women, according to the National Osteoporosis Foundation. Screening is usually started at age 70 for men, however earlier screening should be done in men who have risk factors, including rheumatologic illnesses and certain cancers.
Q: We know if you don't change the oil, your car will break down sooner. So what is the equivalent of car maintenance so bones don't fall apart?
A: First, I'd say diet and nutrition are key. ... One glass of milk has 300 milligrams of calcium and one yogurt has 300. ... So, if you have both of those you're already meeting half of the 1,200-milligram-a-day requirement. Then, I'd add, watch your caffeine intake — which can leach both calcium and vitamin D. Try limiting yourself to three cups of coffee a day. Excessive alcohol and smoking should be avoided, as they can also lead to weakening of the bones. And exercise, of course.
Q: What about exercise?
A: Weight-bearing exercises are very beneficial ... walking, hiking, jogging, running, low-impact aerobics and dancing. For people with osteoarthritis, low-impact aerobics — such as an elliptical machine or Pilates — will help.
Q: I am guilty of mainlining Diet Coke because it satisfied my sweet tooth and I'm convinced its a better vice than eating cakes and cookies. Will I pay a price when I'm older?
A: That's a tough one. Moderation is the key to everything.
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