Michael L Gross, MD  
Male, 64
Hackensack,Westwood, NJ

Specialties: orthopedic surgery, sports medicine

Interests: Orthopedics, Knee and Shoulder Arthroscopy
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Nine Steps to Healthy Bones

Apr 27, 2011 - 2 comments

Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of the people 50 years of age and older. In the U.S. today, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis. While osteoporosis is often thought of as an older person's disease, it can strike at any age.

Osteoporosis is a disease in which bones become fragile and more likely to break.  If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fragility fractures, occur typically in the hip, spine, and wrist.  The US Surgeon General has identified osteoporosis and fragility fractures as major public health problems.

Osteoporosis has no symptoms. You notice no pain or change as the bone becomes thinner, although the risk of breaking a bone increases as the bone becomes less dense.  A bone mineral density (BMD) test is usually done to see whether you have osteoporosis. The most accurate test of BMD is dual-energy X-ray absorptiometry (DEXA), although there are other methods. DEXA is a form of X-ray that can detect as little as 2% of bone loss per year. A standard X-ray is not useful in diagnosing osteoporosis because it is not sensitive enough to detect small amounts of bone loss or minor changes in bone density.

Many men don't think they are at risk for osteoporosis, since these are commonly considered to be conditions of older women. Because men have a higher peak bone mineral density than women at middle age, osteoporosis tends to happen at an older age in men. But aside from the hormonal change in women as they go through menopause, the risk factors are risks for men as well as women. Men are also at risk if they have low levels of the hormone testosterone.

Your bones don't reach their greatest density until you are about 30 years old, so for children and people younger than 30, anything that helps increase bone density will have long-term benefits. If you're older than 30, it's still not too late to make these lifestyle changes. A balanced diet and regular exercise will help slow the loss of bone density, delay osteopenia and osteoporosis, and delay or prevent osteoporosis.

1.  Maximize calcium intake.  Most recommendations are for 1000 milligrams of calcium per day for both men and women.  According to the NIH, after age 50, both men and women should increase their intake to 1200 milligrams.  Dairy products contain calcium, so do broccoli, almonds, and sardines.  Calcium supplements are also useful.  Discuss these with your doctor or pharmacist before starting.

2.  Increase Vitamin D intake.  Once calcium is ingested, vitamin D is essential to help your body absorb it and utilize it.  For both men and women, the recommended daily intake of vitamin D is between 400 and 800 international units.  This can usually be met with a balanced diet.  However supplements are available.

3.  Exercise Regularly.  To improve and maintain bone density a combination of regular low impact, weight bearing exercise and resistance exercises works best.  Weight bearing exercise includes walking, jogging and even dancing.  If you are fit, and your doctor approves, jogging, tennis, basketball, or jumping rope are all weight bearing exercises, but are not low impact.  Low impact activities include walking, elliptical or stepper routines, and cycling.  Resistance exercises use weights or elastic bands to increase the work as you move against gravity.  Body weight also provides resistance, so push-ups, pull-ups, and toe raises can be a good place to start.  Be sure to start slowly, and increase slowly to avoid injury.  A functional exercise program that increases balance and agility is your

4.  Play Outside.  Exposure to sunlight on the skin allows the body to manufacture vitamin D3 from cholesterol.  As little as 15 minutes a day of moderate sunlight is enough to provide enough vitamin D to meet the most people’s needs.  Humans make 90 percent of our vitamin D naturally from sunlight exposure to our skin – specifically, from ultraviolet B exposure to the skin, which naturally initiates the conversion of cholesterol in the skin to vitamin D3.  It is not possible for the body to over produce Vitamin D in this manner. Excess production is metabolized away.  However, exposure to ultraviolet rays to the point of burning is not advised.  If one regularly avoids sunlight exposure, it may be necessary to supplement with at least 5,000 units (IU) of vitamin D daily. To obtain this amount from milk one would need to consume 50 glasses. With a multivitamin more than 10 tablets would be necessary. Neither is advisable.
The skin produces approximately 20,000 IU vitamin D in response 20–30 minutes summer sun exposure—100 times more than the US government's recommendation of 200 IU per day!

5.  Avoid excessive alcohol.  Moderating alcohol intake has a direct effect on bone strength.  Drinking heavily increases calcium absorption from bone and decreases bone density and strength.  Excessive drinking also leads to falls which can be a cause of fragility fractures.  Carbonated colas also promote absorption of calcium from bone.  Excessive cola consumption should also be avoided.

6.  Stop Smoking.  Smoking is toxic to your bones.  It appears to increase the rate of bone loss when bone density is compared in smokers versus non-smokers.  In addition, the effects appear to build up over time.  Quitting smoking will halt and partially erase the effects of cigarettes on the bone over time.  However, it will not eliminate them completely; therefore, the best advice is not to start.

7.  Speak to your doctor.  Your doctor can evaluate your family history and current lifestyle to identify risk factors for osteoporosis.  Current medications or other medications may increase your risk of osteoporosis. Evaluation of your diet and nutritional counseling can help to insure to the proper intake of calcium and Vitamin D necessary to maintain bone health.  Bone Mineral Density testing can be arranged to identify problems and their severity, to institute the appropriate level of treatment.

8.  Medications.  Although there is no cure for osteoporosis, currently bisphosphonates (alendronate, ibandronate and risedronate), calcitonin, estrogens, parathyroid hormone and raloxifene are approved by the US Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis.  Like all medications, these drugs each have specific risks and benefits. There may also be possible interactions with drugs you are currently taking.  This should be carefully discussed with your doctor and your pharmacist.

9.  Start young.  Since most adults don not reach their peak bone density until age thirty, early habits are the most important.  The higher the bone density before it reaches its peak, the better.  Children should learn early to eat a diet adequate in calcium, to maintain high levels of activity, and to get enough time outdoors in the sunshine.  Needless to say, children should be taught not to smoke and to avoid excessive alcohol.  

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280005 tn?1304154742
by Dr.Pink, Apr 28, 2011
thanks doctor
i found it very informative

746512 tn?1388807580
by Tammy2009, Apr 28, 2011
I'm hoping I don't end up with osteoporosis but I have too many risk factors (small frame, family history and meds) :(

I'm currently on max dose of advair, twice daily of protonix and we're trying a week trial of nexium on top of that.  What is the best way to take calcium supplements when I'm taking three doses of PPIs?  I take 2000 IUs of vitamin D in the morning during breakfast and end up taking 333mg calcium before bed because it's not suppose to be absorbed with the reduced acid.  However, then the calcium is not be taken with a meal.  I also can't more than one 333mg pill because it makes me even more nausea than I already am and makes me very sleepy (don't understand the fatigue part with it though).

What would be the best way to take the supplements?  I also can't eat dairy because it either increases the asthma because of reflux or I'm allergic/lactose intolerant, even small amounts of cheese bother me. I do drink 2 glasses of almond milk daily.

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