Osteoporosis: Caring for Our Patients, Caring for Ourselves
As the average age of America’s nurses creeps toward the mid-40’s, we need information on osteoporosis prevention as much for ourselves as we need it for patient counseling. 10 million individuals, including two million men are now estimated to have the disease, with an additional 32 million at increased risk due to low bone mass.
Osteoporosis strikes all ethnic backgrounds, but white and Asian people are at a somewhat higher risk. This public health problem is also thought to be responsible for a fracture in one out of every two women over the age of 50, mainly in the hip, wrist, or vertebra. For many women a hip fracture means long term care and never returning to normal function. Can all this be prevented?
Bone formation and bone loss are dynamic processes. The skeleton needs calcium for bone production, which increases until the early 20’s for most women, and then slowly decreases until menopause. At that time the process reverses and the rate of bone loss increases. The result is a net loss in bone mass, and bones that are thinner and more fragile than in earlier years. The process can’t be prevented, but adequate calcium intake during the formative years and throughout puberty will maximize bone stores and establish a good basic bone foundation.
What Can Be Done?
Some risk factors for osteoporosis cannot be changed. Women over the age of 50 are more likely to have estrogen deficiency, and it is known that bone loss is estrogen related. There’s nothing that you can do to change a thin frame, your race, gender, ethnicity, or family history.
There are, however, some simple things that you can do to improve your bone health. Small lifestyle changes can make a big difference. Cigarette smoking, excessive alcohol use, and too much protein intake are known to interfere with bone formation. Three other steps will optimize bone health and help minimize the risk of osteoporosis:
• Eat a balanced diet rich in calcium and vitamin D
• Engage in weight bearing exercise
• Have bone density testing followed by use of medication when appropriate
Vitamin D is a fat-soluble vitamin that is useful for regulating the amount of calcium and phosphorus in the bloodstream. Without adequate vitamin D bones may become thin and brittle. The UV rays in sunshine trigger Vitamin D synthesis in the skin, but most areas of the United States don’t get enough sunshine to promote sufficient Vitamin D production. In addition, the use of sunblock to prevent skin cancer further reduces the Vitamin D available. Taking a multivitamin is recommended in order to get at least 400 – 800 iu daily. Too much phosphorus is also disruptive to bone formation; dietary phosphorus in the form of carbonated beverages, specifically cola drinks, may also be implicated as a problem. .
A 1200 mg. daily intake of calcium is recommended to prevent bone loss. The optimum sources for dietary calcium are milk, cheese, dark green vegetables, dried beans, and the soft bones in canned fish. For individuals who are lactose intolerant, or those eyeing the high fat content in many dairy products, it may not be possible to get all the necessary calcium from your meals. In that case, use of a calcium supplement such as Caltrate 600 or Cal-Plus may be suggested. Look for a supplement with added Vitamin D. Don’t take more than 500 mg. at a time, and pay attention to the amount of elemental calcium, which is different from the total calcium content. Elemental calcium is the calcium available to your body, and may be only half of the total calcium amount on the label. Excess calcium could encourage urinary calculi and cause constipation, so always increase fluids when taking calcium supplements.
Finally, probably one of the easiest and least expensive ways to decrease the risk of osteoporosis is through weight bearing exercise. No need for fast paced aerobic or tough cardio training—weight bearing consists of exercises as easy as walking or lifting free weights. Something as simple as lifting soup cans into the cupboard can put an amount of stress onto the vertebral structure that will encourage bone deposition. Bone remodeling, though, takes a minimum of three to four months, so it takes commitment to an exercise program to see progress.
What Should We Tell Our Patients?
Tell them to talk to their doctor before starting any exercise program and give them a safety checklist for their homes. This will help them identify dangerous items like unsecured rugs, stairs with loose railings, or inadequate lighting. Even putting a nightlight in hallways can have a positive effect. Each fall can mean a fracture, with loss of function, and may be preventable.
What should you tell yourself? Resolve to pay more attention to your diet and exercise. It’s not just about how you look on the outside. It’s also about what these small changes can mean for your bone health.
Christine Contillo has worked as a nurse since 1979, and has written extensively for various nursing publications as well as the New York Times.