Understanding The Types Of Osteoporosis
After undergoing a bone mineral density (BMD) and NTx bone loss test, you may be diagnosed with one of the following types of osteoporosis:
Postmenopausal Osteoporosis (Type I)
As women age, there is a gradual decline in ovarian function and loss of estrogen and progesterone production. The physical sign of this is menopause, the cessation of menstrual periods.
As estrogen production falls, loss of bone tissue also begins. The onset of menopause is associated with increased activation of bone remodeling sites and an increase in bone breakdown (resorption) while bone formation increases to a lesser degree.
Clinical features include hip fractures, occasional incidence of upper arm, shin and pelvic fractures, as well as dorsal kyphosis (“dowager’s hump”).
Age-associated Osteoporosis (Type II)
Type II osteoporosis occurs in both men and women 65 years and older. Its primary cause of bone loss is due to increased bone turnover over an extended period (during the 35 years since peak bone mass was reached around age 30). There is also an age-related decline in renal production of 1,25 dihydroxy-vitamin D, subsequently causing secondary hyperparathyroidism. It is the hyperparathyroidism that is largely responsible for the excess cortical bone loss.
Hip fracture can also be associated with Type II osteoporosis, and the clinical features are similar to that of Type I — occasional incidence of upper arm, shin and pelvic fractures, as well as dorsal kyphosis (“dowager’s hump”).
Secondary osteoporosis is caused by an identifiable agent or disease. Many rare medical conditions are associated with secondary osteoporosis, including:
- Hyperthyroidism – abnormal increase and uncontrolled secretion of the thyroid gland.
- Early oophorectomy – removal of the ovaries, which produce estrogen.
- Bone metastases – a bone tumor that is invasive and resistant to treatment.
- Subtotal gastrectomy – partial removal of the stomach.
- Hemiplegia – stroke.
- Systemic mastocytosis – mast cell infiltration of the system.
Immobilization, alcohol abuse and certain pharmacologic agents also increase the risk of osteoporosis. You may want to check with your healthcare provider if you take any of the following: glucocorticoids, thyroxine, gnRH analogs, anticonvulsants (hypnotics and barbiturates), loop diuretics (furosemide), and heparin (long-term use).
Prevention & Treatment
In many cases, osteoporosis can be prevented by maintaining a healthy lifestyle and diet, and exercising regularly. If you and your health care provider decide that treatment is necessary, you may consider natural hormone therapy.
If you smoke, stop. If you drink more than moderate amounts of alcohol, cut back. Smoking and excessive alcohol consumption is bad for the skeleton. Women who smoke have lower estrogen levels than non-smokers and go through menopause earlier. Excessive alcohol use increases the risk of bone loss and fractures, due to both poor nutrition and increased risk of falling.
Why Life-Long Exercise Is Important
When you reach the age of about 30, bone thinning is a natural process and cannot be stopped completely, though you can thicken your bones with some lifestyle changes. Whether you develop osteoporosis depends not only on the thickness of your bones early in life, but also on your health, diet, and physical activity throughout your life. The thicker your bones are to begin with, the less likely they are to become thin enough to break. Young women in particular need to be aware of their risk of developing osteoporosis and take steps early to slow its progress and prevent complications. Plentiful physical activity during the preteen and teen years increases bone mass and greatly reduces the risk of osteoporosis in adulthood.
Building Bone Strength With Weight-Bearing Exercise
If you want strong bones, you have to use them! Girls and young women especially should concentrate on building strong bones now to cut their risk of osteoporosis later. But it is never too late to initiate bone-building habits. Muscles respond to stress by getting strong enough to handle the load. Bones respond to the pressure of weight-bearing exercise in the same way, by adding osteoblasts, or bone-forming cells, which boost bone density. For adults, “adding” bone density in this way is essential for keeping pace with loss of bone density that comes with age.
The term “weight-bearing” means your bones are working against gravity to support your body weight or, in the case of weight lifting, even more weight. For bone health, doctors recommend weight-bearing exercise for at least 30 minutes a day, four or more days a week.
Exercise for longer periods of time does not necessarily reap more bone benefits. What is most important to remember is that bones respond to short, sharp bouts of loading. For maximum bone strengthening, it is best to have periodic increases in the intensity, duration and amount of stress applied. That’s why aerobic step exercise, jogging, and resistance training with weights are so effective.
Keep in mind, there are so many ways to exercise your bones! Yard work, such as pushing a lawn mower and heavy gardening, count, as does stair climbing, hiking, yoga or pilates, tennis and skiing. Brisk walking is ideal when you include hills or jog periodically for added benefit. Remember, you want to use gravity to stress your bones.
Nutrition & Supplementation
Getting the right nutrients in the right amount is also essential for keeping bones strong and preventing osteoporosis.
In general, experts recommend maintaining a slightly alkaline pH that is helped by taking calcium, vitamin D and eating a healthy diet.
It’s well known by now that calcium is an essential ingredient for bone health. For women 24 years old to menopause and postmenopausal women using hormone replacement therapy (HRT), WomensHealth recommends 1,000 mg/day. Postmenopausal women not using HRT experience the highest rate of bone loss, so for this group, we recommend 1,500 mg/day of calcium.
If you’re not getting the calcium you need from your diet, consider a calcium supplement, but read labels carefully. The most important piece of information to look for is the amount of elemental calcium (the kind your body needs) contained in the supplement. Some formulations of calcium contain less elemental calcium than others. In addition, calcium citrate is more easily absorbed in older women. Our digestive tracts secrete less acid as we age, making it harder for our bodies to absorb other forms of calcium.
Elemental Calcium By Type
Type % elemental
calcium carbonate – 40
calcium citrate – 21
calcium lactate – 13
calcium gluconate – 9
The Debate Over Calcium
Recently, studies have shown calcium alone cannot prevent bone loss. In fact, one study, looking at the effects of different doses of calcium, found that rates of bone loss were the same, regardless of the calcium regimen. Others have shown that calcium therapy is not an effective substitute for hormone replacement therapy (HRT). Rather, we see this supplement as part of a healthy lifestyle regimen that includes diet, exercise and healthy living choices.
Vitamin D plays a critical role in osteoporosis prevention as it enhances calcium absorption in the body. It also suppresses the increased secretion of the parathyroid hormone (PTH) – a hormone linked to a decrease in bone mass in some women as they enter menopause.
The sun is a great source of Vitamin D so performing weight-bearing exercise outside increases your prevention benefits. For many, however, daily sun exposure is not possible or not enough. In these individuals, supplementation is necessary.
Though recent studies show health benefits and no toxicity at levels up to 4000 IU daily, The Food and Nutrition Board of the Institute of Medicine has recommended the following intake of vitamin D for prevention of osteoporosis.
- 600 IU daily for men and women 19 to 70 years old
- 800 IU daily for men and women 71 years and older
Keep in mind, if you have been diagnosed with osteoporosis, your health provider may recommend a higher dose. To find a dose that’s right for you, ask for doctor for a vitamin D blood test to measure the levels of D in your body.
Hormonal Replacement Therapy
Hormone Replacement Therapy or HRT can be used as a preventative treatment in postmenopausal women as it prevents decrease in bone mass and reduces fracture risk. HRT benefits continue the entire time of therapy; withdrawal results in decreased bone mass.
Recent studies show that HRT can potentially prevent 80 percent of vertebral fractures and reduce hip fractures by approximately 50 percent among postmenopausal women. HRT is also an effective first-line therapy for patients with fractures from osteoporosis.
Salmon calcitonin is another medication available for the treatment of osteoporosis. Calcitonin is a hormone secreted by thyroid cells that inhibits bone breakdown over a prolonged period. This process successfully inhibits bone resorption. You may be administered calcitonin via an injection or nasal spray.
Bisphosphonates are a class of drugs that inhibit osteoclast mediated bone resorption — precisely how is not known, but possible mechanisms include interfering with mature osteoclasts, affecting the activation of osteoclasts, and altering the properties of the bone matrix.
Bisphosphonates have been found to successfully treat conditions characterized by excessive osteoclastic (bone loss) activity, such as Paget’s disease of bone and hypercalcemia (too much calcium in the blood) associated with malignancy. This class of drugs often leads to or increases gastroesophageal reflux disease (GERD) and, if used too long, can actually increase bone loss.