What is osteoporosis anyway?
Osteoporosis literally means “porous bones.” This occurs for several reasons. About 62% of your bone density is a result of genetics — you may never have had dense bones. Look to your parents for hints. If you did not build bone sufficiently during your bone building years, you are at a lower threshold when you age. With the falling levels of estrogen (in women) and testosterone (in men) and its associated bone loss, you may have bone density below a normal level. Inadequate intake of calcium and vitamin D as a child or as an adult or both will lead to osteoporosis. Some medications, although necessary, will cause bone loss.
I feel fine, quite healthy and exercise every day so do I have to worry about osteoporosis?
Since you build all the bone you are ever going to have by the time you are 30, much of your bone health depends on your genes and how well you built your bone density during those teenage years. A bone density test will tell you if you have to worry about osteoporosis and fractures.
What should I have done during my teenage years and can I do anything now?
Sufficient calcium, vitamin D and weight bearing exercise are the building blocks for strong bones. If your bones are still above the -2 T-score level that may be all you need to do. If your T-score is -2 or lower, bone medications in addition to the measures above are probably necessary. Your doctor will write a prescription if medication is necessary.
My mother broke her hip and my sister was just diagnosed with osteoporosis. Should I be worried?
There is certainly a strong genetic factor in determining if you may get osteoporosis. It is one of the main risk factors. The only way you can find out is by having a bone density test.
My doctor suggested a bone density test but since there is x-ray involved, I am concerned. Should I be?
There is a tiny amount of X-ray involved in a bone density test – about the same amount of radiation that you would get flying from California to New York. We naturally absorb about 1 mrm of radiation per day if we are living at sea level or 2-3 times that much if we live at higher elevations like Denver (elevation 5,000). A bone density test would give you about 0.1mrm of radiation.
My doctor told me that I didn't need a bone density test because I am so sturdy. Is this so?
The only way to determine how healthy your bones are is to have a bone density test. The United States Preventive Services Task Force published guidelines for testing. Medicare pays for bone density tests every 24 months for women over 65 and for men over 70. Other insurance companies will pay for a bone density test if you have risk factors for osteoporosis and fracture.
Since I am a man do I have to worry about osteoporosis?
One out of every two women and one out of every four men has an osteoporotic fracture if they live past 50. We also know that men die more often than women following a hip fracture. So yes, men do have to be concerned.
What is the best kind of calcium and vitamin D supplement?
It’s best to get your calcium through your diet, but for many people this is not possible. Take the kind of calcium you will take regularly! You benefit from all kinds of calcium, if you take it correctly, every day. Keep chewables in your car or on your desk. Put your tablets where you will remember to take them with meals. Calcium is a life long requirement so choose a calcium supplement that is compatible with your life style and one that you can afford.
Is it true that you should take calcium at bedtime so your body can assimilate it while you sleep?
No, if taken properly it doesn’t matter when you take calcium as long as you don’t exceed a dose of 600 mg. at a time and do take the supplement with something in your stomach. Food helps your stomach produce the acid needed to break calcium down for absorption.
I read that if you are taking certain medications you cannot absorb calcium supplements. Is this the case?
Some medications like proton pump inhibitors* reduce stomach acids. However these are usually prescribed because the individual’s stomach acid levels are too high and the medication reduces the acids to a more normal level. You might consider calcium citrate rather than calcium carbonate if you are on these drugs.
*Clinically used proton pump inhibitors:
Omeprazole (brand names: Losec, Prilosec, Zegerid, ocid, Lomac, Omepral, Omez)
Lansoprazole (brand names: Prevacid, Zoton, Inhibitol, Levant, Lupizole)
Dexlansoprazole (brand name: Kapidex)
Esomeprazole (brand names: Nexium, Esotrex)
Pantoprazole (brand names: Protonix, Somac, Pantoloc, Pantozol, Zurcal, Pan)
Rabeprazole (brand names: Rabecid, Aciphex, Pariet, Rabeloc. Dorafem)
I heard that people with celiac disease and ulcerative colitis don't absorb calcium. What should we do?
Doctors are discovering more and more individuals with these types of gastrointestinal issues that affect calcium absorption. If you have absorption issues, you must maximize your calcium citrate and vitamin D3 intake. Talk to your doctor about the most absorbable form of calcium for you.
Can you take too much calcium?
There are reports of patients who have developed heart disease and severe hypercalcemia from taking excessive calcium supplements. Anything below 2,000 mg. per day is generally safe for the vast majority of people. An excellent study showed that 4,000 mg. per day caused hypercalcemia.The 2,000 mg. limit is for people with normal absorption – but may not be necessary if you are getting enough calcium through your food. People with gastrointestinal absorption defects may require more than the limit mentioned – talk with you doctor if you fall in this category.
Can taking too much calcium cause kidney stones?
Calcium containing kidney stones are most common in people with a common congenital disorder called idiopathic hypercalciuria. In this condition, the kidney excretes excessive amounts of calcium that tends to crystallize in the urine with oxalate and form calcium oxalate stones. People generally do not form kidney stones because they take calcium supplements; however, if you have had kidney stones it would be wise to check with your doctor about what kind of calcium to take.
Should I take magnesium along with my calcium?
Magnesium is needed for good bone health; however many of our foods are rich in magnesium so supplementing it in modest quantities is not essential but will do no harm. Sometimes people will get constipated from calcium, so adding a bit of magnesium can help. It is important to recognize that loop diuretics such as furosemide (Lasix) can deplete the body of magnesium if it is not supplemented.
I stopped taking calcium because it constipates me. What should I do?
Calcium is essential for good bone health and to avoid future fractures. Try drinking more water or taking another type of calcium. Many people buy calcium with magnesium for that reason.
I am taking a drug for osteoporosis; do I still need to take calcium?
All osteoporosis treatment plans must include calcium and vitamin D. Calcium is the mineral that is deposited in the bone as the treatment is working. Some medications are now formulated to include calcium. Check with your doctor to make sure you are getting the right amount of calcium and vitamin D.
I can't swallow those big calcium pills. Do you have a suggestion?
The very best way to get your calcium is through your diet, and dairy products have the most concentrated amounts of calcium. There are also calcium chews that provide all the calcium you need. If you are on blood thinners, you should ask your doctor since some chewables contain vitamin K.
I don't like milk and don't want to supplement, but I am concerned about my bones, so I am eating a lot of greens, especially spinach and broccoli. Is this enough?
The green leafy vegetables like spinach and broccoli are very good for you, but are not the best source of calcium. Those vegetables contain phytic and oxalic acids that bind with the calcium. This means that the body is not able to absorb the calcium. Additionally, these high fiber vegetables move through the body quickly and reduce the ability of the body to extract the calcium.
Since I spend time in the sun I would think that I do not have to worry about vitamin D. Is this right?
There are a number of good reasons to supplement vitamin D. If you are using sunscreen, it screens out the UV rays that convert precursors of vitamin D to vitamin D in your skin. People with darker skin do not process vitamin D as well as those with lighter skin. People, especially older adults, are not generally out in the sun on a regular basis. In northern latitudes for much of the year, vitamin D is screened out by the atmosphere due to the low angle of the sun. And as we get older, our skin does not process vitamin D as well as it does when we are younger. Vitamin D is being shown to have a beneficial effect on many body functions and is safe at the recommended 1,000-2,000 IUs/day and not expensive to supplement.
My calcium has vitamin D in it, and I take a multi-vitamin. Is that enough?
Current science suggests that the RDA of vitamin D (200-400 IUs) is too low and these levels are under review by the Institute of Medicine. American Bone Health recommends 1,000-2,000 IUs daily. Most calcium does not have enough vitamin D and multivitamins contain very little. The combination of vitamin D from all sources should be 1,000-2,000 IUs daily.
Do I have to take Vitamin D with food?
You can take Vitamin D at any time of day with or without food.
Can I take too much Vitamin D?
There are reported cases of vitamin D intoxication causing hypercalcemia and renal failure at extremely high daily doses exceeding 50,000 IUs taken for protracted periods of time. In fact it is important that precautions be taken to keep such preparations of vitamin D out of the hands of children because they are dangerous if they ingest them. 1,000-2000 IUs a day are safe, and many doctors are using 50,000 IUs once a month in their patients who are deficient.
How do I understand my Bone Density Test results?
Normal = T-score greater than -1
Low bone density = T-score from -1.1 to -2.4
Osteoporosis = T-score of -2.5 and lower
Severe or established osteoporosis = T-score of osteoporosis + fracture
I had a bone density test and my doctor said my bones were "just fine." What does that mean? Should I be doing something special?
Always ask to have a copy of your report sent to you so you can see how strong your bones are for yourself. Following good bone health practice is always appropriate and is a life long task.
After my bone density test my doctor told me I had osteopenia. What is that?
Osteopenia or LOW BONE MASS is a status classification used to describe bones that are thinner than normal, but have not yet reached the osteoporosis stage. We are now beginning to refer to osteopenia as LOW BONE MASS since osteopenia suggests that you have lost bone density. It is possible that you never built bone that was any stronger. If you are older with a bone density in this range, your doctor may consider a bone medication to prevent fractures.
I had a peripheral scan at a health fair. How accurate is that?
Many health fairs or pharmacies offer screening using peripheral machines. Some are ultrasound and some are X-ray. Since osteoporosis is a systemic disease, peripheral scans can be a good indicator of the bones in the rest of your body. However, you should have a hip and spine bone density test on a table DXA prior to beginning treatment so that your physician can follow your progress.
Can I use my peripheral screening as a baseline test before I begin treatment?
No, peripheral tests are a screening tool only. Since the sites usually screened (heel, forearm, fingers) are metabolically less active, they are not suitable for following treatment.
How often could/should I repeat my bone density test (DXA)?
That depends on a number of issues including your age, menopausal status, bone depleting drugs you may be on and what type of osteoporosis treatment you may have started. Generally, doctors follow-up with DXAs every two years since changes in bone density are usually slow.
Do I have to fast prior to the bone density test?
No, but many testing centers ask that you not take calcium supplements 24 hours before your test. This is because as the tablet goes through your digestive tract, it may obscure the view of one of your spine bones.
Is a bone density test (DXA) a blood test? I have heard you can have one to determine bone status.
A DXA is not a blood test. It is a low dose X-ray that is fast and painless. You lie on a table and the arm of a machine passes over your hip and spine. Sometimes doctors order a blood test called a bone turnover marker to determine how rapidly you are losing bone.
What treatments do you recommend?
Depending on your T-score and other risk factors, there are a number of good treatments both for the treatment of osteoporosis. All of the osteoporosis treatments have been shown to significantly reduce the risk of fractures.
- SERMS (selective estrogen receptor modulator – brand name Evista¨)
- Bisphosphonates (generic alendronate, brand names Fosamax¨, Actonel¨, Atelvia¨, Binosto¨, Boniva¨, Reclast¨)
- Denosumab (monoclonal antibody – brand name Prolia¨)
- Parathyroid hormone (brand name Forteo¨) might be considered.
All of these treatments require a prescription from a doctor.
I don't want to take any hormones or medications. Will herbal or natural supplements keep my bones strong?
Studies have not shown that herbal or natural supplements, other than calcium and vitamin D, have any effect on bone mineral density. Additionally, it is difficult to determine how much of any ingredient you may be getting in many herbal or natural remedies. Studies are required to determine if there is sufficient evidence to recommend these supplements.