Osteoporosis at 40

In January of 2006, about three weeks after my 40th birthday, I went to the doctor and had a bone density scan. This was prescribed by my doctor who measured my height as a matter of course one day when I went in for my annual exam. I guess when you approach 40, your doctor starts looking at your body in a different way. The appointment had been late in the afternoon, and I was kind of worn out from the day, so when my height was measured at one inch shorter than usual, I figured I was slumping and apologized. The doctor said I should get a bone density test just to check it out.

So in January I had the test and immediately got the results. “You have osteoporosis in your spine and osteopenia in your hip bone.” They sent me home with a prescription for Fosamax and told me to start eating more calcium and taking supplements.

Now because I’m a librarian–and you all know what I mean–I am sort of cursed with curiosity. Like Pandora, we need to know why. Why did I get it? What do I do about this? Why, having loved milk all my life, do I have a problem with my bones? What the heck happened???

I marched into the Tecumseh Library to look for answers. I read a very good book called Strong women, strong bones : everything you need to know to prevent, treat, and beat osteoporosis by Miriam Nelson, where I learned a whole lot about osteoporosis, and what I needed to do to get rid of it.

Osteoporosis doesn’t seem like a disease, although it is a disease. It’s not catching or anything. It’s more like a condition. It happens when your body starts losing bone mass at a faster rate than you are replacing it. We make bone mass up until our 30s, and we lose it at the same time (like skin cells, we make more, and we lose the old stuff). But if we don’t take steps to keep the bone we have, we’ll lose it and that’s bad news. And it’s called a “silent disease” because you can’t feel it, you don’t know it’s happening and you don’t see its effects unless you look with a bone scan, or you notice you’re shorter or becoming hunched-over.

Here are some risk factors from the National Osteoporosis Foundation’s Risk Factor Questionnaire:

1. Do you have a small, thin frame and/or are you Caucasian or Asian?

2. Have you or a member of your immediate family broken a bone as an adult?

3. Are you a postmenopausal woman?

4. Have you had an early or surgically-induced menopause?

5. Have you taken high doses of thyroid medication or used glucocorticoids (for example, prednisone) for more than 3 months?

6. Have you taken, or are you taking, immunosuppressive medications or chemotherapy to treat cancer?

7. Is your diet low in dairy products and other sources of calcium?

8. Are you physically inactive?

9. Do you smoke cigarettes or drink alcohol in excess?

And here are some more I found out about:

* drinking excessive caffeine (because caffeine is a diuretic, you lose valuable nutrients in your urine)

* taking some seizure medications

* having a history of depression or severe stress (a chemical made by your body called cortisol will totally wreck havoc on your bones as a result of depression or stress)

* taking certain birth control medications that cause your body to stop producing estrogen (such as Depo-Provera)

* having an eating disorder or fasting

* not taking a multivitamin, which provides minerals and vitamins which aid calcium absorption

* exercising too much

* weighing less than 127 lbs. (yes, that is actually the magic number)

I met about 10 or more of the risk factors that I had read about, and now the nurses actually told me that I was in danger of breaking a hip. I was no longer allowed to do anything that might cause me to fall, get hit (including karate), bend over at the waist, slip or other fun stuff.

For several months I was really screwed up in the head about this. I was only 40 and didn’t know other women who had this problem. I joined the National Osteoporosis Foundation’s e-mail support network to talk with others about it, but the more I talked to others and read their e-mails too, I started to get kind of obsessive about it. And others did, too. I was spending way too much mental energy calculating my daily calcium intake, my weightlifting progress, and other stuff and it was just taking over my life. So, because I am such a black and white person, life happened, I got off track and then I swung in the other direction and stopped taking good care of myself. By this past fall, I had stopped going to the fitness center altogether, and the calcium and vitamin supplementation was just not happening.

But then after New Year’s a few weeks ago, I went in for my two-year follow-up DEXA (bone scan). The news was good! The bone density in my hip bone (actually, the upper femur bone) had increased and is no longer osteopenic (lower than normal bone density, approaching osteoporosis)–it is now within the normal range of bone density for a woman my age! The bone density in my lumbar spine has increased in each vertebrae as well. All but two of those bones have are now osteopenic, which is still low, but no longer in osteoporosis.

Finding out that my bones have started to gain back more mass and density has inspired me to continue treating them well.

Eating

Remember how earlier I said that having eating disorder or fasting or dieting too much, or weighing less than 127 pounds, is a risk factor? Well, it’s been a long time since I weighed that little, but I read something very interesting about this when I was learning about osteoporosis. In a book which I will name later (because I can’t remember what the title was), the author, a natural health physician comments that most patients that he sees with the disorder are emaciated, bent-over women. I learned that our bodies need to have a combination of fat, sugar and protein in order to be able to absorb calcium, in addition to all those wonderful minerals in supplements that we can take. When we diet severely, we don’t get enough of any of those three. He says that the most liberating thing that a woman can do is to EAT. Now, I have never had a problem with eating, but I have at times been typical of most American women and worried about my weight, always wishing I weighed 115 pounds (I’m short so I should weigh no more than that, right? Yeah, right; and I’d also like to win a million dollars but that’s not likely to happen).  So–weigh at least 127 pounds?  No problem!

Supplements

Here’s one of the areas where I went a little crazy and failed to use common sense.

When you take calcium supplements, you have to pay attention. Now, wouldn’t it be nice to take all your calcium for the day at once and be done with it? Especially when you are trying to build your bone density and you are told to take 1800 mg a day. OK, so there’s 300 mg in an 8 0unces glass of milk. And I love to drink milk, so what’s the big deal?

The big deal is that our bodies can only absorb 600 mg of calcium at a time. So you have to space it. So I couldn’t take supplements at the same time that I was drinking milk. Compound this with the fact that you shouldn’t take any calcium, supplements or milk with caffeine or alcohol (like a really nice cold beer on a summer afternoon) because later you just excrete it. This was frustrating. I love coffee! I love lattes (milk + really strong coffee)! I love beer! I love Oliver Soft Red wine! How was I expected to live a satisfying gastronomic existence while feeling like a test tube?

I can’t believe it took me two years to figure this out, but this is what I’m doing now and I get my calcium, vitamin D, and other nutrients:

1. I drink milk whenever I feel like it, up to two full cups if I want. Cold plain milk, hot milk with chocolate syrup or hot chocolate mix (sooo much better than water!), decaf lattes (occasionally I get the snarky “What’s the point?” which I just ignore).

2. I take a vitamin whenever I drink milk. This adds a lot of those minerals that are really good for the absorption. Vitamin D is already added into the milk, so I don’t worry about that.

3. I eat supplements again whenever I think about it. Viactiv (chocolate chews) and Citracal (big horse pills) can be taken without food, so I can pop those whenever. Caltrate (a big chewable chalk-like “fruit-flavored” thing) has to be taken with food so that means YAY! I get to eat something with it.

4. I take a supplement at night before bed. I usually have food in my stomach at the time, so I can take my favorite one, Caltrate, and be happy that during the night, my digestive system will be moving along slowly, giving my body eight long hours to take everything in.

Here’s the big three supplements:

Caltrate: 600 mg of calcium, along with vitamin D3 (your body’s favorite flavor), magnesium, zinc, copper, manganese, and boron, which scientists have found is a fabulous combination for delivering calcium to your bones. Chewable, yet yucky. Must be taken with food, which is a good idea anyway–to get the taste of them out of your mouth afterwards.

Citracal: Two tablets have 630 mg of calcium and 400 IU of vitamin D3. Can be taken anytime, but these are horse pills and are unpleasant to swallow (gag).

Viactiv: 500 mg of calcium, a little bit of fat and sugar, plus vitamins D and K. These things are chocolate-flavored and not that good. They taste and look like Ayds candies from the 70s.

Exercise

OK, this is not my favorite subject right now. Mainly, because I am a couch potato. But, here’s the lowdown on why exercise (not too much!) increases bone density.

Our bones are living tissue. Their existence is kind of similar to muscles. When they get used, they grow. If they aren’t used, they die. It’s that simple.

But to make our bones grow new tissue, they require a little harder work than just standing up. When they bear weight, they get stimulated and start making new bone tissue. This is why it’s not good to weigh too little. Without enough weight to hang on your bones, it’s like they have nothing to do. So it was indeed quite liberating to know that I never had to weigh any less than 127 pounds. Not that I had been anywhere close to this in several years, except once during a very intense Lenten fast (which I will never repeat).

Besides weighing a decent amount though, we’ve got to really stimulate those bones with weight-bearing exercise. This includes weight-lifting and doing exercise that involves some kind of impact. A lot of people avoid exercise of any kind which involves impact because of their joints, but walking is one that just about everyone can do and survive. But it has to be more than just a casual saunter. Walking uphill is good. Walking kind of fast works, too.

Did you know that there are some forms of exercise which are not weight-bearing, and too much of these types of exercise can cause you to lose bone? Like, bicycle-riding. It’s great exercise! But long-distance cyclists have to make sure that they walk and do other stuff off their bikes because they have a high rate of osteoporosis. Weird! Some other seemingly healthy people who are in danger of developing low bone-density are swimmers and astronauts. Think about it: astronauts are exposed to zero-gravity for weeks or months at a time, therefore nothing is challenging their bones, therefore their bones become less dense. We have those guys to thank for helping us learn a lot about osteoporosis.

By now, you can figure out that weightlifting is great. It doesn’t have to be intense and it’s not hard unless you make it. I learned my exercises from the good people at the osteoporosis clinic at Lutheran. I also learned occupational therapy from them, to learn about body postures to avoid (like bending at the waist) and better ways to pick up dropped items, and reasons to avoid dangerous activity. Those therapists are very good at what they do and can teach patients stuff they never would have thought of.

And, finally, yoga is weight-bearing, too. It’s challenging, so I don’t do it too often, but it’s definitely good for your bones. Spend several minutes in downward dog and see how your wrists feel, and you’ll know what I mean!

My personal opinion

Knowing all this stuff now about osteoporosis, I worry about women in this country. When you think about all the unhealthy habits that young women are steeped in–smoking, drinking, drinking too much coffee, dieting, overexercising or not exercising at all, taking birth control which causes them to no longer have periods (because they no long make estrogen, which is good for bones), and not taking vitamins or eating healthy–it’s scary to think of how many girls are walking around with bones on the verge of cracking.

Health insurance doesn’t pay for women my age to have a bone density scan. It costs about $300. That stinks.

And I think about all those women in third-world countries who are being given Depo-Provera as a form of birth control. Do you think they are properly nourished or weigh more than 127 pounds?

So I am just counting my blessings that I have food, shelter, good health insurance and good health care. I really do have it good! And at least for now, the osteoporosis is gone!