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Friday, August 18, 2017

Looking At How Your Weight Affects Your Bones

Thick or thin, fat or skinny, what’s best for your bones? Because
most other health issues say thin is better, you may assume the
same is true for your bones, but that’s not necessarily the case.
Excessive dieting isn’t good when it comes to osteoporosis.

Some studies show that thin women who are overly concerned
about their weight and diet frequently have bone density that is 6
percent lower than women of average weight. If your weight drops
below 127 pounds, your physician needs to be appropriately concerned
that you’re at higher risk for development of osteoporosis.

Clearly, obsessive dieting to the point of anorexia or amenorrhea
(lack of menstrual periods, caused by low estrogen levels) can
result in low bone density that may last a lifetime. (See Chapter 4
for more on anorexia.) Plenty of low calorie sources of calcium are
available to keep you both trim and bone-strong at the same time.

What about the other side of the coin, that is, being overweight?
“Fat” has a negative connotation in the United States and elsewhere.
And even though “fat” in the sense of true obesity is certainly
bad for your health, some fat is necessary.

 Research has shown that higher body weight can influence bone mass through
four mechanisms:

Larger mechanical loading
More muscle mass
Higher levels of sex hormones
Less bone resorption

Estrogen levels in your body are related to fat, and estrogen helps
build strong bones by decreasing bone breakdown and helping
maintain adequate levels of vitamin D.

Osteoporosis is actually less common in overweight people, but
that’s hardly a reason to gain large amounts of weight, because the
risks of obesity on many other body functions are well documented.
The bottom line for adults is that you need to discuss
your proper weight with your physician. Too much is harmful. Too
little is harmful as well.

With regard to children, weight issues may be different. Some
recent studies have shown that overweight children have lower
bone density than their normal weight peers. Their lower exercise
levels and decreased intake of calcium and increased amounts of
carbonated beverages may account for these findings.

You can help your overweight child develop better bone density
by cutting out sodas and substituting low-fat milk. Encourage your
child to be active; your child may never make the Olympics, and
may not want to play competitive sports, but cycling, weight lifting,
or just walking can pay big dividends in stronger bones. Better
yet, go out with your child when he exercises, and you’ll develop
not only stronger bones, but also a closer relationship with
your kid.

Examining the Critical Role of Vitamin D

You can’t have healthy bones unless you take in enough vitamin D.
Although you probably already know that calcium is essential to
build strong bones, you may not realize that without vitamin D,
your body can’t properly absorb or utilize calcium (see Chapter 11
for more on vitamin D supplementation).

In many parts of the world, people easily obtain vitamin D through
sunlight exposure, the main source of vitamin D. However, many
elderly housebound people, as well as those cooped up in an office
with nary a ray of sunlight exposure day after day, and those who
live where it seems the sun rarely shines, may all be vitamin D deficient,
unless they work at getting enough to compensate in their

Fortunately, many processed foods are fortified with vitamin D.
Companies began fortifying milk and cereals with vitamin D in
the 1930s to help prevent rickets, a disease caused by vitamin D

Milk is a good source of vitamin D only because manufacturers
add vitamin D to the milk. Cows’ milk alone has none! Because milk
is a good source of vitamin D, you may assume that cheese and
other dairy products, such as ice cream and yogurt, are also good
sources, but only milk is artificially fortified with vitamin D. You
won’t find vitamin D in large quantities in other dairy products, so
don’t count your daily ice cream bar as a part of your vitamin D
requirement! Vitamin D–fortified milk isn’t used in the production
of many other dairy products.

Because only certain foods are fortified with vitamin D, doctors are
recognizing more and more patients with blood levels of vitamin D
below the recommended amount. Years ago, doctors didn’t have
particularly accurate ways of measuring the amount of vitamin D
in their patients’ blood. Newer tests are more accurate.

To complicate matters, many foods have less vitamin D than they
used to have. We believe (and there is literature to back this up)
that vitamin D deficiency is becoming much more common among
adults especially those living in northern climates. One cup of milk
has about 100 International Units (IU) of vitamin D in it, but the
minimum requirement is 200 IU daily. If you have osteoporosis,
your doctor may recommend upwards of 800 IU of vitamin D daily.

So if you don’t drink milk, if you’re not exposed to enough sunlight,
and if you don’t take a multivitamin, you may be at risk for vitamin
D deficiency. Other options do exist. For example, raisin bran is
fortified with 77 IU of vitamin D, but the amount can vary from
brand to brand.

Living with lactose intolerance

Millions of people worldwide are lactose intolerant, meaning that
they can’t break down and use lactose, the main sugar found in
milk and other dairy products. These people are deficient in the
enzyme that breaks down lactose known as lactase. The symptoms
include bloating, lower abdominal pains, and loose stools after
drinking milk. As time goes by, people who are lactose intolerant
often drink less milk to avoid the symptoms.

Lactose intolerance affects all races to some degree, although
African Americans, Asian Americans, Hispanics, and Native
Americans are affected more frequently than Caucasians. For
example, some studies in the United States quote a 70 percent
incidence in African Americans and a 15 percent incidence in

76 Part II: Keeping Your Bones Healthy
Lactose intolerant people are twice as likely to suffer from osteoporosis
than people who aren’t lactose intolerant. They have a
higher rate of osteoporosis because they typically take in less calcium,
or because they don’t absorb calcium well.

You can take some easy steps to maintain your calcium intake if
you’re lactose intolerant by:

Drinking lactose-free milk, such as Lactaid. In lactose-free
milk, the lactose has been chemically removed.

Drinking soymilk. We thank comedian Lewis Black for pointing
out that soymilk is more appropriately referred to as “soy
juice” because it doesn’t come from a cow! Have you ever
seen a soy cow before? Neither have we!

Trying Ultra Lactaid tablets. Take one just before consuming
any product with lactose. These tablets often aren’t effective
in people with severe deficiencies of the enzyme.

Checking our charts in this chapter for calcium contents of
foods that don’t contain lactose. We provide plenty of alternatives,
for example, oranges, almonds, and salmon. (A yummy
spinach salad topped with orange slices, sliced almonds, and
chunks of grilled salmon sounds good right now!)

Looking for calcium-fortified drinks, such as orange juice.
Make sure you know what you’re getting by reading the label.

Eating yogurt with active cultures. Yogurts with live active
cultures contain bacteria that help digests lactose. (One cup
of yogurt contains 5 grams of lactose.)

Chopping up some cheese. Hard cheeses, such as cheddar
and Swiss, have much of their lactose broken down during the
production process. (Swiss cheese still has a gram of lactose.)

Treating corticosteroid-induced osteoporosis

Like it or not, some children need to be on daily doses of oral corticosteroids.
The treatment goal is to minimize bone damage, even
if it can’t be avoided completely. If your child takes oral corticosteroids,
ask your doctor to start with the lowest effective dose to
treat, instead of pulling out the big guns from the start.

Children on corticosteroids must maintain an adequate calcium
and vitamin D intake. This amount may be higher than the normal
recommended daily allowance, which for calcium is 400 mg for
infants aged 0 to 6 months, 800 mg for children 1 to 10, and 1,200
mg for adolescents and young adults 11 to 25. Children on corticosteroids
need to have 1,000 to 1,500 mg of calcium daily, and
400 to 800 IU of vitamin D.

Furthermore, keep your child exercising, even if you and your
doctor have to modify the exercise program for your child’s limitations.
Maintaining weight-bearing activities stimulates bone mass.
Have a baseline bone densitometry test done so your doctor can
watch for any changes. Your doctor may also want to monitor
24-hour urinary calcium, phosphorus, and creatinine (a waste
product that can help measure kidney function) levels to check
for mineral loss. Taking blood tests for osteocalcin, which helps
measure bone turnover, may also be helpful.

Corticosteroids and osteoporosis in children

The use of corticosteroids for inflammatory diseases, such as
asthma, in children is one of the biggest childhood risks for developing

Most children who develop corticosteroid-induced osteoporosis
are taking oral steroids. Although researchers and doctors haven’t
ruled out high-dose inhaled steroids as a possible cause of osteoporosis,
studies haven’t been conclusive (see “Substituting inhaled
corticosteroids” later in this section). If your child is likely to be on
oral corticosteroids long term, ask your doctor to conduct a baseline
bone densitometry to monitor any changes (check out
Chapter 9 for more on baseline testing).

One study by the National Jewish Medical and Research Center of
400 asthmatic children on daily oral corticosteroids made the following

Daily doses of 10 mg of prednisone can cause bone loss.

Thirty to 50 percent of children will have bone loss.

Bone loss in children will be mainly in the vertebrae and
radius (forearm).

Bone loss won’t have any symptoms until a fracture occurs.

Bone densitometry starting at age 5 is essential in high-risk

Bone loss is most common in children taking a daily dose of
20 mg or more of a corticosteroid. Short “bursts” or occasional
corticosteroid use doesn’t appear to cause bone loss.
Substituting inhaled corticosteroids

Although studies measuring possible bone loss in children who
have used inhaled corticosteroids have been inconclusive, some
preliminary results show less chance of bone loss and osteoporosis
if the children use inhaled corticosteroids rather than oral

Studies have shown some conflicting information, however. In
2001, studies in young women showed that inhaled corticosteroids
to treat asthma resulted in loss of bone density. Eight puffs daily
had the greatest effect. Then in 2003, further data appeared in the
literature that showed that inhaled corticosteroids in children
didn’t seem to affect bone. These preliminary results are great
news, but need to be viewed with caution, because there is conflicting

Several studies in adult asthmatics have shown decreases in osteocalcin,
a protein made by bone forming osteoclasts, in inhaled corticosteroid
users, so inhaled corticosteroids could possibly be
damaging, although not to the same extent as oral doses.

With chronic disease requiring the daily use of corticosteroids, the
best advice is to start with the smallest dose that gives good effect,
start with inhaled corticosteroids rather than oral doses if possible,
and monitor bone closely. Keep the number of puffs used daily
to a minimum. Inhaled corticosteroids for asthma are critically
important in treating this potentially life-threatening and lungdamaging

Osteogenesis imperfecta (OI)

Osteogenesis imperfecta (OI) is a genetic bone disease usually
inherited from a parent. Occasionally, OI occurs as a spontaneous
mutation with no family history. A parent with OI has a 50 percent
chance of passing the gene on to a child.

64 Part I: Understanding Your Bones
People with OI are missing a protein called type I collagen. This
protein helps make up bone, ligaments, teeth, and the white outer
part of the eyeball, the sclera. The lack of type I collagen creates
fragile bone that fractures easily, although it heals at a normal rate.
OI can range from mild to severe, and anywhere between 20,000
and 50,000 people in the United States have OI.

 Some individuals
with OI have distinctive features: They’re shorter than average.
They have a blue, gray, or purple tint to the whites of their eyes.
Some have hearing loss.

Someone with OI may have anywhere from ten fractures to hundreds
in their lifetime. Some fractures may need surgical treatment.
For example, metal rods may need to be inserted into the
long bones of the arms and legs. Spinal fusion may be necessary to
limit scoliosis. The rate of fracture often declines as OI children
become adults, but may increase again as women enter
Doctors aim treatment at maximizing function, minimizing disability,
and maintaining overall health and independence. Doctors may
prescribe an injectable bisphosphonate drug, pamidronate
(Aredia), to strengthen bones and reduce fractures.
Chapter 4: Men and Kids G Idiopathic juvenile
osteoporosis (IJO)
Idiopathic juvenile osteoporosis (IJO) is a rare disease, with less than 100 cases
reported, and occurs in previously healthy children between the ages of 4 and 16.
Most of the time, the disease goes into spontaneous remission within two to four
Children with IJO may complain of pain in their back, hips, and feet, and may have
trouble walking. Their DXA scans may show low bone density, and X-rays will reveal
fractures of weight-bearing bone or collapsed vertebrae.

Treatment of IJO is aimed at protecting bones from fracture until remission occurs,
through physical therapy and reduced activity. Doctors generally don’t use medications
unless the disease is severe and not resolving spontaneously.

Damage from IJO can result in permanent collapse of the rib cage or scoliosis, but
often the disease leaves no permanent disability. Growth may be hindered during the
active phase of the disease, but normal growth usually resumes in remission. Most
children experience complete recovery with no later recurrence.

If your child or grandchild suffers from IO, take extra care when
handling him. (Don’t avoid touching your child. Give him or her
plenty of hugs and kisses — just be gentle.) Casts are probably
going to be a way of life for your child, so make sure the car seat
and stroller you buy are big enough to accommodate them.

Little Kids Can Have Osteoporosis

Even though osteoporosis is rarer in children, it can occur. But
some diseases, such as rickets, osteogenesis imperfecta, and the
very rare idiopathic juvenile osteoporosis (IOA), can also cause
osteoporosis or bone loss in children. And some medical treatments,
such as corticosteroids to treat asthma, can also lead to
osteoporosis. This section examines these conditions in more

Rickets: A real risk for bone loss 

You may think of rickets as a disease of the past, and to some
extent you’re correct. Rickets, a vitamin D deficiency, was much
more common before the early 1920s, before milk was fortified
with vitamin D and rickets greatly decreased.

But rickets is still around, although it’s not a common disease. In
adults, rickets is known as osteomalacia (see Chapter 1 for more on
osteomalacia). Rickets and osteomalacia both have the same
causes and effects.

Some of the symptoms of rickets are
 Bone fractures
 Bone pain
 Fever, restlessness, and weakness
Chapter 4: Men and Kids Get Osteoporosis, Too 63
 Growing wings and jumping from grass blade to grass blade
(Wait, ignore that. That’s from Crickets For Dummies.)
 Muscle cramps
 Short stature
 Skeletal deformities such as bowlegs, pigeon breast, spine
curvatures, or odd-shaped skull
 Soft teeth

Rickets is a childhood metabolic disease that causes an imbalance
between bone breakdown and remodeling. This imbalance can
happen because the child isn’t taking in enough vitamin D, or
because an intestinal disease, such as celiac disease (or sprue),
is blocking the absorption of vitamin D.

Vitamin D is available from two sources: sunlight and food. In
industrial areas, pollution may block sunlight. In cold areas, sunlight
may be limited during the winter. People with dark skin
absorb less sunlight and are more prone to vitamin D deficiency.

Newborns sometimes are vitamin D deficient because their breastfeeding
mothers are. Breast milk normally doesn’t contain adequate
amounts of vitamin D, but the amount can be increased if
mom takes vitamin D supplements. Breastfed babies can also take

Sometimes children with special diets can develop rickets. For
example, a child allergic to milk and dairy products or a vegetarian
child who avoids milk products needs vitamin D supplementation
to avoid rickets. Consult with your doctor about the appropriate
amounts, depending on your child’s age.

A hereditary inability of the kidneys to retain phosphate or a
kidney disorder that causes acidosis can cause rickets. Liver
disorders can also cause problems with vitamin D absorption
or metabolism.

The female athlete triad

The female athlete triad may sound like some sort of Olympic
event, but it actually describes a serious result of eating disorders
combined with too much exercise. Young athletes involved in
sports, such as ballet, gymnastics, and figure skating, where keeping
their weight low is important, often suffer from this condition.
What causes this condition? The combination of stringent dieting
and excessive exercise results in a loss of menstrual periods,
which lowers estrogen levels. The outcome? The athlete lacks the
nutrients to grow strong bones and hormones to maintain bone,
which causes osteoporosis at a young age, leading to stress fractures
and weakened bones that can last a lifetime.

A young athlete may seem to be taking in a normal number of
calories, but the amount eaten may be far below what she needs
because of her greatly increased physical activity.

The female athlete triad isn’t an uncommon problem. In fact,
among female athletes, the syndrome may be present in as many
as 50 percent or more of athletes. If you’re a parent, grandparent,
or close friend of a young athlete, watch for these signs to see if
the child is taking training to a dangerous level:

 Loss of menstrual periods for three months in a row

 Preoccupation with eating and/or using diet pills, laxatives, or

 Frequent visits to the bathroom immediately after eating

 Menstruation not begun by age 16

 Always wearing baggy sweatshirts and pants so weight loss
isn’t evident

Girls with the female athlete triad may be put on hormone replacement
therapy to supply necessary hormones. They also need to be
under a physician’s care.

If you’re the relative, coach, or friend of a young athlete, how can
you help them avoid the trap of the female athlete triad? Follow
these three simple steps:

1. Don’t emphasize winning as the most important thing.
The benefits of sports are many, and although winning
is great, don’t seek it at the price of permanent health

2. Be aware.

Watch for the signs that your athlete is taking diet and
exercise to an extreme, and don’t wait until you notice
everything is out of hand before doing something about it.

3. Take action.

Don’t bury your head in the sand when you see signs. Don’t
assume that just talking to your athlete will fix the problem.
Enlist the help of your doctor and the coach.

Dieting and bone loss

Avoiding the “it’s in to be thin” emphasis today is difficult, especially
if you’re young and impressionable. Being severely underweight
can have devastating consequences to bone, especially
if there is an associated eating disorder, such as anorexia and

The American Psychiatric Society defines anorexia nervosa and
bulimia nervosa in the following way:
Anorexia nervosa is

 A refusal to maintain weight that’s over the lowest weight considered
normal for age and height

 An intense fear of gaining weight or becoming fat, even though

 A distorted body image

 In women, three consecutive missed menstrual periods without

Doctors and counselors direct treatment of anorexia at achieving
weight gain. When an anorexic reaches 90 percent of her normal
body weight, her period usually resumes. Estrogen therapy may
also help. Studies have shown that bone lost during this time
period isn’t easily regained, and the increased risk of fracture may
be permanent, even with treatment.

Meanwhile, bulimia nervosa is

 Recurrent episodes of binge eating, which means eating more
than needed to satisfy hunger; (minimum average of two
binge-eating episodes a week for at least three months)

 A feeling of lack of control over eating during the binges

 A regular use of one or more of the following to prevent
weight gain:
• Self-induced vomiting
• Strict dieting or fasting
• Use of laxatives or diuretics
• Vigorous exercise

 A persistent over-concern with body shape and weight
Chapter 4: Men and Kids Get Osteoporosis, Too 61
Finding out a bit more about anorexia
The following important tidbits are important to know about anorexia nervosa and
how it can affect bone development:

 Anorexia nervosa is a psychological disease that has physical consequences
lasting all through life. Around 1 out of 100 adolescents, 90 percent of whom are
female, develops anorexia.

 Anorexia can cause bone loss in several ways. Girls with anorexia stop having
menstrual periods because their estrogen levels fall too low due to a lack of body
fat. Falling estrogen levels are a prime cause for a decrease in bone density.

 Anorexics generally don’t consume an adequate amount of calories, which
results in less bone formation during adolescence, a time when up to half of
peak bone density is being achieved. In addition, anorexics often have a high
level of a glucocorticoid called cortisol, which contributes to bone loss.

 Teens with anorexia have been found to have spinal density 25 percent less
than that of healthy teens, and up to two-thirds of anorectics have bone density
more than two standard deviations below the normal on a DXA scan, a test done
to determine your bone density. (See Chapter 9 for more about DXA scans and
how to interpret them.)

Bulimics aren’t always underweight; many maintain their weight
within normal limits and don’t experience the stopping of menstrual
periods and bone loss that anorexics do.

Why Too Thin Is Bad for Bones — Especially in Teens

You may remember the teenage angst of feeling “too fat,” even
when your weight barely touched the 100-pound mark. Teens
today are as acutely aware of their weight, and many, if not most,
teenage girls want to be thin. Unfortunately, the desire to be thin
can lead to behaviors that can have disastrous consequences for
bones down the road.

Because the teen years are so important in building the bone mass
that you draw from for the rest of your life, behaviors aimed at
staying thin, such as smoking and excessive dieting, will result in
bone loss that can never be regained, even if you change behaviors
as an adult.

For example, some teenage girls see smoking cigarettes as a way
to curb their weight. One Japanese study showed teens that were
concerned about their weight were four times more likely to start
smoking. In fact, nearly

Prostate cancer and osteoporosis

Some evidence suggests that men who have prostate cancer and
are receiving androgen-deprivation therapy are at increased risk
for osteoporosis. Androgen-deprivation therapy focuses on
decreasing the level of testosterone in men with prostate cancer,
because testosterone may encourage growth of the cancerous
cells. Around 40 percent of men with prostate cancer receive antihormone
therapy as part of their treatment.

One large study showed that men who had received nine or more
doses of hormone therapy were 45 percent more likely to sustain a
bone fracture and had a 66 percent higher chance of needing hospitalization
after a fracture. Another study showed that five years
after treatment, slightly more than 19 percent of men had a fracture,
compared to 12.6 percent of men who hadn’t had any antihormone

Taking drugs to fight osteoporosis called bisphosphonates (see
Chapter 10 for more on bisphosphonates) may reduce the risk of
bone loss and consequent fractures in men taking antihormone
drugs, such as leuprolide acetate (Lupron). If you’re taking an antihormone
drug, ask your doctor about taking bisphosphonates to
help offset bone loss.

Focusing on prevention
and treatment

Outside of the use of testosterone in men, prevention and treatment
of osteoporosis in men and women is similar. Whether you’re
male or female, the best way to treat osteoporosis is to prevent it
from happening, by eating well, exercising, and by not smoking or
drinking alcohol excessively. (See Chapter 3, which covers all the
prevention measures you can take to avoid osteoporosis.)

Treating men with osteoporosis

Because osteoporosis is recognized in men less often than in women,
fewer men are put on medication to reduce the risk of osteoporosis
until the damage has already been done. However, studies are beginning
to show that the same drugs successfully used to treat women
with osteoporosis also help men (see Chapter 10 for medications
used to treat osteoporosis). The major difference in treatment in men
and women is that hormone replacement differs.

Chapter 4: Men and Kids Get Osteoporosis, Too 57
In 2001, the FDA approved use of alendronate (Fosamax) in treatment
of osteoporosis in men. Before this point in time, few studies
had been done exclusively in men. Just after that, Forteo was
approved to treat osteoporosis in both men and women.
Because many men who develop osteoporosis have low levels of
testosterone, which drops gradually as they age, they may need to
take testosterone supplements. Androgens, or male sex hormones,
such as testosterone, stimulate bone formation. Doctors may prescribe
testosterone in the form of injections, patches, or gel to
raise the testosterone to normal levels.

Although testosterone is effective in reducing calcium loss and
helping to maintain bone density, it isn’t without side effects. Men
with prostate cancer shouldn’t take testosterone, because prostate
tumors may grow larger with added testosterone. Other potential
side effects of testosterone therapy include enlargement of the
breasts, swelling of hands and feet, and erectile dysfunction.
Researchers are studying new ways to give testosterone, such as
patches, injections, under the tongue, or gel, that may bypass the
liver. When the drug doesn’t pass through the liver, the chances of
liver damage are greatly reduced. Bypassing the liver can also
result in more of the drug being available for absorption.

Don’t take testosterone replacement therapy if you have

 Breast cancer (men can get that too)
 Liver disease
 Polycythemia (an abnormal increase in the number of red
blood cells)
 Prostate cancer
Avoid DHEA (a steroid hormone that decreases with age and is
often sold as a “rejuvenation” drug in health food stores) supplements
if you’re taking testosterone, because the combination of
the two may be dangerous.

Researchers are also working to develop designer androgens that
might have the desired bony effects without increasing the risk of
prostate cancer.

Focusing on Osteoporosis in Men

Although most of the research has focused on women with osteoporosis,
researchers are slowly starting to place more emphasis on
understanding when and why men develop osteoporosis.

Men generally start adulthood with larger, heavier bones than
women, and have a higher peak bone mass. But between 15 to
25 percent of all men will develop osteoporosis, and after age 50,
6 percent will fracture their hip. Table 4-1 shows the relationship
of hip fractures in men and women more clearly:

Table 4-1 Comparing Osteoporosis-Related
Hip Fractures in Men and Women
Factor Men Women
Peak bone mass 10 to 12 percent
higher than women
Lifetime risk of 6 percent 17 percent
hip fracture
54 Part I: Understanding Your Bones
Factor Men Women
Mortality from 31 percent 17 percent
hip fracture
Sex distribution 30 percent 70 percent
of hip fractures
U.S. incidence 4 to 5 per 1000 8 to 10 per 1000
of hip fracture
at age 65

Osteoporosis begins to affect men about ten years later than it
affects women. And because both men and women are living longer,
researchers and doctors anticipate more people will have hip fractures
in the future. In fact, by the year 2050, researchers project
that men will have one half of all hip fractures in the United States.
By the age of 86, the incidence of hip fracture in men is equal to the
incidence in women, meaning that by age 86, osteoporosis isn’t a
“women’s disease” in any way.

Because osteoporosis apparently becomes an equal opportunity
disease as you age, you may be curious as to when men should
start having bone mineral density scans. All men older than 70
need a baseline scan, as well as men under age 70 who have risk
factors, such as long-term corticosteroid use or use of drugs to
treat prostate cancer. (See Chapter 9 for more information on baseline
scans, and check out the next section for more on risk factors
in men.)

Seeking answers in
the “Mr. OS” study

A seven-year study begun in 1999 by the NIH National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS), along
with the National Institute on Aging and National Cancer Institute is
following 5,700 men older than age 65. The study, called “Mr. OS,” is
looking at men’s risk factors for osteoporosis and how osteoporosis
affects men specifically. Knowledge of the diseases and conditions
that can affect bone mass can help to prevent men as well as women
from reaching the point of fracture before diagnosis.

Chapter 4: Men and Kids Get Osteoporosis, Too 55
One part of the study is looking at the possible relationship
between high bone mass and prostate cancer. This increased risk
may be related to levels of hormones, such as testosterone, which
protect bone. Other findings that are being examined in the study
include the following:

 Although men sustain hip fractures less frequently than
women, their mortality rate one year after hip fracture is two
to three times higher than for women.

 Risk factors for developing osteoporosis appear to be the
same in men as in women:

• Alcohol abuse: Alcohol abuse increases bone loss.
Approximately 25 to 50 percent of men seeking treatment
for alcohol abuse have low bone mass.

• Inadequate calcium and vitamin D intake: Men older
than 50 must consume 1,200 mg of calcium and 400 to
800 International Units (IU) of vitamin D daily.

• Lack of exercise: Men, like women, need to do weightbearing
exercise 20 to 30 minutes a day three days a
week to build bone strength. (See Chapter 6 for more on

• Low hormone levels: Up to 30 percent of men with
osteoporosis have low testosterone levels and may need
hormone replacement. In one study, one-third of men
older than 70 with a fracture were hypogonadal, or suffering
from low testosterone levels. Hypogonadism is
often underdiagnosed in men because there’s no obvious
precipitating event. In women, when estrogen levels
drop and menopause begins, their menses stops and hot
flashes start. But in men, during andropause, falling
testosterone levels may not be detected. Hence,
andropause (male menopause) may be subtler than
menopause in women, because signs of andropause
might just be attributed to aging, such as lack of sex
drive or difficulty maintaining an erection.

• Prostate cancer: Chemotherapy to treat prostate cancer
and other malignancies may also lower testosterone

• Smoking: Men who smoke are two to three times as
likely to fracture vertebrae as nonsmokers.

• Use of corticosteroids for diseases, such as asthma:
Men who have osteoporosis are more likely than women
to develop the disease because of another medical
condition or because of medication they take, such as
56 Part I: Understanding Your Bones
corticosteroids. Use of corticosteroids accounts for
between 15 to 20 percent of osteoporosis in men. Men
taking these drugs need to maintain an adequate calcium
intake, have their testosterone levels checked, and
may need to take antiresorptive medications (see
Chapter 11 for more on osteoporosis medications).

Table 4-2 compares the risk factors for men developing osteoporosis
and divides them into high, medium, and less common risks

Table 4-2 Comparing the Risk Factors for
Men Developing Osteoporosis
High Risk Medium Risk Less Common
Factors Factors Causes
Corticosteroid use of Alcohol abuse Cushing disease
5 mgm or more per
day times six months
Hyperparathyroidism Anticonvulsant drugs Gastric resection
Hypogonadism Family history of Low body weight
Nontraumatic fracture Hypo- or Liver or kidney
of hip, vertebrae, hyperthyroidism disease
or wrist
Osteopenia seen Multiple myeloma
on X-ray or lymphoma
Rheumatoid or
inflammatory arthritis
Risk of falling due to
unstable gait, dementia,
or stroke

Reducing the Risks of Getting Osteoporosis

Osteoporosis isn’t just an inevitable part of getting older or a disease
that only women get. It’s a complicated disease that can have
many causes, and it’s also a disease you can prevent by being
proactive about your health.

Women do develop osteoporosis more frequently than men. So,
given the fact that if you were born a woman, you’re most likely
going to stay one your whole life, what can you do to reduce your
risk of osteoporosis? Be aware that osteoporosis is more common
in women and start early to prevent it. Use these helpful tips and
keep osteoporosis at bay:

Eat well from an early age if possible. If you’re already “over
the hill,” start eating well now, making sure you get at least
1,200 to 1,500 mg of calcium daily and 800 IU of vitamin D.
Take supplements if necessary, and medications as ordered
by your doctor. (See Chapter 5 for more on nutrition and
Chapter 11 for more on supplements.)

Exercise, exercise, exercise! It helps you build more bone
mass and protects what you already have. (See Chapter 6 for
more on the benefits of exercise at any age.)

Don’t smoke! If you already are smoking, do whatever you
can do to stop or least reduce the amount you smoke.

Limit your daily alcohol intake. Have no more than one to
two alcoholic drinks each day.

Take medications your doctor prescribes. Studies have
shown that up to half of all prescriptions written by doctors
aren’t filled or aren’t taken properly. (See Chapter 10 for more
on medications that fight osteoporosis.)

Keep other health problems closely monitored. If you have
other health problems, such as the ones listed in “Noting
Other Diseases Associated with Osteoporosis,” earlier in this
section, make sure you’re especially diligent about your diet,
exercise, and medication routines.

Know your family history. If osteoporosis runs in your family,
start working on changing history by changing your diet and

Thursday, August 17, 2017

Other Diseases Associated with Osteoporosis

Many different diseases can increase your risk of developing
osteoporosis. In many cases the medicine you take, such as
48 Part I: Understanding Your Bones
corticosteroids, to treat the disease increases your risk. In other
cases the disease itself can cause bone loss.
Some other diseases associated with increased risk of osteoporosis

Chronic kidney disease: Kidney disease raises the amount of
phosphate, a mineral that binds to calcium to maintain healthy
bones, in the blood. The extra phosphate circulates in the
blood looking for calcium to bind with, and will take calcium
from your bones if necessary to attach to the phosphate,
depleting your calcium stores.

Some people with chronic kidney disease who are on dialysis
develop a severe bone disorder known as renal osteodystrophy.
Your kidneys are critical in the metabolism of vitamin D.
When your kidneys start to fail, you become deficient in certain
important active forms of vitamin D. Technically this
condition isn’t osteoporosis. A bone biopsy in this situation
would reveal secondary hyperparathyroidism. Nonetheless,
if you suffered from renal osteodystrophy, you could develop
many fractures. A great deal of progress has been made in
recent years in prevention and treatment of this disorder.
Careful regulation of phosphorus levels and new forms of
vitamin D supplementation have greatly reduced the incidence
of this complex disorder.

Cirrhosis of the liver: Many factors associated with liver failure
can affect bone metabolism, such as the accumulation of
toxins related to the ineffectiveness of the damaged liver to
filter them out.

Ehler-Danlos syndrome: This hereditary disease affects connective
tissue and is associated with decreased bone density
and hypermobility of joints.

Hypercalciuria: People with hypercalciuria lose too much calcium
through their urine, often in the form of calcium kidney
stones. Your doctor might look for this problem by collecting
your urine for 24 hours and measuring the amount of calcium
in the urine.

Juvenile rheumatoid arthritis and rheumatoid arthritis:
People with rheumatoid arthritis are twice as likely to develop
osteoporosis as the general population; the risk is even higher
among rheumatoid arthritis patients who take corticosteroids.

Multiple myeloma: This is a cancer of blood cells that results
in bone tumors. Patients with multiple myeloma have abnormal
plasma cells in their bone marrow. These cells make substances
known as cytokines that stimulate osteoclasts and
Chapter 3: Breaking Down the Risk Factors 49
inhibit osteoblasts, thus weakening the bone. (See Chapter 2
for the lowdown on osteoblasts and osteoclasts.)

Osteogenesis imperfecta (OI): Several types of OI exist. Most
are inherited and cause very brittle bones and fractures in
childhood. OI is due to defects in the production of collagen,
an important protein in the maintenance of bone strength. (See
Chapter 4 for more information on osteoporosis in children.)

Overactive parathyroid gland: An overactive parathyroid
results in a rise in blood calcium levels, causing mental confusion,
kidney damage, dehydration, nausea, and vomiting. (See
Chapter 2 for more about hyperactive parathyroid glands.)

Overactive thyroid gland: It negatively affects bone mineral
density. (See “Avoiding excess thyroid medication” earlier in
this chapter for more information.)
The problem is that doctors and researchers don’t thoroughly
understand the mechanism in these various diseases. For example,
in people with Ehler-Danlos, the link could be genetic.

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