Are your bones similar to straw, sticks or stone?

Nancy Van Vessem, MD

Chief Medical Officer

Just like a house’s framing, the human body has bones which hold up everything else. Adults have over two hundred bones ranging from tiny bones in the inner ear which miraculously allow the movement of the ear drum to be interpreted by the brain as sound, to the skull which protects the brain, to our arms and legs which allow movement. Strong bones are necessary for us to function at full capacity.

Our bones reach 90% of their peak strength at about age 20. First of all, it is important to build bone when we are young. Maintaining bone through adulthood is necessary to avoid loss of calcium from the bones which, when mild, is called osteopenia ( literal meaning is deficient bones = house of sticks) and when more severe, osteoporosis (porous bones = house of straw). There is an ongoing struggle between osteoclasts which are cells that remove calcium from the bones and osteoblasts, cells that put calcium into the bones. Osteoclasts win in the end if nature is left to take its course.

Remember the three little pigs who built houses? One had a house built of stone, one of sticks and one of straw. When the wolf came around, only the house of stone stayed standing. A fall can be the beginning of the end for people with osteoporosis: a fractured hip can be the event that leads to nursing home placement and ongoing disability. Multiple fractures of the spine lead can lead to disabling chronic pain. For people with severe osteoporosis, a sneeze can break a rib. That is the reason you should be tested for bone strength if you are a women 65 years old. Men or younger women who are at high risk need to discuss testing with their physician.

What are the risk factors?

Older Age. Bones naturally lose strength through the years. Some of that is due to the aging process but it is accelerated by habits such as not exercising, smoking and poor diet. It happens slowly which is why it doesn’t make sense to routinely test bone strength frequently or at younger ages. That is the simple reason for the recommendation of bone density screening every other year for women starting at age 65. The older you live, the more reasonable it is to have bone density screening.

Smaller Size. The bigger and stronger the bones are when a person is young, the less likely it is that bone loss will occur to the extent that it becomes a risk for bone fracture. This is the primary reason why smaller people, women generally, have more risk for osteoporosis than larger people, men. Body weight of less than 154 pounds is the most powerful indicator of low bone mineral density. Bones that hold up more weight are stronger than bones that hold up less weight. Don’t use this as an excuse for an unhealthy weight. A women who weighs 130 pound, runs 2 miles a day and eats vegetables is likely to have stronger bones than a women who weighs 130 pounds, drinks more than one alcoholic drink a day and smokes.

Lack of Exercise. Weight bearing exercise such as walking, running, and lifting weights causes muscles to pull on the bones. This stress encourages the bones to become stronger through the remodeling process: it gives osteoblasts an advantage.

Low calcium and Vitamin D intake. If calcium isn’t circulating in adequate levels via the blood, then calcium can not be incorporated into bones. Vitamin D which has recently become a pop hero, although the data is pretty confusing at this point, is required for proper absorption of the calcium in the intestine. Adults under age 50 need a total of 1,000 milligrams (mg) of calcium from all sources (food and supplements) and 400 - 800 international units (IU) of vitamin D every day. Adults age 50 and older need at total of 1,200 mg of calcium from all sources and 800 - 1,000 IU of vitamin D every day.

Low estrogen levels for women. Estrogen encourages the cells that build bone. One problem (continued from previous page) for women is that estrogen production gradually diminishes as menopause approaches. Most estrogen is made in the ovaries so when the ovaries stop functioning naturally or are removed, estrogen production by the ovary also goes away. Other cells, like fat cells, can produce estrogen so it doesn’t go away completely. Estrogen replacement is complicated because it has been shown that certain regimens are associated with an increased risk of breast cancer. There are other drugs which can be used that mimic the estrogen effect on bone without the breast cancer risk.

Certain lifestyle choices. Smoking, heavy caffeine use and heavy alcohol use all lead to bone loss. Some of the chemicals in these substances sway the balance of power toward bone breakdown by the osteoclasts vs bone building by the osteoblasts.

Family history. We all are a product of our genes so if there is a family history of osteoporosis it statistically means that people within that family are at higher risk.

Certain drugs and some metabolic problems. Loss of calcium from the bones is hastened by certain drugs such as corticosteroids and some metabolic conditions such as overactive thyroid or overactive adrenal glands. Again, this is a function of skewing the remodeling process away from bone building.

Getting a bone mineral density test (DEXA) is easy and painless. All that is required is to make an appointment and lie still for a few minutes. There is no copay for the test for CHP members. If you find out that you have a house of sticks or straw, there are multiple therapies available.

Now is the time to know if you are at risk and take this solvable problem in hand before the wolf is at your door.

There are multiple locations where Capital Health Plan members can receive DEXA scanning with a physician’s order. Please check with your primary care physician’s office regarding further instructions.

If you want to read up on osteoporosis, a good resource is the National Osteoporosis Foundation at www.nof.org.

Capital Health Plan wants to help seniors stay savvy on the latest in health care, wellness and prevention. We’re pleased to offer The Savvy Senior, a monthly lunch and learn program now in its fifth year.

And, there’s good news! We have added a second monthly (repeat) program in Leon County due to increased attendance. We also have meetings quarterly in Gadsden, Wakulla, and Jefferson counties. And in 2011, we are excited to plan programs in Calhoun and Liberty.

The events are free and open to anyone. Call 850-523-7333 to RSVP or to find out about dates and times for programs in Calhoun, Gadsden, Jefferson, Liberty or Wakulla County.

Below are upcoming Savvy Senior Programs held at Capital Health Plan’s Governor’s Square Health Center, 1491 Governor’s Square Blvd., Tallahassee.

• Friday, March 4, 2011, and Friday, March 18, 2011 Noon to 1 p.m. Topic: Osteoporosis
• Friday, April 1, 2011, and Friday, April 15, 2011 Noon to 1 p.m. Topic: Urinary Incontinence
• Friday, May 6, 2011, and Friday, May 20, 2011 Noon to 1 p.m. Topic: Staying Healthy and Out of the Hospital

If you are unable to attend a Savvy Senior program in person, you can download and view a podcast recording of each presentation on capitalhealth.com. Podcasts are posted the first Friday of each month for the previous month’s program. Check out what you have missed at www.capitalhealth.com/Members/Live-Healthy/Savvy-Senior-Podcast.