Boning up: preventing osteoporosis requires more than just calcium. Here's your complete bone health guide

Muscle & Fitness/Hers, May, 2004 by Stacey Colino

SOMETIMES when a disease gets a lot of attention, it's hard to tell whether the media is just being alarmist or whether the disease really is rampant--and you personally are at risk. Such is the case with osteoporosis. We all hear a lot about this brittle bone disease, but who actually gets it and why? Are you doomed to develop it if you don't drink milk? Is it only in the cards for you if osteoporosis runs in your family? As someone who works out all the time, should you feel more confident that you'll avoid the disease--or less?

The truth is, one in two women over the age of 50 will have an osteoporotic fracture in their lifetime. What's more, recent research shows that many women as young as college age may already be on the road to osteoporosis. Yet as alarming as these reports are at first glance, there are lots of things you can do to prevent yourself from joining this particular club. For instance, you might think you know how to eat right to prevent osteoporosis--get calcium, calcium and more calcium--but there's actually quite a bit more to the story: Several other nutrients also play important roles in maintaining bone health. Likewise, you may have heard that working out is your best defense against osteoporosis, but there, too, are some oft-missed specifics about the type of exercise that works best. Perhaps most important of all is the fact that osteoporosis prevention hinges on balance. In between watching what you eat and obsessing over your diet and in between exercising enough and working out too much lies a middle ground that can set you up for good bone health.

THE BONE BANK

As far as your bones are concerned, time is of the essence. During your teens and early twenties, your body continues to build bone and deposit it in your skeleton and also "remodels" bone, a process in which the body breaks down the bone, then builds it back up to the same level. After the age of 25, however, you start withdrawing from the bone bank, breaking bone down but not building it all the way back up. Most women, in fact lose bone mass at a rate of .25 percent to .5 percent a year until about age 45. Then menopause hits and things get worse because of dropping estrogen levels. Estrogen is what helps the bone remodel itself, explains Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation and an osteoporosis specialist at the Helen Hayes Hospital in West Haverstraw, NY. That's why women end up losing even more bone mass after menopause, thus increasing their risk of developing osteoporosis.

But why worry about the disease before menopause? Because invisible and insidious bone loss can also happen well before a woman hits her late 40s and early 50s. In fact, many active, younger women have weaker bones than they realize. In a recent study involving 164 women, researchers at the University of Arkansas found that 2 percent of college-age women already have osteoporosis and another 15 percent have suffered significant losses in bone density and may be on their way to developing the brittle bone disease. "What you do earlier in life will affect your chances of developing osteoporosis," Cosman says. "It's never too late to start doing something to protect your bones, but the earlier, the better."

It's especially important to take action if you've ever fractured a bone after falling, if you're very thin, if you've gone through menopause at a relatively young age (in your early 40s), or if osteoporosis runs in your family. Recently, researchers in Iceland identified a common gene among a large number of families with osteoporosis; other researchers have identified a handful of different genes that are related to bone density or bone turnover. "There's no way we can tell which is the most important gene," Cosman says. "Clearly, the disease is inherited. It probably relates to multiple genes, not just one." In the future, these discoveries may lead to novel treatments or preventive measures for osteoporosis.

While you can't change certain facts of life such as being a woman, growing older or being of Caucasian or Asian descent--all of which increase your risk of developing porous bones--there are lots of preventive steps you can take. It's a matter of giving your bones the nutrients they need, the exercise they crave and the lifestyle habits that support, rather than deplete, their density.

BEYOND CALCIUM

Many women of childbearing age still don't get the recommended 1,000 mg of calcium daily. In fact, a recent survey by the American Dietetic Association found that while 89 percent of women believe calcium is important to their health, 45 percent 'fess up to not getting enough of the mineral in their diets. You, too? Perhaps you're not much of a milk drinker. Dairy products--including milk, yogurt, and cheese--are a superior source of calcium. And low-fat dairy products are up to 20 percent higher in calcium than whole-milk products, notes David Hamerman, MD, director of the Center for Bone Health at Montefiore Medical Center in New York.