On May 12, 1990, I was speeding on my mountain bike down an unfamiliar mountain trail. All of a sudden, the trail veered sharply to the left while I kept going straight. I went flying over a short wooden fence down a steep mountain hillside, and rolled and tumbled like I was in a bad dream. When I finally came to a stop, I was surprised I was still conscious. My bike helmet and glasses frame were cracked, and with the awareness of sharp pain emanating from my left wrist, I feared my wrist was cracked too. After I was transported to the ER, I found out that I had a broken wrist bone and derangements of the surrounding ligaments. I needed to have surgery if I was ever to play the violin again.
I didn’t realize until years later that I had osteoporosis. Broken bones, even from serious accidents, can be the first sign of underlying osteoporosis. Although we think of only white older women getting osteoporosis, men get it too, and it can affect anyone of any race. Unlike osteoarthritis, which results in joint pain, osteoporosis is a silent disease until a fracture occurs. 80% of Americans who get osteoporosis are women, which is the reason why you see so much attention focused on their bone health. To put this in perspective, the risk of getting a hip fracture in women equals the combined risk of getting breast, ovarian and uterine cancer. In men over 50, one is more likely to break a bone due to osteoporosis than to get prostate cancer. To exemplify this point, two of my cycling friends have sustained traumatic hip fractures (while biking I might add), but fortunately no one in the group has prostate cancer.
Osteoporosis means “porous bone,” and it is easy to ignore until something bad happens. Peak bone mass occurs when a person is between the ages of 18 and 25. This means our bones will never be as strong as they were then. So, it’s smart to encourage teenagers to have adequate intake of calcium and vitamin D to build new bones. But what can we advise older adults to do to prevent bone loss which leads to osteoporosis? The answer is in three parts which I will discuss briefly:
1. Calcium and vitamin D.
2. Nutrition for bones.
1. Calcium is necessary to build strong bones. 1000 mg/day is advised in men and women below the age of 50, either from foods rich in calcium or in combination with supplements. After the age of 50, 1200 mg/day of calcium is advised. Calcium supplements are best taken with food, unless you are taking calcium citrate, which can be taken any time. When you are reading the label, be sure to pay attention to the “amount per serving” and serving size. For example, the big print on the front of the bottle may say “calcium 600 mg” but the fine print on the back of the bottle may say you need to take 2 pills to get 600 mg of calcium.
There are many guides to calcium rich foods, but let me point out one observation since many people eat yogurt: 6 oz. of plain low fat yogurt has 310 mg of calcium, 6 oz. of Greek yogurt has 200 mg of calcium, and 6 oz. of frozen yogurt has less than 80 mg of calcium.
2. Vitamin D is necessary to help our bodies absorb calcium. It can be obtained from sunlight, food or supplements. Since there are not many foods with vitamin D, and many people are told by their dermatologists to stay away from the sun, most people need to take vitamin supplements to have adequate levels. The overall vitamin D deficiency rate in the U.S. is around 50%, even in California. People who are even more prone to vitamin D deficiency are those who are homebound, have intestinal disorders that interfere with vitamin D absorption, and people with dark skin. Adults 50 and older should get a minimum of 800-1000 IU daily. It is probably safe to take up to 4000 IU of Vitamin D per day, but certainly don’t exceed this. I learned about a patient in a morbidity conference who took large doses of vitamin D because she thought taking more of something good could be even better. She was hospitalized with acute kidney failure from calcium accumulation in her kidneys due to taking too much Vitamin D.
3. Exercise with high impact activities helps to build strong bones. However, if you already have osteoporosis, check with your doctor to be sure what you’re doing is safe. Examples of high impact activities include hiking, jogging, dancing, playing tennis, or jumping rope. Low impact activities include using an elliptical or a stair-stepping machine, or walking on a treadmill. Bicycle riding is a low impact activity – unless you fall off.
Other exercises that are important for your bones include muscle strengthening exercises, balance, posture, and functional exercises. If you are not sure what exercises are best for your particular situation, you should consult with a personal trainer at the PJCC.
On May 12, 1990 I had pins placed in my left wrist to align the broken bone and ligaments, and then a second surgery on May 16, 1990 because my hand surgeon was not pleased with the outcome of the first one. I am still playing violin, run much more than I ride my bicycle and I make sure I am getting adequate calcium and vitamin D.
Visit the National Osteoporosis Foundation for further information. There you’ll find tips on diet, exercise, bone density testing, fall prevention and other resources. I never want to have another broken bone, and I don’t want anyone else to experience one either!
Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.
Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider