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You like to think you've got an advanced degree when it comes to health: You wear sunscreen. You've traded cream for skim in your coffee. As for exercise, friends call you the Boot-Camp Queen. So what if we told you that these things could potentially put you at a much greater risk for developing osteoporosis?
"In my practice, I see healthy-looking women in their 20s and 30s with brittle bones who think they're doing all the right things for their bodies," says Elizabeth Shane, MD, a professor of medicine and endocrinology and an osteoporosis researcher at Columbia University Medical Center in New York City. "They are trying so hard to keep their weight low that they're skimping on important nutrients or working out too much. It's a recipe for early bone loss." In fact, a disturbing 15 percent of college-age women have lost enough bone mass to put them at an elevated risk for osteoporosis; another 2 percent already have the disease, according to a study from the University of Arkansas at Fayetteville. Even children are suffering: Girls are 56 percent more likely to fracture an arm today than they were 30 years ago, which researchers speculate may be due in part to lower calcium intake.
Though thinner women are more susceptible to bone loss at a young age, the chance of any young woman getting properly screened is slim. "The medical community usually thinks of bone loss as a problem for older people," says Susan Brown, PhD, director of the Foundation for Better Bones, a nonprofit organization in East Syracuse, New York. "Doctors seeing a young woman with a fracture may not think to investigate the strength of her bones, even when the break occurs from a minor trauma." The U.S. Preventive Services Task Force, a panel that advises the Department of Health and Human Services, recommends regular bone-density scans (an enhanced form of x-ray technology that's used to measure bone loss) only for women 65 and older. There are no guidelines for younger women, opening the door to some serious errors.
Take 30-year-old Marcia Cronin, a strong and athletic gym enthusiast. Marcia took a tumble down a flight of stairs in 2001, fracturing her ankle. "The orthopedic surgeon in the ER was shocked by how severe the break was," Marcia says. "I remember him repeating, 'Really, just one flight of stairs?'" Three years later a car crash caused four separate fractures between her forearm and wrist. Her bones splintered so badly that titanium plates were needed to repair them. But it wasn't until a regular checkup in 2006 that her general practitioner thought to order a bone-density scan. The diagnosis: osteopenia, aka low bone density, a precursor to osteoporosis. A later blood test showed that Marcia had a very low amount of vitamin D, a bone-building nutrient, in her system. Even though her D levels quickly returned to normal after she increased her intake of the vitamin, her bones never fully recovered. Marcia's doctors suspect that her naturally thin build and her genetics (she comes from a long line of small-framed women) also played a role in her low bone density. "It took so long to get my bones checked that they're now permanently weakened," Marcia says. Just last summer, she broke her foot by simply stepping off a curb.
Marcia's case is exceptionally severe, but it's not too late for most women to take charge of their bone health -- even after the "building" stage ends at around age 30, says Robert Recker, MD, director of the osteoporosis research center at Creighton University in Omaha. "New research shows that you can still fight osteoporosis well past 30 by maintaining what you've got," he says. Your plan starts here.
Women who engage in weight-bearing activities such as jogging or stair climbing can increase their bone mass by up to 6 percent compared with those who don't, say researchers at the Washington University School of Medicine in St. Louis. "Exercises like these, in addition to strength training, force your muscles and bones to work against one another, as well as against gravity," says Connie Weaver, PhD, who chairs the department of food and nutrition at Purdue University in West Lafayette, Indiana. "Impact exercises send a signal to your bones to build new cells, called osteoblasts, which migrate to the bone's surface and make your skeleton stronger. Without that signal, the process is slowed down." Bonus: Increasing your muscle strength and balance lowers the chance of bone-breaking falls.
But Beware of...Too Much of a Good Thing If you work out so intensely that your period stops for at least three months, you have what doctors dub athletic amenorrhea. Basically, it means your ovaries have stopped making estrogen, an important hormone for building bone mass. (Estrogen signals cells known as osteoclasts to stop breaking down bone while also signaling osteoblasts to build more.) Exercise-induced amenorrhea occurs in up to 25 percent of all athletic women, and it's one of the most common causes of brittle bones. "Anything that lowers estrogen levels -- too much exercise or too low a body weight, for example -- interferes with building bone," Dr. Shane says. Your simple fix: everything in moderation. Mix hard and easy workout days and at least one day of rest every week. Training for a race or another event? Check with your doc to make sure you aren't overdoing it.2. Up Your Calcium and Vitamin D
Calcium, a powerhouse bone builder, is not the "I work alone" type. It does a significantly better job at protecting your skeleton when partnered with magnesium, vitamin D, and more than a dozen other nutrients. While it is possible to get all you need from food, it's pretty darn hard. "This is especially true for women, who often stop eating dairy after childhood because they mistakenly think it's fattening, despite studies showing that consuming low- or nonfat dairy may actually contribute to weight loss," Brown says. Compounding the problem: You can get only small amounts of vitamin D through foods such as fortified milk and cereal, salmon, and egg yolks. The nutrient is mainly produced from ultraviolet B radiation in sunshine. And since basking SPF-free in the sun's dangerous rays could cause more harm than good, most American women are deficient in the vitamin, Dr. Recker notes.
What to do? Start by boosting your calcium and D as much as possible directly through your diet. Research shows that women who get their calcium through food and drink have stronger bones than those whose calcium comes from supplements alone. Next, review your diet with your health practitioner and see what kind of supplements you may need. In all likelihood, she'll recommend that you take a multivitamin and, for maximum absorption, shoot for about 1,000 milligrams of calcium and 320 milligrams of magnesium between diet and supplements. Since the proper amount of vitamin D is not yet found in a multi, you'll have to pop a separate supplement that contains between 1,000 IUs and 1,700 IUs of the nutrient. Try for a total of 1,000 IUs to 2,000 IUs of vitamin D a day.
And, yes, get a vitamin D lift from the sun, too. A number of experts say short bursts of SPF-free sun exposure can be a safe way to get more D. "Unfortunately, an SPF of 30 blocks 99 percent of the body's ability to produce the nutrient, so it's imperative to get about 10 to 15 minutes of unprotected exposure regularly," explains Michael Holick, MD, PhD, director of the General Clinical Research Center at Boston University Medical Center.
But Beware of...Fatty Dairy and Sun Overkill Just because calcium is crucial to bone health, that doesn't mean you have the go-ahead to pig out on a pint of ice cream whenever you please; it will pack on the pounds and up your risk of heart problems. (People who consume high-fat dairy regularly have an almost 10 percent higher risk of heart failure than those who don't, according to new research in the Journal of the American Dietetic Association.)
And while the indoor-tanning industry would love you to believe that bronzing beds offer a safe way to increase your vitamin D levels, it's not true. Not all tanning beds emit D-producing UVB rays. Bottom line? It's never a good idea to tan -- indoors or out.3. Be Happy
Feeling blue is bad for your bones. A study from the National Institute of Mental Health found that depressed women had significantly more hip and spine bone loss than their happier counterparts. It seems that depressed women may have lower levels of bone-strengthening proteins and higher levels of other proteins that cause bone loss. They also have an excess of the stress hormone cortisol, which can weaken bones. Adding to the problem: When depressed, you tend to stay inside and exercise less, putting you at risk for vitamin D deficiency and bone loss, Recker says. (At least one study has found lower levels of vitamin D in depression sufferers.)
But Beware of...Antidepressant Excess Before battling your blues with meds, know that women who take the most widely used type of antidepressants, serotonin reuptake inhibitors (SSRIs), such as Prozac and Paxil, may be at increased risk for bone loss, according to recent studies. SSRIs are believed to help alleviate depression by allowing more serotonin, a neurotransmitter that helps control mood, to circulate. In recent years, however, scientists have discovered that serotonin, as well as depression itself, inhibits bone mass formation. More research is needed to definitively connect depression and antidepressants to bone loss, but many experts recommend monitoring bone density in at-risk women (read thin, athletic) receiving SSRI treatment. If you're concerned about the effects of SSRIs on your bones, talk to your doctor about taking additional supplements and adapting your exercise routine.
This routine, courtesy of Alana Reed, a New York City Pilates instructor, targets your biggest danger zones: shoulders, arms, spine, wrists, hips, and legs. Complete the circuit twice every other day.What You Need
BEGINNER A pair of 5-pound dumbbells
INTERMEDIATE A pair of 10-pound dumbbells
ADVANCED A pair of 15-pound dumbbells and one 5-pound dumbbell
ALL Resistance band
Jog in place for 5 minutes.Wall Squat
Targets: Hips and quads
Stand with back flat against a wall, feet shoulder-width apart about 1 1/2 feet in front of wall, dumbbell in each hand, arms by sides. Slide down wall until thighs are parallel with floor, keeping knees above ankles. Hold for 10 seconds, abs engaged. Return to start. Do 3 reps. Advanced: Hold each squat for 20 seconds.Tabletop Reach
Start on all fours (shoulders above wrists, hips above knees). Extend right arm and left leg so both are parallel to floor. Hold for 5 counts; return to start. Switch sides; repeat to complete rep. Do 10 reps. Advanced: Hold each lift for 10 counts.Wrist Strengthener
Targets: Shoulders, arms, and wrists
Stand with feet hip-width apart, holding the end of a resistance band in each hand. Wrap band behind back and extend arms straight out in front of you at shoulder level (tension should be medium-tight), knuckles facing floor. Keeping the band pulled tight, slowly rotate wrists so knuckles face ceiling. Rotate knuckles back down to complete rep. Do 5 reps; rest for 1 minute, then repeat. Work up to 10 reps per set at a time.The Clam
Lie on right side with hips and legs stacked, right arm extended under head, abs engaged. Keeping upper body and right leg still, lift left leg straight up to hip level; lower. Do 15 reps. Switch sides; repeat. Work up to 30 reps on each side. Advanced: Hold a 5-pound dumbbell in your top hand, arm resting on top thigh, while you do the move.
If you answer yes to one or more of the bone-loss risk-factor questions, ask your doctor if you should get screened for osteoporosis. The more yeses, the greater your risk for developing the condition.The Bone-Density Test
Do you have a family history of fractures or osteoporosis?
Are you small-framed or very thin?
Have you missed your period for three months or longer?
Do you work out more than seven hours or fewer than two hours a week?
Have you ever been anorexic or bulimic?
Are you a smoker or heavy drinker?
Is your diet low in dairy and vitamin D?
Have you used thyroid meds or another steroid in the past three months?
Originally published in FITNESS magazine, April 2009.