Osteoporosis : Drugs Not Enough, Reducing Risk, Calcium

by Food and Drug Administration (FDA)

(Page 3 of 3)

Drugs Not Enough

Calcium and vitamin D supplements are an integral part of all treatments for osteoporosis. At the same time, people who take supplements should keep in mind that it is possible to consume excess amounts of these and other nutrients. Attention to diet and exercise are important not only for treatment, but also for prevention.

"If you go to the doctor and get a prescription, and that's all you do, you're probably not going to be helped very much," Recker says.

Calcium intake is critical, and those who need it most — younger women and girls — may not get enough. (See "Calcium (Ac)Counts.") But calcium alone can't build bones. Vitamin D is needed to help the body absorb calcium. Most people appear to get enough vitamin D because the skin produces it in sunlight. And many foods, such as milk products and breakfast cereals, are fortified with vitamin D. But older adults and people with little exposure to sunlight may need a vitamin D supplement.

A lifelong habit of weight-bearing exercise, such as walking or biking, also helps build and maintain strong bone. The greatest benefit for older people is that physical fitness reduces the risk of fracture, because better balance, muscle strength, and agility make falls less likely. Exercise also provides many other life-enhancing psychological and cardiovascular benefits. Increased activity can aid nutrition, too, because it boosts appetite, which is often reduced in older people. The biggest reason older people don't get enough calcium, Recker says, is that they simply don't eat much.

"The truth is, you don't have to do very much to get most of the benefits of exercise," Recker says. He suggests 30 minutes of brisk walking five days a week. Add a little weightlifting, and that's even better. It's always smart to ask your doctor before starting a new exercise program, especially if you already have osteoporosis or other health problems. Brighter Horizons

The search for bone-building drugs continues. Some naturally occurring bone-specific growth factors have been identified and their use as drugs is being investigated. "The way I visualize the ideal future is that we'll be able to give Drug X that builds up bone to where it's stronger and the risk of fracture is no longer present, then Drug Y maintains it by preventing breakdown," says Paula Stern, Ph.D., a pharmacologist at Northwestern University Medical School in Chicago.

The study of risk factors also continues. "We consider that to be the research that has the greatest public health significance," says Sherry Sherman, Ph.D., of the National Institute on Aging.

Reducing Your Risk

Many factors can affect your chances of developing osteoporosis. The good news is that you control some of them. Even though you can't change your genes, you can still lower your risk with attention to certain lifestyle changes that will help build and maintain bone mass. The younger you start, and the longer you keep it up, the better.

Here's what you can do for yourself:

• Be sure you get enough calcium and vitamin D.
• Engage in regular physical activity, such as walking.
• Don't smoke.
• If you drink alcohol, do so in moderation.

A sedentary lifestyle, smoking, excessive drinking, and low calcium intake all increase risk.

Other factors are beyond your control. Being aware of them can provide extra motivation and can help you and your doctor to make health care decisions. These risk factors are:

• being female: Women are at five times greater risk than men.
• thin, small-boned frame
• broken bones or stooped posture in older family members, especially women, which suggest a family history of osteoporosis
• early estrogen deficiency in women who experience menopause before age 45, either naturally or resulting from surgical removal of the ovaries
• estrogen deficiency due to abnormal absence of menstruation (as may accompany eating disorders)
• ethnic heritage: White and Asian women are at highest risk; African-American and Hispanic women are at lower, but significant, risk.
• advanced age
• prolonged use of some medications: These medications include some antiseizure medications, glucocorticoids (certain anti-inflammatory medications, such as prednisone, used to treat asthma, arthritis and some cancers), certain cancer treatments, some treatments for endometriosis, excessive use of aluminum-containing antacids, and excessive thyroid hormone. It is important to discuss the use of these drugs with your physician, and not to stop or alter your medication dose on your own.
• growth hormone deficiency in children and youth.

Risk factors may not tell the whole story. You may have none of these factors and still have osteoporosis. Or you may have many of them and not develop the condition. It's best to discuss your specific situation with your doctor.

Calcium (Ac)Counts

Your skeletal calcium bank has to last through old age. Frequent deposits to this retirement account should begin in youth and be maintained throughout life to help minimize withdrawals. Recommendations for daily calcium intakes were established a few years ago by the Institute of Medicine. (See "How Much Calcium Do You Need?") Most women get much less calcium than they need — as little as half.

Nutritionists recommend meeting your calcium needs with foods naturally rich in calcium. Adequate calcium intake in childhood and young adulthood is critical to achieving peak adult bone mass, yet many adolescent girls replace milk with nutrient-poor beverages like soda pop. "Bone health requires a lot of nutrients and you're likely to get most of them in dairy products," says Connie Weaver, Ph.D., who heads the department of foods and nutrition at Purdue University. "They're a huge package rather than just a single nutrient." With so many low-fat and nonfat dairy products available, it's easy to make dairy foods part of a healthy diet. People who have trouble digesting milk can look for products treated to reduce lactose. A serving of milk or yogurt contains about 350 milligrams of calcium. Fortified products have even more.

"People who don't consume dairy foods can meet their calcium needs with foods that are fortified with calcium, such as orange juice, or with calcium supplements," says Mona S. Calvo, Ph.D., a calcium expert in the FDA's Center for Food Safety and Applied Nutrition. Other good sources of calcium are dark-green leafy vegetables like kale and turnip greens, tofu (if made with calcium), canned fish (eaten with bones), and fortified cereal products.

The food label can help you identify foods that are a good source of calcium and other nutrients important for bone health, such as vitamin D. You can use the Nutrition Facts found on the label to see if a food is a good source of these nutrients — that is, if it has at least 10 percent of the Daily Value (DV) per serving. Also, if a food has at least 10 percent of the DV, the label may bear a claim that it is a good source of a nutrient. If it has 20 percent or more, the label can say that it is "high" in or an "excellent source." Some foods that are excellent sources of calcium may also bear a health claim about the role of diet and other factors in reducing the risk of osteoporosis.

But keep in mind that foods with smaller amounts (such as between 5 percent and 10 percent of the DV) can still make significant contributions to your daily calcium intake. This may be especially true if you often eat more than one serving of the food in a day, or if your actual serving size is typically larger than the one on the label.

Finally, remember that label values are based on a single Daily Value established by the FDA for food labeling purposes — 1000 milligrams in the case of calcium. They do not take into account that some age groups have lower or higher recommendations for intake.

What about too much calcium? A few years ago, the Institute of Medicine established a level of 2,500 milligrams as an upper intake level for calcium for most people. While intakes considerably above this level may be safe for many, others may be particularly susceptible to calcium's potentially harmful effects at these levels. Those with higher sensitivities, such as people at risk of kidney stones, should discuss calcium with their doctors.

Calcium is critical, but even a high intake won't fully protect you against bone loss caused by estrogen deficiency, physical inactivity, alcohol abuse, smoking, or medical disorders and treatments.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.