Bone is a living tissue that provides a frame for the body, protects organs, makes blood and stores minerals that the body needs to function effectively.

Bones grow in size and strength from birth until age 35. After that, more bone is lost than gained. The bone mass formed during childhood determines your skeletal health for the rest of your life.

Requirements for bone health
Bones need calcium, Vitamin D, sunshine and regular weight-bearing exercises to stay strong.

Why sunshine? When you eat, your stomach absorbs vitamin D. To do its job effectively, Vitamin D must be carried by the blood to the skin to be chemically altered by sunlight and then to the kidneys to be chemically altered one more time.

Activated Vitamin D is necessary to be able to absorb and utilize calcium. The daily required Vitamin D dose is normally 400iu (i.u., or international unit(s), is an internationally-accepted unit of measurement for vitamins), per day and is also available in milk, canned tuna and salmon, fortified foods and juices, multiple vitamins and in some calcium supplements.

Calcium Supplements
Vegans, individuals with lactose intolerance or those who don’t like milk or dairy products, should consider taking daily calcium supplements. Calcium supplements are available in regular oral applications including chewable tablets such as Viactiv® as well as in liquid and multi-vitamin form.

Because no more than 500 mg of calcium can be absorbed by the body at one time, the recommended daily dose (see chart below) should be divided and taken throughout the day with meal. Any more than 500 mg at a time will be excreted by the body.

Hormones
Hormones produced by your body have important roles in bone health. Para-thyroid hormone and calcitonin are hormones that regulate calcium levels.

Testosterone and Estrogen, both hormones, affect bone metabolism. As we age, levels of these hormones naturally diminish. Women lose most of their estrogen at menopause and tend to develop osteoporosis earlier in life than men. Men typically develop osteoporosis ten years later than most women.

Osteoporosis causes bone to lose density, become weak and fracture easily. In women, the risk of suffering a fracture from osteoporosis is greater than the combined risk of suffering a stroke, heart attack or breast cancer. Most fractures occur in the spine, wrist and hips.

Risk factors for developing osteoporosis include increasing age, female gender, family history of fracture as an adult, Caucasian or Asian ethnicity, normal or early menopause, inactive life style, smoking, inadequate calcium intake, certain medications, small and/or thin frame and excessive alcohol intake.

Lack of exercise, lack of calcium intake, smoking and excessive alcohol intake are all under your control, so take charge to keep your bones healthy.

Bone Density and Testing
Bone mineral density scans measure bone density at various sites to determine the risk for fracture.

Who should be tested? All women over age 65, women who have suffered a fractured vertebra, anyone taking medications known to cause osteoporosis, all post-menopausal women with risk factors and anyone with primary hyperthyroidism.

Recent tests also suggest people taking certain reflux medications for more than one year also are at an increased risk of bone density loss. Check with your physician for more information.

Medications and Therapy
For people with osteoporosis, medications are available to help rebuild bones. Most of these medications work on balancing the effects of osteoblasts and osteoclasts and the utilization of calcium. Osteoblasts are bone building cells that lay down calcium like bricks to form bones. Osteoclasts absorb bone for remodeling and to release calcium into the blood for other body functions if not enough calcium is absorbed through your diet.

Some medications prescribed for bone loss include Evista®, Fosamax®, Boniva®, Actonel® and Miacalcin®. To ensure effectiveness, calcium (or supplements) must be taken with these medications.

Estrogen replacement therapy can also help prevent osteoporosis. However, there may be increased risks of breast cancer, blood clots and strokes from taking estrogen. Check with your doctor to see if this treatment is recommended for you.

Bone Strengthening Tips
Bones are constantly remodeling in response to needs. Weight-bearing exercises like walking, jogging, dancing, tennis and stair climbing stimulate osteoblasts to build stronger bone by laying down more calcium.

Twenty to 30-minutes of weight-bearing exercise at least three times a week is necessary to maintain good bone health. Inactivity stimulates osteoclasts to absorb calcium, weakening the bones.

Pregnancy is a critical period during which women should be extra vigilant in getting enough calcium. The developing fetus has a tremendous calcium need and will take calcium from the mother’s skeletal system if not enough calcium is ingested. Prenatal vitamins have added calcium to help meet these needs.

Bone Building Interference
Kidney disease, thyroid problems, para-thyroid disease, digestive problems, some cancers and other medical conditions can cause problems with bone metabolism. Regular check-ups with your doctor can catch these diseases before they become problematic.

Smoking, soft drinks, alcohol, caffeine and some medications can negatively affect bones by interfering with calcium absorption and bone metabolism. Poor nutrition causes inadequate calcium intake, which also leads to poor bone quality.

The best prescription for healthy bones?

Eat right, get regular weight-bearing exercise, quit smoking, limit caffeine and soft drinks, drink alcohol moderately and get yearly check-ups to keep “boned up.”

Michelle Henderson, MD, is a board-certified Orthopedic Surgeon specializing in hip and knee mini-incision surgery for joint replacements. She is also a member of Health First Physicians. Visit online at www.healthfirstphysicians.org or call at (321) 868-8330.