Our Bodies, Ourselves (113 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
If weight gain has you feeling bad about your body and your looks, even questioning your sexual attractiveness, you are not alone. Many of us are working out a balance between staying fit and accepting our body as it changes.
Although the same basic principles of healthful eating apply throughout life, nutritional requirements change somewhat with age. Good nutrition is essential to health, independence, and quality of life for women at midlife and older, and it is one of the major elements in successful aging. Eating well can also help prevent or manage chronic diseases and even enhance sexuality.
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Because women living in low-income communities face obstacles to locating and purchasing fresh fruits and vegetables and other healthful foods, some innovative projects are now taking on the critical issue of food equity. Having been ignored by food retailers for decades, inner-city neighborhoods suffer the most from our unequal food distribution system. Some communities have started urban farms and gardens as a way to improve health and to change the social landscape in both literal and figurative ways. See the documentary
Food Fight
(foodfightthedoc.com) for more details.
Bone, like all the other living tissues in our bodies, is constantly replacing itself throughout life. If you are physically active and eat a healthful diet with adequate calcium during youth, you build bone when it matters most and give yourself a lifelong advantage. Some bone loss is normal in women and men as the years go by. By the mid-thirties, we start to lose bone more quickly than we replace it. Most women lose bone even faster from the start of irregular periods in perimenopause until four years after the final flow. Another period of increased bone loss occurs in our seventies. This is important because bone loss is associated with an increased risk for fractureâa potentially devastating injury as we age.
Osteoporosisâa condition of significantly low bone densityâis a somewhat arbitrary designation of the World Health Organization (WHO) of a level of bone loss that is 2.5 standard deviations below the average bone density of a healthy young woman at her maximum bone density. Not all bone loss is osteoporosis. Many of us who develop osteoporosis will never know about it unless we break a bone. Publicity campaigns by drug companies that make medications to treat bone loss give the impression that
all
women will get osteoporosis unless we take medication (although the ads target mostly middle-class women, who are assumed to have money for these products). It is important to focus on preventing fractures, not just on taking drugs that might prevent osteoporosis.
It is never too late to begin strengthening your bones. Weight-bearing exercise builds and maintains adequate bone density, muscle mass, and balance; yoga, jogging, strength training with weights, special back exercise regimens, and physical therapy also help. Exercising in water provides beneficial resistance to movement while placing less stress on joints, but swimming itself is not weight-bearing, so it does not build bone strength.
COMPARING CALCIUM SUPPLEMENTS | |||
You can use calcium supplements to help fulfill the daily recommendation of 1,200 to 1,500 mg. Calcium supplements come in various forms. | |||
COMPOUND | HOW MUCH CALCIUM | FORM | EFFECT ON DIGESTION |
Calcium Carbonate | 40 percent Calcium | Tablets | May upset stomach |
Calcium Citrate | 21 percent calcium | Tablets | May be easier to digest |
Calcium phosphate | 39 percent calcium | Added to orange juice or soy milk | Easily absorbed without upsetting digestion |
What you eat and drink can help build bones (see below). Avoid harmful habits such as smoking, and drink no more than one alcoholic drink a day on a daily basis. Keep foods with low nutrient density (“empty calories”) to a minimum.
You can also prevent early osteoporosis by avoiding, when possible, medical interventions that contribute to bone thinning, such as oophorectomy (removal of the ovaries). Women on steroids for more than three months, or on high doses of thyroid medication or some anti-seizure medications, are at increased risk for osteoporosis. The following commonly used drugs are also associated with an increased risk of osteoporosis: corticosteroid medications (long-term use), aromatase inhibitors to treat breast cancer (long-term use), a class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs), the cancer treatment drug methotrexate, the acid-blocking drugs called proton pump inhibitors, and aluminum-containing antacids.
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Many fractures are preventable with commonsense safety measures. These include wearing low-heeled shoes, using handrails, and getting rid of scatter rugs. For a complete list of indoor and outdoor safety tips, see “Preventing Falls and Broken Bones” at the National Osteoporosis Foundation (nof.org/aboutosteoporosis).
Calcium
Calcium helps prevent bone loss, which can lead to osteoporosis, and is critical for skeletal health. Since women over age thirty-five absorb calcium less easily, it is important to exercise more (necessary to absorb calcium) and get enough calcium in your diet, along with other nutrients that help your body absorb calcium. If you can't tolerate milk products, owing to lactose intolerance or other sensitivities, don't worry; many other sources of calcium are available, such as dark leafy greens, beans, and calcium-fortified orange juice. Interestingly, long-term studies consistently show
no
reduction in fractures for people with high consumption of dairy products. (The addition of retinol/vitamin A to milk is currently being considered as a possible explanation for this. See ncbi.nlm.nih.gov/pubmed/20599880.)
Many experts suggest 800 and up to 1,200 IU of vitamin D a day for optimal calcium and phosphorus
absorption.
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The main sources of vitamin D are sunshine, oily fish such as salmon and mackerel, fortified milk, and cereal. Yogurt and cheese, though good sources of calcium, contain no vitamin D. As we age, we absorb less of the vitamin D we eat, and those of us who live in the north or spend much of the day indoors don't get much sun exposure. Vitamin D deficiency, which is common in adults in the United States, can both cause and increase osteoporosis. Blood tests for vitamin D levels are available. Especially if you live in a northern climate, you may want to take a vitamin D supplement or combination calcium/vitamin D pills.
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Many researchers recommend that calcium be balanced with magnesium in a two-to-one ratio, although healthy adults without serious bowel disease are not magnesium-deficient. If your magnesium level drops lower, calcium will not be absorbed as well. Fruits and vegetables contain magnesium, as do some calcium supplements.
Although most prevention messages have focused on calcium and vitamin D, recent research has shown that several additional nutrients and food constituents are important. And supplementing with calcium and vitamin D has not always produced as good results as hoped for, suggesting that other factors need to be kept in mind. Eating fruits and vegetables has emerged as an important way to protect bone health. Several other nutrients, including magnesium (discussed above), potassium, vitamin C, vitamin K, some of the B vitamins, and carotenoids, have emerged as more important than researchers initially thought. In June 2010,
Osteoporosis International
published a study showing that the antioxidant lycopene (from tomato juice or supplements) can help to reduce bone loss.
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The thinking has changed on protein: Rather than having a negative effect on bone, protein intake appears to benefit bones in older adults. Drinking carbonated soft drinks such as cola is associated with negative effects, and modest alcohol intake (one glass of wine per day) shows positive effects on bone density, particularly in older women. The current data on diet and bone health support balanced diets with plenty of fruits and vegetables, adequate dairy products and other protein foods, and minimal consumption of unhealthful foods with low nutrient density.
Do You Need a Bone Density Test?
The recommended age for beginning periodic bone density tests is sixty-five, although if you and your health care provider identify risk factors for osteoporosis you may choose to be tested sooner. The dual-energy X-ray absorptiometry (DEXA) test compares your bone density with that of a healthy young adult. Following this test, some of us are told we have osteopenia, which refers to bone loss that is usual with aging and could potentially lead to osteoporosis but presents no immediate danger. This diagnosis is controversial among women's health activists, as it has led to early and
unnecessary medications
.
DO YOU NEED MEDICAL TREATMENT FOR YOUR BONES?
The Marketing of Osteoporosis and Osteopenia
Until relatively recently, osteoporosis was not diagnosed until a fragility fracture occurred. At a 1993 meeting hosted by the World health Organization (WHO) and funded primarily by drug companies, researchers radically changed the definition of osteoporosis. Thus, what had formerly been labeled a risk factor (bone loss) became a disease (osteoporosis), complete with an arbitrary measure of what constituted osteoporosis (a bone density measurement 2.5 standard deviations or more below that of a younger woman).
The concept of osteopenia, or preosteoporosis (bone density between 1 and 2.5 standard deviations below that of a younger woman), was also introduced. These definitions, along with the intense promotion of bone density testing and medicationsâincluding the free installation of bone density testing machines in medical offices by Merck, the maker of the osteoporosis drug Fosamaxâresulted in many more women pursuing drug interventions to avoid a potential fracture.
Ironically, the nonhormonal drug most promoted to prevent bone loss, alendronate (Fosamax), has no proven benefit in women around the typical age of menopause who have no history of fracture. Moreover, the vast majority of hip fractures occur after the age of sixty-five, with the highest percentage occurring after age seventy-five. Advertising campaigns featuring celebrities who were paid spokespersons for Merck helped to create a climate of fear about bone fractures in midlife women. As the consumer advocate Barbara Mintzes points out, “Bone mineral density testing is a poor predictor of future fractures but an excellent predictor of start of drug use.”
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Bone testing is useful primarily for those at high risk, and even then it might not improve outcomes. Early detection is meaningless unless women learn how to reduce bone loss and make necessary changes in eating habits, exercise, and lifestyle patterns. Since these changes can benefit all women, we should be doing them anyway.
Hormone treatmentsâboth estrogen alone and estrogen-progestin combinationsâhave been shown to reduce the risk of osteoporosis and bone fracture while women are taking them. The protective effect of estrogen disappears within two years after the cessation of hormone therapy (HT), and for those who stop HT, the short-term risk of hip fractures increases compared with that of women who stay on HT.
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Since the results of the Women's Health Initiative (WHI) study were announced in 2002 with a finding that one popular hormone therapy can cause breast cancer, blood clots, and stroke (see below), a search has been on for alternatives.
For a fascinating look at how osteopenia became a medical condition that millions of women took Fosamax to treat, visit npr.org and search for “How a Bone Disease Grew to Fit the Prescription,” by Alix Spiegel.
Many women with thinning bones have been prescribed bisphosphonatesâa new class of nonhormonal drug that slows bone breakdownâin the hope that they would be safer than hormone treatments. There was a hope not only that women with osteoporosis could use this medication to prevent further bone loss but also that it would prevent osteoporosis. All bisphosphonates have been shown to decrease spine fractures, compared with a placebo, and some of them decrease hip fractures, compared with a placebo. However, they can make bones denser but more brittle and have been associated with very rare but severe jaw ulcers and deterioration and unusual fractures in the middle of the thighbone.
In October 2010, the FDA announced that bisphosphonates used to treat osteoporosis must include a warning about risk of atypical thigh fractures. (Drugs mentioned in the FDA report are Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia, and Reclast.) The FDA also acknowledged that problems with bisphosphonates may increase with length of use, and it encouraged health care providers to “consider periodic reevaluation of the need for continued bisphosphonate therapy, particularly in patients who have been treated for over five years.”