It may look like Lian, my 15-year-old patient from Aina Haina, is just training for her track meet, but she is also building bones. Many women learn they have osteoporosis at menopause and try to do all that they can at that time to prevent further bone loss. Lian has learned early that healthy bones are the result of a lifetime of weight-bearing exercise and good nutrition.
What is osteoporosis? It is a condition wherein bone becomes excessively porous. A porous bone is a weak bone and can fracture easily. Our bones reach their peak density in our mid-20s. After age 35, there is a slow decline in bone density of about 1 percent a year that accelerates after estrogen and progesterone levels drop at menopause. Osteoporosis primarily occurs in, but is not limited to, post-menopausal women. It can also occur after prolonged bed rest or in men who have an endocrine disorder such as hyperthyroidism or low testosterone.

How do you know if you have osteoporosis? The best way to diagnose it is through a special X-ray called a DEXA scan.

How do we build strong bones? Exercise! According to Miriam E. Nelson, Ph.D. author of Strong Women, Strong Bones, it is never too early or too late to start building bone. Her research, published in the Journal of the American Medical Association in 1994, shows that strength training just twice a week dramatically reduced the risk of osteoporotic fractures in post-menopausal women. Strength training means weight-bearing exercise such as jogging and weight lifting.

Nutrition also plays an important role in bone health. Many studies have shown that the minerals calcium, magnesium, zinc, and folic acid, and the vitamins D, B6, and K, are essential to strong bones. These nutrients are found in a well-balanced diet high in leafy greens and vegetables. Dairy products can be good sources of calcium for those who can tolerate them. Beware, ice cream lovers! Nutrition experts warn that the fat in ice cream actually impairs calcium absorption. Good alternatives include calcium-fortified soy milk and orange juice.

How much calcium do you need daily? The total recommended intake is 1,000 to 1,500 mg per day. Many studies have suggested that calcium citrate is the best form of calcium supplementation.

Good news! The angle of the sun from Hawaii’s position near the equator is strong enough for adequate vitamin D synthesis in our bodies all year long. Only ten minutes of sun each day ensures adequate amounts of vitamin D. However, as we age, our ability to synthesize vitamin D decreases; studies suggest we should supplement with at least 800 i.u. per day. The best food sources of vitamin D are salmon, tuna and shrimp.

What decreases bone density? Smoking has been proven by many studies to be a major risk factor for osteoporosis because it significantly decreases estrogen levels. Alcohol has also been shown to inhibit bone-building activity, and a high alcohol intake has been associated with poor nutrition.

A diet high in protein was reported in the Journal of Nutrition to increase urinary excretion of calcium. Many studies have also shown that meats and carbonated beverages, which are high in phosphorous, can lead to further calcium loss. Excessive caffeine ingestion (greater than 400 mg per day) is also a risk factor for bone loss and, according to Dr. Nelson, doubles the risk of hip fracture.

At only 15 years of age, Lian is out on the track, busily building bones. This weight-bearing exercise, combined with a healthy diet and lifestyle, will ensure that her bone bank has adequate reserves when she confronts the hormonal changes of menopause.

Article was originally printed in the Honolulu Advertiser, honoluluadvertiser.com