Reprinted from the Health District's quarterly publication mailed to district residents (Winter 1999)

Most people wouldn't wait until they were 65 to start saving for their retirement, yet a surprising number of adults wait almost that long before they worry about building bones strong enough to last a lifetime.

By the time many older adults learn that they have osteoporosis, it is too late to do much about it. That's because strong bones, like a healthy nest egg, require years of "investment" beginning early in life.

Although nothing can substitute for a lifetime of bone-building habits, recent medical advances offer some hope to those at risk for osteoporosis, including tests to detect the disease earlier and medications that bolster bankrupt bones and reduce the risk of crippling fractures.

"Osteoporosis is much easier to prevent than it is to treat," says Bruce Cooper, MD, medical director of the Health District. "For prevention, we still believe in the importance of dietary calcium—especially during the teen years—and weight-bearing exercise, which is practically any kind of exercise except swimming."

More than 28 million Americans, mostly women, are at risk of developing osteoporosis. The bone-thinning disease causes an estimated 1.5 million fractures annually, including more than 300,000 debilitating and potentially deadly hip fractures.

Those most at risk include women who are slender, inactive or who have a family history of osteoporosis. Individuals who smoke or drink heavily are also more prone to the disease. Men can get brittle bones, too, but they usually lag 10-15 years behind women.

For all adults, the threat of osteoporosis looms by age 35 when the body starts to lose bone faster than it can make it. For women, that risk accelerates at menopause due to declining levels of estrogen, which protects against bone loss.

"In its early stages, osteoporosis usually has no symptoms," Cooper says, noting that a hip, spine or wrist fracture is often the first indication of a problem. But that doesn't have to be the case.

There now are simple, painless tests that can spot early signs of osteoporosis. Medicare and some private insurance plans cover these tests, which use X-rays or ultrasound to measure bone density. In fact, the National Osteoporosis Foundation now recommends widespread screening for all women over age 65 and for younger women with multiple risk factors. For those most at risk for brittle bones, there is a growing list of prevention and treatment options.

Estrogen replacement therapy remains one of the oldest and most effective ways to prevent osteoporosis in post-menopausal women, reducing the risk of spine, hip and wrist fractures by up to 70 percent. It is most effective when begun at menopause and continued for many years. Estrogen also has a beneficial effect on cholesterol levels, thus reducing heart attack risk. But since its long-term use is also linked to an increase in the risk for breast and uterine cancer, women should discuss this option with their physician and carefully weigh the risk and benefits.

Another medication recently approved for preventing osteoporosis is Evista, the first of a new class of drugs called selective estrogen receptor modulators because they mimic somewhat the bone-protecting effects of estrogen. Like estrogen, they also lower blood cholesterol, yet they don't increase the cancer risk.

Among the most promising treatments currently available is Fosamax, an oral medication approved for both prevention and treatment of osteoporosis in postmenopausal women. In studies, it slowed or stopped bone loss, increased bone density and substantially reduced the incidence of spine and hip fractures.

Although these new therapies are encouraging, they'll never make up for lost opportunities to prevent osteoporosis, Cooper says. If you want to enter your golden years with strong, healthy bones, you need to start saving now. And your best investments, he says, are a good diet, an active lifestyle and — for some — estrogen replacement therapy.

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