1. Osteoporosis: Keeping the Bone Thief at Bay AHMAD ALGUHANI MOSA A. ALHAFI

2. Osteoporosis: Keeping the Bone Thief at Bay Osteoporosis is common: all too common. It is estimated that 25%-30% of all women will break or fracture a bone because of osteoporosis, and by the age of 75, 50% of women have osteoporosis. Unfortunately there are no early warning signs, a broken bone or osteoporotic fracture is usually the first indication The bone thief doesn't arrive over night. When you are younger, your bone constantly replenishes itself. As you age this process slows down. Between ages 35-40, you begin to lose bone mass. After menopause, when your body is no longer making estrogen, bone loss accelerates. Over time, bones may become brittle, and too weak to withstand normal stress by this time you already have osteoporosis. Osteoporosis does not need to be a consequence of aging, however. It is largely a preventable disease.

3. So how you keep the bone thief at bay? Many people mistakenly believe that the answer is to increase calcium intake, yet the amount of calcium in your diet does not correlate with the amount of calcium that your body retains. Research has shown that keeping healthy bones depends more on preventing calcium loss than on increasing calcium intake, in fact, eating too much calcium in the absence of other nutrients may actually lead to osteoporosis. Other substances are needed to prevent calcium loss, such as boron, phosphorous and vitamin D. There are also other tactics you can use to protect calcium levels. Reducing meat protein, which causes calcium to leach away in urine, is just one. There are many other easy adjustments to make right now, so the bone thief won't sneak upon you later.

4. Exercise and Osteoporosis Weight bearing exercise (that you do on feet, that works the bones and muscles against gravity) and muscle contraction combined have been shown to effectively increase bone density in the spine. It is recommended that an individual perform 20 to 30 minutes of aerobic exercise 3 to 4 times weekly to increase bone mass. Diet and Osteoporosis Adequate calcium intake is critical in keeping bones strong, and it is estimated that approximately 70% of people do not regularly ingest adequate amounts of calcium or vitamin D. Vitamin D is also critical, to ensure absorption and retention of calcium in the bones. The recommended amounts of calcium and vitamin D for adults are as follows:

5. For pre-menopausal women 25-50 years old and post-menopausal women on estrogen replacement therapy, 1,000 milligrams of calcium per day with 400 i.u. of Vitamin D. 1,500 milligrams of calcium per day is recommended for pregnant or lactating women. For postmenopausal women less than age 65 not on estrogen replacement therapy, 1,500 milligrams of calcium per day is recommended along with 400-800 i.u. of Vitamin D. For men ages 25-65, 1,000 milligrams of calcium per day is recommended. For all people (women and men) over age 65, 1,500 milligrams of calcium per day is sufficient.

6. Foods that contain calcium include: dairy products (e.g., milk, yoghurt, and cheese), dark green vegetables (e.g. spinach), grains, beans and some fish. Calcium supplements are also available. Vitamin D comes from sunshine, fatty fish, liver, and fortified foods like milk, orange juice and cereals. Vitamin D supplements are also available. Minimize protein and sodium intake. Diets that are high in protein and/or sodium increase the loss of calcium through the urine and contribute to decreased calcium availability. Amounts above 2000 milligrams of calcium per day can be harmful to the kidneys and cause kidney stones. However, when calcium is taken in the recommended dose there is no increase in kidney stone formation. People with pre-existing kidney disease should consult their physician.

7. Estrogen is probably the most widely known and discussed of all hormones. The term "estrogen" actually refers to any of a group of chemically similar hormones; estrogenic hormones are sometimes mistakenly referred to as exclusively female hormones when in fact both men and women produce them. However, the role estrogen plays in men not entirely clear. The term "estrogen" includes a group of chemically similar hormones: estrone, estradiol (the most abundant) and estriol. Overall, estrogen is produced in the ovaries, adrenal glands and fat tissues. More specifically, the estradiol and estrone forms are produced in the ovaries, while estriol is produced by the placenta during pregnancy. In women, estrogen circulates in the bloodstream and binds to estrogen receptors on cells in targeted tissues, affecting not only the breast and uterus, but also the brain, bone, liver, heart and other tissues. Estrogen controls growth of the uterine lining during the first part of the menstrual cycle, and regulates various other metabolic processes, including bone growth and cholesterol levels. Oral contraceptives containing estrogen may also relieve menstrual cramps and some perimenopausal symptoms, and regulate menstrual cycles in women

8. Other Roles of Estrogen Bone Estrogen produced by the ovaries helps prevent bone loss and works together with calcium and other hormones and minerals to build bones. Osteoporosis occurs when bones become too weak and brittle to support normal activities. Your body constantly builds and remodels bone through a process called resorption and deposition. Up until around age 30, your body makes more new bone than it breaks down. But once estrogen levels start to decline, this process also slows. Thus, after menopause your body breaks down more bone than it rebuilds. In the years immediately after menopause, women may lose as much as 20 percent of their bone mass. Although the rate of bone loss eventually levels out after menopause, keeping bone structures strong and healthy to prevent osteoporosis becomes more of a challenge

9. The American Society for Nutritional Sciences The American Society for Clinical Nutrition "The bone-building imbalance that occurs in osteoporosis results in fragile bones with an increased susceptibility to fracture, which can lead to death in the elderly," added Dr. Baumgartner. "That's why knowing what protective effect a factor such as fat might have in elderly women not taking estrogen can be so important. Also, we believe that lean women with low body fat are more likely to benefit from estrogen replacement therapy." INTRODUCTION Prior to menopause androgens, mostly testosterone, are produced by the ovaries and adrenal glands. Androgens are important for maintaining bone density and sex drive. After menopause the ovaries stop making androgens, the adrenals continue, but the total amount produced by the body is greatly diminished. Androgens are available combined with estrogen, for replacement therapy. The only combination drugs is ESTRATEST®,. This is prescribed as second line therapy. For women who have not achieved good relief from hot flashes, or who are complaining of loss of sex drive, on estrogen. BONE MINERAL DENSITY ( BMD ) After menopause bones loose significant amounts of calcium. In 25% of women this bone loss can result in osteoporosis with the resultant high risk of broken bones. Taking estrogen stops the loss of any more calcium but does not replace the calcium already lost. Taking calcium supplements and vitamin D will not replace the lost calcium either. There is now evidence that taking a estrogen- androgen combination can promote new bone formation.