Gina Shaw
WebMD Feature
If you have osteoporosis -- or are at high risk -- odds are you're not getting the care you need.
A 2004 Stanford study determined that more than half of all people with osteoporosis remain undiagnosed. What's more, even high-risk patients -- such as those who have already had a hip fracture - often don't receive calcium and vitamin D supplements or antiosteoporosis drugs. The 2004 Surgeon General's Report on Bone Health adds that most physicians don't even discuss osteoporosis with their patients after a fracture.
Why is this the case? "I have no idea," says a baffled Michael Holick, MD, PhD, professor of medicine, physiology, and biophysics at Boston University Medical Center. "But the numbers are out there. Only one in four women between the ages of 45 and 75 will ever talk to a doctor about osteoporosis."
What's tragic about those numbers is that it's relatively easy and cost effective to take care of your bones -- but it can be devastating when you don't. Osteoporosis causes more than 1.5 million fractures every year. If you're a woman older than 50, you have 50-50 odds of having an osteoporosis-related fracture sometime in your remaining lifetime (don't stop reading if you're a man: your chance of a similar fracture is one in four).
Here are some things you can do to help protect your bones without breaking the bank -- especially if you're at high risk for osteoporosis, or nearing an age at which you will be.
* Get Cs and Ds: Calcium and vitamin D, that is. A recent study of postmenopausal women on osteoporosis treatment shows that 52% had vitamin D insufficiency -- even though they'd been told by their doctors to take calcium and vitamin D.
The National Osteoporosis Foundation recommends 400 to 800 IU of vitamin D every day, but Holick says that might not be enough now.
"To prevent skin cancer, we're avoiding sun exposure, which is a major source of vitamin D," he says. "If you're doing that, you should be making sure to get 1,000 IU of vitamin D daily." Fortified dairy products, egg yolks, fish, and liver contain vitamin D, but you'll probably need a supplement to ensure you get enough.
If you're postmenopausal, you should also be getting 1,200 milligrams of daily calcium, and 1,000 milligrams if you're pre-menopausal.
* Exercise: Here's the good news: The best exercise for maintaining your bone mass costs you nothing, other than maybe a good pair of shoes. It's walking, as little as 3-5 miles a week.
"The pounding on the pavement as you walk increases muscle tone and maintains bone density," says Holick. "No other type of exercise does this as well."
If you're looking to increase (not just maintain) bone density, you can't hope to increase your bone density through exercise -- not unless you stress yourself abnormally (think super weightlifter-type workouts) -- but it can help you keep the bone that you have. Jogging, stair climbing, and other types of weight-bearing exercise are also effective.
Strength training is the other half of the exercise equation. It maintains and possibly even improves bone mineral density, according to several studies, according to results from the Bone, Estrogen, and Strength (BEST) study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
You don't have to join a pricey gym to get strength-training benefits. A few inexpensive hand weights or a rubber tubing used for resistance exercises are all you need. A simple program with one or two exercises for each muscle group is fine. Ask your doctor for some sample exercises.
You can also order the National Osteoporosis Foundation's BoneWise exercise video from its web site (www.nof.org) (be sure to check with your doctor before starting any exercise program, especially if you've had falls, fractures, or other injuries).
* Testing: Bone density screening is the best way to assess the health of your bones. But will your insurance coverage pay for it? The answer is yes and no, says Holick. "If you're 50 to 55 years of age and perimenopausal, bone density screening provides an important baseline, but insurance coverage is spotty."
Many insurers won't cover bone density screening for women under 65 (the age at which the National Osteoporosis Foundation recommends regular screening begin for all women) unless you have one or more additional risk factors. Be sure your doctor and your insurer know if you have any of these risk factors:
o Being postmenopausal, and/or early onset of menopause
o Smoking
o Family history of osteoporosis or fractures
o Low weight/having a thin frame
o Using corticosteroids for longer than three months
o Late onset of menstrual periods
o History of anorexia or bulimia
o Excessive alcohol intake
o Low intake of calcium or vitamin D
o Taking certain medications, such as some cancer drugs, thyroid drugs, and anticonvulsants-ask your doctor
If you already have osteoporosis, insurers generally cover prescribed medications such as bisphosphonates, although the monthly co-payments for a drug you will take for years can add up.
If these payments become a serious burden, or if you're uninsured, don't risk your bone health by dropping your medications -- explore these options:
* NeedyMeds (www.needymeds.com) is one of the best sources of information on the many drug assistance programs offered by states, localities, and pharmaceutical manufacturers themselves.
* AARP Bulletin online has a state-by-state, plan-by-plan guide to pharmacy assistance programs at http://www.aarp.org/bulletin/prescription/Articles/statebystate.html.
* Seniors Inc. (http://www.seniorsinc.org/medication.htm, or (303) 300-6945) and the Medicine Program (www.themedicineprogram.com) are both free services that help people enroll in medication assistance programs.
* Partnership for Prescription Assistance (www.pparx.org), a web site run by pharmaceutical companies, doctors, and patient advocacy groups that offers access to public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies.
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