Protect Your Bones

By Raymond D. Cohen

As with many issues in the lives of people with disabilities, the health of our bones generally takes a back seat to the primary condition with which we must contend. This is understandable, given how demanding conditions like spinal cord injury, multiple sclerosis and the like can be. But, it’s also dangerous, because osteoporosis — a decrease in bone quantity and quality — can mean serious damage, often without any signs until a fracture occurs.

It’s a serious problem for the population as a whole. Dr. Sophie Jamal, assistant professor of medicine at the University of Toronto, staff endocrinologist and director of the osteoporosis research program at Women’s College Hospital, says that despite the fact that one in four women and one in eight men is affected by osteoporosis, it should not be considered a normal part of aging.

“Genetics certainly play a role. So, if you have a parent or another relative who’s had a fracture, you are at increased risk. And genetics can explain anywhere from 40 to 70 percent of bone density and fracture risk,” says Dr. Jamal. “Another consideration is bone hygiene — so both calcium and vitamin D intake as well as exercise play a role.”

People with certain disabilities are at greater risk. “Physical activity is important in terms of maintaining bone mass because it stimulates the building of bone. Physical activity also improves muscle strength and co-ordination and by doing this, decreases falls,” says Dr. Jamal. People who have decreased mobility or use wheelchairs or scooters to get around are at a disadvantage.

Certain medications can also affect bone density. The worst culprit is prednisone, a corticosteroid used to treat lupus and many other conditions. “If you are taking prednisone, it is recommended that you have a bone density test because prednisone is associated with bone loss and fracture,” says Dr. Jamal. Other medications that may cause trouble include antiseizure medications (which can interfere with the metabolism of vitamin D), heparin (a blood thinner), and those that inhibit menstrual function in women, such as medication for endometriosis.

The good news is that we can take steps to prevent osteoporotic fractures. Here are ways to lower your risk:

Get moving: Weight-bearing exercise such as walking, stair-climbing and dancing is good for bone health and decreases the risk of falls. For people with limited mobility, lifting weights may be an option. Resistance training and swimming can also be helpful. (Talk to your doctor before starting a new exercise program.)

Food for thought: “You probably need about 1,200 to 1,500 milligrams of calcium daily,” says Dr. Jamal. Include calcium- rich foods in your diet. These include low-fat dairy products, almonds, calciumfortified orange juice and calcium-fortified tofu. If you cannot tolerate calcium-rich foods, consider a calcium supplement.

Get your D: Vitamin D is necessary to absorb calcium. It may also help boost muscle strength and co-ordination, which helps prevent falls. Dr. Jamal suggests aiming for 800 to 1,000 I.U. of vitamin D daily. If you’re concerned that you’re not getting enough, consider taking a supplement.

Butt out: According to the National Institutes of Health (NIH) in the U.S., studies show a direct relationship between tobacco use and decreased bone density. This may be due to smoking itself or other risk factors common among smokers. For example, smokers tend to drink more alcohol, be less physically active and have poor diets. The NIH also says that chronic alcohol use has been linked to an increase in fractures of the hip, spine and wrist.

Pop pills: There are drugs that can reduce fracture risk by as much as 50 percent. Ask your doctor if they are appropriate for you.

“None of these measures is going to cure osteoporosis, but the idea is to prevent fractures, and certainly we can do that,” says Dr. Jamal. She explains that even one fracture can be devastating, as it may lead to what’s known as a “fracture cascade.” For example, she says, people who have a fracture are at higher risk for another broken bone in the first few months after the fracture. “There is a window in which it’s really important to intervene. As a group, people with disabilities need to be proactive about asking for a bone density test. You need to go to your doctor and talk about it.”

Dr. Sophie Jamal will be speaking about osteoporosis at the Women’s Health Matters Forum and Expo in Toronto on January 19th, 2008. Visit www.womenshealth matters.ca for more information.

Raymond D. Cohen is the publisher and editor of Abilities.