Posts Tagged "osteoporosis"

The B’s have it – bursting the belly and bones myth

Posted by Liz on Dec 3, 2010 in bone health | 2 comments

When it comes to aging and women, bone health is a big deal. As I’ve written time and again on Flashfree, women are at a particularly high risk for bone loss as they age because of declining estrogen levels, and in turn, a reduced ability to prevent an increase in net bone resorption (i.e. bone loss due to the activity of bone cells). And while we’ve been told that excess body fat actually protects against bone loss, novel research is putting that myth to rest. This news may affect the millions of women who are considered obese based on their body mass index (BMI > 30), who, although at greater risk for heart disease, diabetes and joint disease, were at least believed to have a weapon against osteoporosis.

In a small study that was presented at this week’s Radiological Society of North America meeting, an assessment of the abdominal and total fat and bone mineral density of 50 premenopausal women of varying BMI showed surprising results. According to the lead researcher, Dr. Miriam Bredella, “the general consensus has been that increased body fat protects against bone loss and obese women are at decreased risk for developing osteoporosis. However, we found that visceral fat — the deep belly fat — makes bone weaker.” In fact, the researchers found that women with more belly fat had significant declines in their bone mineral density and increases in the degree of fat within their bone marrow, but that total body fat or fat existing right below the skin had little impact on bones.

An important challenge for women is not only that metabolism slows and the risk for obesity increases as we age, but also, a natural increased risk for redistribution of fat to the abdominal area. And unfortunately, it’s one of the most challenging areas to address, requiring significant increases in physical activity and decreases in caloric intake. Some data suggest that isoflavones might help reduce waist circumference as well, although they are hardly definitive at this point. Still, a word to the wise: that belly fat is not going to protect your bones. Time to start moving and eating correctly; your bones will thank you.

Wednesday Bubble: Your bones, your health. The lowdown on bisphosphonates

Posted by Liz on Sep 8, 2010 in bone health, osteoporosis | 0 comments

For decades, physicians have been prescribing a class of medications known as bisphosphonates (e.g. Fosamax, Actonel, Boniva) to preserve bone health in menopausal women and prevent fractures in both men and women with osteoporosis at high-risk for them).  Bisphosphonates are often offered as an alternative to hormone replacement therapy or HRT.

Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year.  However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.

If you consider these statistics, it seems that using bisphosphonates is a good thing, right?

Well, not so fast. Earlier this year, I wrote a post highlighting reports of jaw bones collapsing among women taking bisphosphonates over a certain period of time. Included within the information were tips from the American Dental Association for protecting your jaw before any major dental procedures. This week, I want to add another facet to the bisphosphonate story, one that is definitely worth considering when weighing the benefits and risks of these drugs:

It is possible that use of oral bisphosphonates may increase the risk for developing cancer of the esophagus by as much as two-fold.

Here’s what you need to know:

• In this particular study, researchers compared over 15,000 men and women who had been diagnosed with esophageal, gastric or colon cancer over the age of 40 to five healthy individuals with similar characteristics. All study participants had been prescribed bisphosphonates at least once, with some receiving more than 10 prescriptions, which would imply that they used the drugs over time (over the 7-1/2 year period of times examined, a majority used bisphosphonates for at three years or more).
• Use of bisphosphonates over three years and having received at least 10 prescriptions was linked to a significant increase in cancer of the esophagus but not gastric or colon cancer.  People who used bisphosphonates for five years or more had twice the risk compared to those who did not. Note that these rates of cancer held regardless of the exact agent used.
• An increased cancer risk remained even after actors for esophageal cancer, such as age, smoking, alcohol and body mass intake, were accounted for.
• This increased risk, may be due, at least partly, to drug side effects that affect the esophagus directly, such as irritation and inflammation of the esophagus (i.e. esophagitis).

Now, mind you, esophageal cancer is extremely rare, affecting roughly 16,000 people in the US in 2010. However, death from esophageal cancer, is high and the disease is often fatal. Moreover, esophageal cancer tends to affect three to four times as many men as women, which is why this latest bit of information is as critical for men as it is for women entering menopause.

One important thing to keep in mind when you consider the risk and benefits of bisphosphonate therapy is that this particular study compared actual cases of these three types of cancer to healthy individuals in the population. Sometimes, the information yielded in these studies is not considered as conclusive as studies that are conducted proactively, and not retroactively. Still, this is not the first time that bisphosphonates have been linked to cancer of the esophagus.

Maintaining bone health and strength as we age, particularly as hormones decline, is critical to our health in the later years. It’s important to make the right decisions now, while we are still relatively young. Flashfree has plenty of posts on bone health and osteoporosis, and I encourage you to peruse them.  When it comes to your bones, it’s not just about ‘use it or lose it,’ but also, the three P’s:

Protection

Proactive

Prepared

Your bones, your health.

Wednesday Bubble: protein, weight and bones – keep it in balance

Posted by Liz on Aug 4, 2010 in bone health, diet | 1 comment

Weight loss improves health, right? Well, yes, and no. Because it turns out that weight loss also increases the rate that the bone loses density, so in midlife and menopause, weight loss can be a double-edged sword.

In two recent studies published in the online edition of the Journal of Gerontology, researchers are reporting that women already at risk for osteoporosis due to their age and menopausal status may want to pay attention to what they eat when they try to lose weight. In fact, consuming large amounts of protein derived primarily from animal sources, e.g. lean meats like pork, beef and chicken, may negatively impact bone density and in turn, further increase osteoporosis risk.

Here’w what you need to know:

• In the first study, women between the ages of 43 and 80 reduced their daily caloric intake by 750 calories. Over three months, about half of the women ate meat-free diets that derived about 18% of their daily protein from vegetarian, dairy and egg sources and other half, ate diets comprised of about 30% protein derived from lean pork.

• In the second study, women between the same ages consumed about 1,250 calories a day in five meals over nine weeks. While the bulk of these calories were from a vegetarian diet, women were asked to eat either 250 calories of carbs daily (shortbread cookies, sugar coated chocolates), chicken (plus 10 grams of butter) or the equivalent in fat/saturated fat but as beef.

• Although women in the first study lost about the same amount of weight (~19 lbs), those eating animal protein has a 1.4% greater loss of bone mass. Likewise, in the second study, all the women lost weight but those women eating animal protein sources lost significantly more bone mass compared to women eating carbs.

• Women in both of these studies were considered overweight or obese based on their body-mass indices (BMI).

Importantly, many of the today’s popular diets for weight loss (e.g. South Beach, Atkins) emphasize increased intake of protein over carbohydrates (although the former also emphasizes good versus bad (i.e. glycemic index) carbs. What this means is that while you are cutting back, you may also be losing more bone mass than you normally would with weight loss.

Consequently, one of best approaches for women who are going through menopause and trying to keep the weight off may be to increase the daily  amount of so-called “good fats,” which as my friend Mollie Katzen, suggests should include nuts, avocados and fatty fish like salmon. Many of these foods are also good sources of protein and while not necessarily working to build bone, may stave off bone mass loss while you are trying to lose a few pounds or maintain your current weight.

At the end of the day, it’s all about balancing the good, the bad and the ugly. Our skeleton is fragile and it’s critical that we do all we can to keep it in one piece.

Want to learn more? I’ve dedicated several posts to osteoporosis, bone loss and bone health.

Flashfree food for thought: lignans and breast cancer risk

Posted by Liz on Jun 7, 2010 in breast cancer | 1 comment

I’ve written previ0usly about the potential benefits of flaxseed in boosting bone health and alleviating hot flashes.  Now, researchers are suggesting that flaxseed and other foods that contain high levels of lignans –  a type of phytoestrogen with both weak estrogen and antioxidant activities – may also help lower the risk of breast cancer in postmenopausal women.

In a large analysis of 21 studies examining possible links between lignan intake and breast cancer risk, the researchers found that including large amounts of lignan in the diet reduced the risk of developing breast cancer by as much as 14% in postmenopausal women. What’s more, risk was reduced by as much as 16% in studies that specifically examined levels of compounds called “enterolignans,” which are created with dietary lignan enters the stomach and interacts with bacteria residing in the intestines. The researchers say that lignan may offer moderate protection against breast cancer because it blocks estrogen activity that promotes tumour growth, perhaps mostly when natural estrogen is low (i.e. during menopause). However, the study did not provide details as to what constitutes “large” amounts of the compounds.

Flaxseed is one of the richest dietary sources of lignan, although it is also found in other foods including sesame seeds, sunflower seeds, whole grain breads, muesli, kale, broccoli, white cabbage and brussel sprouts, apricots and strawberries. You can find a full list of the lignan content in foods here.

Should you start eating more lignan? The good news is that the foods that are richest sources of the phytoestrogen are also quite healthy.  And, wth the potentially added benefits of preventing osteoporosis and lessening hot flashes, it seems that boosting lignan intake is a win-win all around!

Want to read more? Reuters Health has an excellent write up with additional information on the study.

When it comes to calcium, think moderation

Posted by Liz on Jun 4, 2010 in bone health | 3 comments

There’s a new condition emerging among postmenopausal women: calcium alkali syndrome (milk-alkali syndrome).

Milk calcium what?!

A wonderful commentary slated to appear online this month in the Journal of  the American Society of Nephrology highlights the dangers of consuming too much calcium . In it, the author  tells the tale of Chicago bartender Bertram Welton Sippy, who in 1915, introduced his bar patrons with ulcers to the Sippy diet, hourly intake of milk, cream eggs and farina cereal interspersed with Sippy powders on the half hour (i.e. dissolvable antacid like minerals that included calcinated magnesia, sodium bicarbonate and bismuth subcarbonate). A recipe for disaster? You bet, because the overkill of calcium and minerals led to symptoms that include headache, nausea, vomiting, mental clouding, a distaste for milk and eventually, kidney failure. Yikes!

While men were the primary victims of the condition in the last century, it appears that a new group of victims started to emerge in the 90s – postmenopausal women who have increased their intake of calcium and vitamin D to combat osteoporosis. And although calcium, not milk, is the primary driver, the condition is the third most common cause of hospital admission for significantly elevated blood calcium levels.

It appears that the necessity to preserve our bones has created a modern version of the Sippy diet.

The best strategy for reducing the risk of calcium-alkali syndrome is to moderate your intake of calcium supplements. In fact, the authors say that although an average of more than 4 g/day of supplemental calcium is most commonly linked to illness, small numbers of women have developed it on as little as 1 to 1.5 g calcium a day. Of note, while younger adults are able to store excess calcium in bone, aging seems to reduce this natural defense and instead, calcium tends to leave the bone (thereby leaving us more susceptible to fragile bones and osteoporosis) and in turn, a potential build up in the bloodstream. Still, the authors emphasize that calcium supplements in moderation are a necessary and beneficial option for women at risk for osteoporosis. The trick is to limit supplemental calcium intake to no more than 1.2  to 1.5 grams daily because our bones need protection. Read the label. And speak to your healthcare practitioner. When it comes to protecting our bones through supplementation, moderation appears to be the key.

p.s. Stay away from the Sippy diet. It’s a sippier slope (sorry, couldn’t resist!).