Is there any pain with osteoporosis?
Generally no. That’s why it is known as the “silent” disease. However pain comes if there is a fracture of the hip or arm as a result of having osteoporosis. If wedging or fracturing of the vertebrae occurs, pain may occur in the soft-tissue surrounding that area of the vertebrae, especially upon stretching, as the soft tissues have become accustomed to a flexed or forward position.
Does having kyphosis mean you have osteoporosis?
Kyphosis of the back is an exaggeration or angulation of the posterior curve of the spine and is sometimes called humpback, hunchback or Pott’s curvature. This may be due to a congenital anomaly, disease (tuberculosis, syphilis), malignancy, or compression fracture. If it is due to a compression fracture, that may be the result of osteoporosis. Kyphosis also refers to an excessive curvature of the spine with convexity backward. This may be due to faulty posture, osteoarthritis or rheumatoid arthritis, rickets, or other conditions. Rickets is a deficiency condition in children, primarily a deficiency of vitamin D, which affects the absorption of calcium and phosphorus from the intestine and the reabsorption of phosphorus by the renal tubules.
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I have back pain. Could it be osteoporosis?
Not necessarily. Fewer than 5% of people with back pain have a major medical problem that requires intensive care or therapy. However, if you are at risk for osteoporosis (look at risk factors on this website) you should have a DEXA scan that will show you what your bone mineral density (BMD) is. Osteoporosis is called the “silent disease” because most people don’t know they have it or “feel it” until the disease has really progressed – often to the point of fracture. Even then, most spine fractures may be dismissed as general back pain due to aging or muscle strain. Spine fractures are serious business and can result in severe pain, spinal deformity (loss of height, hunched back), and maybe even more serious medical conditions. First you need to get prompt diagnosis. If it is osteoporosis, there are many things you can do to prevent its worsening and medications you can take for its improvement.
If the doctor says I need to take 1500 mg. of calcium, does that include the food I eat?
Yes it does. For example: You may have milk on your cereal in the morning that has 200-300 mg. of calcium (depending on how much you use; 1 cup = 300). Later in the day you might take a calcium supplement with 500 mg. of calcium. A one-a-day- vitamin will have some calcium in it. Lunch and dinner might include foods high in calcium (keep track) and then if you take another supplement, you will soon accumulate your 1500 mg. of calcium. It is best to have your intake of calcium distributed over the day, for better calcium absorption. When you take too much calcium (usually over 500 mg. at one time), the excess calcium lost through the urine is increased. Calcium is a good thing, but under certain conditions, can be harmful. Your kidneys play a key role in balancing the amount of calcium and phosphorus in your blood. If there is a decline in kidney function, the body is unable to get rid of calcium it absorbs that is not used by the bones and serious health problems can result. Simple blood tests show the health of your kidneys.
I have been told I have osteoporosis. Is there a treatment that does NOT include drugs?
There are many things you can do for osteoporosis that include walking, exercising (weight-bearing, strength training), and insuring you have adequate calcium (1500 mg if you have osteoporosis) and vitamin D in your diet. Most people do not know what their vitamin D level is in their body. Ascertained by a blood test, the normal range is 32 – 100. Vitamin D levels below that, will interfere with calcium absorption. If you have been diagnosed with osteoporosis, you may be at a point where you are losing bone faster than you can build it up even with exercise and a diet rich in calcium and vitamin D, and a medication may be indicated. This should be thoroughly explored with your physician.
Is walking enough of an exercise to prevent osteoporosis?
It may help, but is not enough. Although walking is a good heart-healthy exercise and can be part of a program to prevent osteoporosis, it is not the whole story. According to Dianne Daniels, exercise physiologist and author of Exercises for Osteoporosis, to cause bone to grow it must be challenged with a new, added weight, not the same load over and over again, as with walking. The best strategy is to make strength training (also called resistance training or weight training) a part of any osteoporosis-fighting plan. Strength training also helps improve balance thereby making falls and fractures less likely.
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If I use sunscreen all the time, do I get any vitamin D?
Probably not. Although most Arizona days have sunlight (unlike northern latitudes where very little ultraviolet light is available in the wintertime), recent studies have shown that people in sunbelt states are no longer getting adequate UV exposure due to limited sunlight-exposure occupations and the use of sunscreens to prevent skin cancer which block UV rays. Sunscreens with a sun protection factor (SPF) of 8 or greater will block UV rays. An initial exposure to sunlight (10-15 minutes) may allow adequate time for vitamin D synthesis prior to application of a sunscreen with an SPF of at least 15 to protect the skin. Ten to 15 minutes of sun exposure at least two times per week to the face, arms, hands or back without sunscreen may be sufficient to provide adequate vitamin D. (Holick MF. Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 2002; 9: 87-98) A two-to-three times weekly sun exposure may however be insufficient, if you have a vitamin D deficiency. Your question, a good one, opens up controversial and complicated issues. Best absorption of UV rays occurs at midday, but that is also the time most harmful to the skin, therefore, it is recommended that sun exposure be obtained prior or after midday. Other factors then, like age and health play a role in how much UV rays one actually absorbs. You might wish to explore this further. A good place to start is with The NIH Office of Dietary Supplements, which maintains a Dietary Supplement Fact Sheet: Vitamin D online and is revised periodically.
How much vitamin D do I get from the sun? How long does it take?
For a light-skinned person, a 30 minute full body exposure to summer sun at noon triggers the release of about 20,000 IU of vitamin D into the circulation; half that amount in a dark-skinned person. But most of us simply don’t get outside in the middle of the day. Interestingly, the body prevents vitamin D toxicity from too much skin exposure. This cannot be said of dietary intake or supplementation of vitamin D if too much is taken. It is the current opinion of many authorities that the current recommended daily allowance of vitamin D is far too low at 400 IUs (international units) and should be increased. Caution must be taken about making recommendations to increase sun exposure solely to increase vitamin D. There are downsides to excessive sun exposure, such as skin cancer and premature skin aging.
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I have read that there are different types of vitamin D. Is vitamin D from the sun or food any different than from a pill?
The main source of vitamin D is ultraviolet B light from the sun, but unlike our ancestors, modern man no longer gets adequate exposure. Because most people also do not get adequate vitamin D in typical diets and the potential downside to excessive sun exposure, many may benefit from supplements. With that being said, vitamin D is a group of fat-soluble prohormones, and the two major forms are vitamin D2 (ergocalciferol) and vitamin D3 (cholercalciferol), a form normally added during fortification of foods. Cholecalciferol is produced industrially by the irradiation of 7-dehydrocholesterol (the precurser of vitamin D3) extracted from lanolin found in sheep’s wool. In products where animal products are not desired, ergocalciferol, derived from the fungal sterol ergosterol, is used. In a 2004 study, vitamin D3 has been shown to be 3-10 times more potent than D2 and has more prolonged effects, but the body may not be able to tolerate as much D3. Most authorities recommend a much higher intake of vitamin D than the recommended daily allowance (RDA). It is important to know what your vitamin D level is. Measured easily through a blood test, the normal range is between 32 and 100. If you are below 32, your physician may encourage you to take a vitamin D supplement or try to get more high-vitamin D containing foods into your diet such as cod liver oil, salmon, mackeral, tuna fish, sardines and fortified milk. You might wish to explore this further. A good place to start is with The NIH Office of Dietary Supplements which maintains a Dietary Supplement Fact Sheet: Vitamin D online and is revised periodically.
How often do I need a bone density test?
This question sounds like it should be easy to answer, but in fact it is complicated and even controversial. What may be more important is that you get a baseline bone mineral density (BMD) test and have your vitamin D level checked. MedicineNet.com answers this question in detail, but you should also discuss this with your physician. The usual rate of decline in bone density in postmenopausal women not taking therapy is 1% per year, less than the error of the machine that measures BMD, which is about 3%. In postmenopausal women taking osteoporosis medication, a decrease in fracture risk is mostly due to factors other than BMD changes. Medications work to improve strength of bone (besides changing BMD) which cannot be measured by a bone density scan. Repeated bone density testing may not tell you too much about your actual protection against fracture.
No one in my family has ever had osteoporosis that I know about. I drink lots of milk and walk everyday. Why did I get osteoporosis?
Without knowing your entire medical history this is difficult to answer. You may have to explore each of the risk factors for osteoporosis to answer this. It sounds like you are paying attention to your calcium intake and at least getting exercise through walking. Is your intake of calcium 1500 mg.? Addressing your risk factors is important to find out why you may have gotten osteoporosis. The following all play a role in the development of osteoporosis. Do you have a small frame? Did your menses start late or did you have an early menopause? Do you do strength training in addition to walking? Is your vitamin D intake adequate? (Do you know what your vitamin D level is?) Do you have a history of smoking? Do you drink alcohol or caffeinated beverages to excess? Do you have any history of glandular problems? You and your physician might review some of these issues if you wish to target why this happened to you. But more important now is the prevention of further bone loss………by looking at those risk factors you can change.
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