The Nation’s Largest Integrated Wellnessand Health Network for People 62+

THE ERICKSON TRIBUNE HEALTH EDITIONMAY 2005 PAGE 7

By Wendy J. Meyeroff

THE ERICKSON TRIBUNE

The National Osteoporosis Foundation(NOF) says 44 million Americans eitherhave osteoporosis or are at risk. In conjunction with May being OsteoporosisAwareness and Prevention month, this issueof Erickson HealthSM explains this poten-tially devastating condition, and offers relatively easy ways to prevent it, or at leastmitigate its effects. (We urge you to copy orclip one or more articles and send them tothe people you love.)

Understanding Osteoporosis

“Osteoporosis is a reduction in bonedensity and a disruption in microscopicbone structure, that allows bone to breakeasily,” says Felicia Cosman, MD, theNOF’s medical director. Easy bone break-age is the greatest danger of osteoporosis. Itleads to disrupted quality of life, permanentdisability, and even death.

The National Institutes of Health(NIH) estimates that osteoporosis isresponsible for 1.5 million fractures annual-ly, with 300,000 in the hip. Up to 25 per-cent of people remain institutionalized forat least one year after a hip fracture. Even asmaller fracture, like in the wrist, can bedisabling. Think of trying to tie your shoesone-handed.

Two Major Risk Factors

Cosman says, “Age is one of the keyrisk factors, because our bone density startsdeclining after 30 or 35.” With an agingpopulation (by the year 2040 it is estimatedthose 65 and older will more than double,to 77.2 million), osteoporosis and bone

density problems are only likely to becomemore prevalent.

Gender also plays a role. Women tendto have lighter bone mass than men fromthe start, and menopause’s hormonalchanges speed their bone loss. JohnMarcelis, MD, medical director of Ann’sChoice, a community build and operatedby Erickson, says, “I talk to every femalepatient over 65 about their bone densityand screening and their calcium and vita-min D intake.”

That doesn’t mean men aren’t affected.By around age 70, men start losing bonemass at about the same rate as women. Ofthe 10 million Americans already withosteoporosis, two million are men – and thenumbers are only going to rise for bothgenders. Marcelis notes that he’s especiallycareful to discuss osteoporosis with malepatients who are in high-risk categories orwho are already showing signs, like dimin-ished height.

The Drug Connection

There are numerous ways to preventosteoporosis, or at least minimize its effects.You’ll find good information on how diet,exercise, and supplements can fight this disorder throughout this EricksonHealthSM section.

One concern older Americans andtheir doctors should have are medicationsthat increase bone loss. Thyroid hormones,steroids (like Prednisone) and drugs likeLupron for fighting prostate cancer, are among those Cosman cites as increasingbone loss.

Older people must be wary of drugscausing dizziness or balance problems, sincefalls are the leading cause of fractures in our

older population. If you’ve been havingsuch problems, notify your physician rightaway. Marcelis notes at communities builtand managed by Erickson, the physicianshave Centricity, an electronic medicalrecords system. “Among other things, italerts us as to whether a patient shouldhave a BMD test.”

The BMD Test

That BMD – bone mineral density –test, is an important preventive tool.Cosman says, “It’s the most accurate way todetermine if you have osteoporosis or are atrisk.” The most-used test, DXA, checksbone density at your hip and spine, theareas where fractures are most likely tooccur. It’s a simple imaging test, even lowerlevel radiation than an X-ray.

Yet although this test is painless andquick, very few adults take one regularly.Cosman recommends having a BMD doneevery one or two years, “depending on howmany risk factors you have”. The more riskfactors, the more vigilant you should be.The test is covered by Medicare if you’re at risk.

Understanding Bone Density

The most important thing the BMDchecks is your “T-score,” comparing yourbone density to a healthy 30 year old’s tosee how far off you are. This “standarddeviation” (SD) is what you and your doc-tor need to know.

You’re at risk of developing osteoporosis

if your BMD has an SD of 1 to 2.5 belowthe T-score. You have osteoporosis if yourbone density is lower than a 2.5 deviation.

“There are indications we’ll have ameasurement that may be even more accu-rate later this year. It’s an ‘absolute risk cal-culator’ that will look at someone’s bonedensity, T-score, AND other risk factorsspecific to that person, and come up with apredication of just how high a risk thatindividual has,” says Cosman.

New Medications

There are now medications called bis-phosphonates (e.g., Fosamax and Actonel)for fighting osteoporosis. Cosman says,“They’re taken once a week and are veryeffective and well-tolerated.” Just make sureto follow instructions. Marcelis says, “They should be taken in the morningbefore eating, with lots of water and always in an upright position.” There areindications there’ll be a once-monthlytablet before this year is out and even aonce-yearly injection (though Cosman saysthe latter is way down the road).

There’s also a drug called Forteo, agenetically engineered hormone that actually repairs bone. However its long-term effects aren’t known and it can haveextreme side effects, so for now it is onlybeing used short-term in patients withsevere osteoporosis.

So Get Started

We hope we’ve convinced you of the

The Silent Dangers of Osteoporosis

GOOD HEALTHSTARTS HERE

Are You at Risk?

How Can You Build Your Bone Density?Your Free Erickson Health Guide Offers Ideas

Erickson HealthSM, the nation’slargest and most completely integratedwellness and health system for adults62-plus, offers many programs that canhelp you fight osteoporosis and bonefractures.

The Erickson HealthSM Guide willshow you what we mean. Among theoptions you’ll find:F Water aerobics in our indoor poolsF Balance programs run by trained

physical therapists and wellness counselors

F Tai Chi and other exercise options inour on-site Fitness Centers

F Walking, hiking, dancing, and otherweight-bearing activities

All this and more, overseen byErickson HealthSM doctors, nurses, and other health professionals trained in the specific health needs ofAmericans 62-plus—including fighting osteoporosis.

To get your FREE EricksonHealthSM Guide or for more informa-tion on Erickson HealthSM call theErickson community nearest you (seethe listing on Page 2) or visit our website: www.EricksonHealth.com.

SM

q I’m older than 70.

q I smoke.

q I don’t eat many calcium-rich foods, like milk, tofu, and cheese

q I have a family history of osteoporosis or bone fractures.

q I don’t know if any of my medicines cause bone loss.

Osteoporosis Risk Factors: Are You in Danger?

Check off all the answers that apply to you. Then get more information on what they mean at the bottom of P. 8

By Kathy Chaney, RD, LDN

THE ERICKSON TRIBUNE

The key to fighting bone loss at any age is a diet rich in calcium, the main element in bone composition.

Unfortunately, numerous surveysshow most Americans don’t get enoughcalcium in their diets. The NationalOsteoporosis Foundation (NOF) recommends older adults get between1200 and 1500 mg. daily, but most get600 mg. or less.

Fortunately it is easier than you thinkto get more calcium into your diet, evenwithout supplements. Milking Your Diet

Without a doubt, dairy products areyour best calcium source. Nothing givesyou the calcium bang for the buck thatdairy does—and the best source of all ismilk. One eight-ounce glass of wholemilk provides 290 mg. of calcium, skimmilk has 302 mg. That’s a significant portion of your daily needs right there. Sadly, most older Americans don’t drinkenough milk. Some don’t like the taste,others never developed the habit, Still weall know it’s never too late to change a

bad habit. Here are some fast tricks forincorporating regular or low-fat milk intoyour diet:

F Add a little to your coffee.

F Buy chocolate milk or (to be morecost-effective) add a little chocolatesyrup to regular milk.

F Use it to make delicious soups, likecorn chowder.

F Use non-fat powdered milk as a thick-ener for stews, casseroles, and soups.

F Make a delicious smoothie by addingfresh fruit. (Very good idea now thatsummer’s approaching.)

Bone LossFighting Diet

see Stronger Bones page 8

Choose Your Foods CarefullyCalcium-Rich Foods

0.5 cup part-skim ricotta 337 mg.

1 cup cooked collard greens 226 mg.

3.5oz. bone-in sardines 351 mg.

0.5 cup tofu 204 mg. (approximate)

EricksonFile

Photo

THE ERICKSON TRIBUNE GOOD HEALTH STARTS HERE MAY 2005PAGE 8

By Wendy J. Meyeroff

THE ERICKSON TRIBUNE

It’s critical for older Americansto get calcium and vitamin D tofight bone loss, and to do so,more Americans have turned tosupplements. By 2001, calciumsupplement sales hit had a record $775 million.

Unfortunately, too many con-sumers don’t get what they payfor. One independent lab’s testingfound only 20 percent of calciumsupplements delivered what theypromised. To get your money’sworth, there are three questionsyou should ask about your supplements:1. How much vitamin D does it

provide?

2. How much actual calcium(called elemental calcium) doesit contain?

3. How much of the elementalcalcium actually gets into yoursystem?

The Vitamin D Question

Most stories on calcium supplements start by talking calcium, but at EricksonHealthSM we know there’s anotherimportant issue: vitamin D.“Vitamin D levels not only affectyour bones,” says Felicia Cosman,medical director of the National

Osteoporosis Foundation (NOF).“We now think it affects musclefunction and even fights cancer.”

John Marcelis, MD, medicaldirector of Ann’s Choice, a com-munity built and operated byErickson, adds, “Lack of vitaminD causes osteomalasia, a distor-tion of bone architecture. It alsoaffects the body’s ability to absorband metabolize calcium.”

It’s recommended that olderAmericans get 800 I.U.s(International Units) of vitaminD, twice the 400 I.U.s generallyrecommended for adults.Supplements are so importantbecause there are few other reli-able sources of vitamin D.

There are few natural foodsources. Milk and some otherfoods are enriched with it. It’s also found in certain saltwaterfish, like salmon and mackerel.

Otherwise, humans’ mainsource of vitamin D is sunlight.We only need about 15-20 min-utes exposure daily to get our vita-min D allotment. Unfortunatelynow that most of us spend ourlives indoors, not out, that’s aproblem.

Besides, says Cosman, “Whenwe do go outside, we generallyblock our exposure by wearingprotective clothing and usinghigh-intensity sunscreens.”Cosman would never suggest we

expose ourselves to skin cancer soas to get our vitamin D allowance,but it is why well over 50 percentof older Americans are deficient inthis nutrient.

Looking at Calcium

Calcium supplements containeither calcium carbonate and cal-cium citrate. You’ll find the car-bonate form most often, in prod-ucts like Os-Cal and even Tums.Citracal is a citrate.

There are two misleadingthings about calcium supplementlabeling. First, a 1000 mg tabletgenerally doesn’t deliver thatamount. Carbonates deliver about40 percent of elemental (actual)calcium into your system; citratesonly 21 percent. There’s reallyonly 400 mg. of elemental calci-um in that 1000 mg carbonatetablet—and only 210 mg in thecitrate.

Second, check the supple-ment’s serving size on the label.You might find you need severaltablets to get the dosages prom-ised. Example: one tablet mightcontain only 200 I.U. of vitaminD, instead of the 800 you’re seeking.

The Absorbability Issue

Two other critical factors arethe pill’s solubility and absorbabil-ity. “Solubility is how much will

dissolve in your stomach,”Cosman explains. “Absorbability ishow much finally gets into thebloodstream.”

It is disputed whether citratesor carbonates are better absorbed.As for solubility, look for the USPlabel; it shows the product hasmet U.S. Pharmaceopeia stan-dards in area such as purity,strength, and solubility. Or trythis home test: a supplementdropped into a glass of vinegarand stirred occasionally shoulddissolve in 30 minutes.

What to Do

Be very careful of a productthat’s been highly promoted foryears now: “coral calcium”. Notonly is there no proof it’s particu-larly healthful, there are indica-

tions some brands are so poorlymanufactured they may actuallybe dangerous. At least one highlyadvertised product has been citedby both the FTC and FDA formaking outrageous marketingclaims.

The bottom line: get as muchcalcium as you can from yourdiet. Look for supplements con-taining both calcium and vitaminD at a reasonable price. Tums E-Xis inexpensive, but contains novitamin D. Candy-like Viactivprovides both nutrients, but ismore expensive and gets it tastefrom lots of sugars.Try to find awell-respected brand AND theUSP label. Finally, always checkthe serving size: how many tabletsdo you need daily to get the nutrients you’re seeking?

Understanding Supplements

Other Dairy TricksF Don’t forget there are other

dairy sources of calcium.Read labels carefully, lookat the table on page 7,choose your favorites andtry these tricks:

F Dress up plain yogurt withfresh or frozen fruit, add some raisins—find some-thing you like to make it interesting.

F Use sliced cheddar for grilled cheese sandwiches.

F Make lasagna with part-skim ricotta.

Beyond DairyRemember that calcium also is found – though

in lesser amounts – in other food sources. Amongthem:F Dark green leafy vegetables, like collard greens and

broccoli

F Tofu—Be brave and try it. Just check labels; different brands offer different calcium levels.

F Sardines or canned salmon with bones mashed in.

F Fortified foods, like orange juice and certain cereals. Even some bottled water now has calcium!

The Lactose ArgumentSome older Americans avoid dairy products

because they’re lactose intolerant. Lactase is anenzyme that breaks down lactose in milk products.Without that enzyme, people can’t absorb lactose—asugar—properly and dairy causes stomach problems.

Fortunately, there have been solutions for lactoseintolerance for years, including tablets to aid indigesting the enzyme and lactose-free soy milk or icecream products.Get Creative

Some people worry about their cholesterol or fatlevels, which is smart of course. Look for lower-fatalternatives. Many times the low-fat food, like icemilk instead of ice cream, and yogurt instead of sourcream, is a better calcium source anyway.

Kathy Chaney is a dietitian and nutritionist atRenaissance Gardens at the health care neighborhood at Oak Crest, a community in Parkville, Md, built and managed by Erickson.

From Stronger Bones page 7

The more risk factors youchecked off on P. 7, the morelikely you are to develop osteoporosis. You may even haveit already. Here’s why:

Age—Women are four times as likely as men to develop osteo-porosis between ages 50 and 70.After that it becomes an equalopportunity disease with bothsexes at equal risk.

Smoking—Smoking doublesyour risk of osteoporotic fractures. Calcium-deficient diets—Mostadults get less than 600 mg. ofcalcium daily – but fighting boneloss needs between 1200 and1500 mg daily.

Family history—Like most conditions, osteoporosis runs infamilies. If you don’t know ifthere’s a specific history, ask

yourself if you had a lot of relatives with hip or other fractures, or “dowager’s hump”.The hunched-over look of thelatter can be a sign of disk frac-tures that have already occurred.

Certain medications—Checkour “Silent Dangers” article (andask your doctor) to find out ifany drugs you’re taking mightcause bone loss.

Exercise Your Wayto Stronger BonesBy Wendy J. Meyeroff

THE ERICKSON TRIBUNE

Bone is living tissue, just like muscle, and like muscle, it getsstronger as you exercise it. Exercisingto combat bone loss is ever more critical as we age. Before any exerciseprogram, check with two people: yourdoctor—to get a good sense of any physical restrictions, and a skilledphysical therapist or exercise instructortrained in working with older adults.

Christine Soares, P.T., is a physicaltherapist at Renaissance Gardens, the health care neighborhood atBrooksby Village, a community inMassachusetts. She is very careful tocheck a resident’s complete health picture before she begins any program.Besides checking for problems likeheart trouble or diabetes, she says, “Iwant to see their bone density test, soI’m sure just how much stress theirbones can take.”

Weight-Bearing Exercises

Weight-bearing exercises are mostrecommended for improving bonestrength. Soares says, “We’re not talking about lifting 10 or 20 pounds.

We’re talking smaller increments and,even more important, the number ofrepetitions.” The amount of weightand the number of reps should vary byindividual. That’s why an assessmentby a professional.

Soares points out, “Walking is aweight-bearing exercise.” Think howmuch weight your feet and spine aresupporting in keeping you upright!The reason so many adults shrink orhunch over is they already have smallspinal disk fractures. Walking doesn’tinterest you? Try hiking, golf, or evendancing.

The Fall Factor

Soares says, “Falls are one of mybig bug-a-boos.” People with low bonedensity are more likely to experiencedisabling fractures once they fall. Sheworks very hard to make peopleunderstand the many factors con-tributing to falling.

Among them: “Their medicationsmake them dizzy. They’re dehydrated,because incontinence fears made themrestrict their fluid intake. They sufferfrom ‘postural hypotension’—theirblood pressure falls if they go fromlying down to sitting or sitting to

standing, too quickly,” says Soares.There are also obstacles—like

throw rugs—at home. That’s why,Soares says, home visits is a criticalservice at Renaissance Gardens.Experts find and eliminate as many fall-inducers as possible.

Paul Bell, PT, CSCS, once worked at the Charlestown community supported by the Erickson HealthSM system, and is now director of rehabilitative servicesfor Orthopedic Specialty Centers ofBaltimore, Md. He says, “Improving an older person’s gait is critical to preventing falls.” Too often they shuffle, which makes it easy for themto trip. Whereas a younger person can often right themselves with noproblem, once someone older tripsthey often go over like a tree.”

One trick Bell teaches older adults:marching. “It forces them to pick up their feet.” They can do it up and down a hallway or even whilewatching TV.

Go Get Started

Ultimately both experts say it’scritical to start an osteoporosis-fightingexercise program sooner than later.They emphasize that you’re not just indanger if you fall. If you’re truly osteo-porotic, your hip could fracture whileyou’re standing—and then you’ll fall.

Bell says, “Find a class or group to help you stay motivated.” Soaresagrees, saying, “Increased strength, balance, and bone density are notlong-term benefits. To maintain them, you must maintain your exercise program.”

Understanding Osteo’s Risk Factors

To maintain bone strength, find a weight-bearing exerciseyou will enjoy continuing regularly.

Erickson File Photo

Erickson File Photo

Erickson File Photo