Integrative Rheumatology

Window of Opportunity for the Big “O”

By: Farhan Tahir MD,

Osteoporosis is a skeletal disorder of compromised strength as a result of poor quality of bone and increased risk for fracture. Osteoporosis is linked to high risk of fractures causing pain and permanent disability. Avoiding osteoporosis requires proactive preventive strategies, an active lifestyle, and anti-inflammatory nutrition.

More than 10 million people in United States have osteoporosis, and more than 2 million osteoporotic fractures occur each year. Women have a higher risk of fractures than men, and 75% of fractures affect women; however, men are at a greater risk of dying of a hip fractures. Diagnosis of osteoporosis involves the use of DEXA scans, which assess bone mineral density, but they do not assess bone quality. It is estimated that about 47% of women over 50 have low bone density.

Risk factors
A Women’s Health Initiative study found that the following risk factors play a major role in osteoporosis: age above 50, weight, height, race, ethnicity, physical activity, history of fracture, parents with hip fracture, smoking, chronic inflammation, and corticosteroid use as well as history of rheumatoid arthritis, hypothyroidism, celiac disease, and diabetes.

Pharmacological treatment
There are many treatment options available for patients with osteoporosis, including estrogen hormone replacement, bisphosphonates, selective estrogen receptor modulators, calcitonin, and strontium, to mention a few. Fosamax, Actonel, Boniva, and Reclast belong to class of drugs called bisphosphonates. In recent years, new medications like Prolia and Forteo have been approved. All medications have scientifically proven benefits, but they also can have side effects. Therefore, a thorough discussion with your healthcare provider is important to inquire about your need for osteoporosis early detection, preventive steps to take, and choice of medications.

Attaining a high peak bone mass between the ages of 30 and 50 is an important factor in preventing osteoporosis, and studies show that women with a diet adequate in calcium, vitamin D, and proteins along with an active lifestyle during adolescence and young adulthood have less risk of developing osteoporosis.

The substances that are harmful to bone health include excessive amounts of vitamin A, caffeine, sodium, and an imbalance of calcium and phosphorus. Smoking and excess alcohol are also linked to increased risk of osteoporosis-related fractures and complications.

Nutritional supplements
The following supplements have been studied extensively for their proven role in building and maintaining healthy bones.

Calcium is important, and, to get about 300 mg of calcium, you will need 8 oz. of milk or yogurt or 1 oz. of Cheddar, Swiss or Monterey Jack cheeses. Nondairy calcium sources include 1 oz. of white beans, 1/2 cup of spinach or turnips greens, 1/2 cup of cooked or fresh broccoli or bok choy, 1/2 cup of soybeans, or 1 oz. of dry-roasted almonds. Salmon and dried figs are also good sources.

Which calcium type is the best-Calcium carbonate should be taken with meals and is less expensive. It provides 40% elemental calcium. Calcium citrate is expensive but has some advantages; it is well absorbed and can be taken with or without meals. If you are on medication to reduce stomach acids, this is the best form. Calcium citrate provides 21% elemental calcium. Calcium from sources like dolomite, oyster shell, or coral are not recommended.

How to take it-Large tablets may be difficult to swallow and may not absorb or disintegrate in the stomach, so calcium in powders, capsules, and liquids is better.

How much to take-Remember that calcium supplements should not exceed 500 mg at any one time. You should avoid taking calcium supplements along with psyllium or with foods high in oxalic acid (e.g., spinach) or phytic acid (e.g., wheat bran).

Vitamin D—the sunshine vitamin
Over the last decade, there has been enormous advancement in research about vitamin D. Active forms of vitamin D improve transport of calcium across the intestinal system. Vitamin D also stimulates the absorption of other minerals such as phosphate and magnesium. Vitamin D and K stimulate bone mineralization.

It is not a secret that Vitamin D deficiency is widespread throughout North America. Studies have found that women, older adults, obese and dark-skinned individuals, and breast-fed infants are at higher risk. An international study found that 64% of postmenopausal women with osteoporosis have low vitamin D (less than 30 ng/mL level). It makes sense to supplement with vitamin D at doses of 400-800 units/day. Vitamin D supplementation has been shown to reduce fracture risk and the chance of falls and to improve leg function in older adults.

Vitamin D supplementation doses
Normal dosing of vitamin D depends on your blood levels. After you have discussed this with your healthcare provider, a treatment dose ranging from 2,000 to 10,000 units per day will be recommended. If you are already taking vitamin D, add calcium, magnesium, and vitamin K.

How much is too much-It is very difficult to get too much vitamin D, but regular monitoring is required. People with sarcoidosis, lymphoma, or kidney disease have to monitor their vitamin D levels to ensure they don’t rise too high.

2014-06-04_10-07-50About the author: Dr. Farhan Tahir, MD is board certified through the American Board of Internal Medicine, Rheumatology and Integrative & Holistic Medicine. He is a member of the American College of Rheumatology and founder of Pennsylvania’s first and only integrative rheumatology practice. He lives in Bucks County with his wife and three young boys. To contact Rheumatology Care Consultants, PLLC,
call 267-685-6070 or email: Its website is http://www.RheumPA.



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