STEP ON IT! ! physicians physicians are not recognizing the need for treatment. So I’m hoping that this condition will be taken more seriously by phy-sicians treating women and men in their 70s and 80s and 90s. And that they don’t jump on the treatment bandwagon so early with people in their 50s. Q: Should all women get their bone density measured? A: Most don’t need it until they’re 65.Women under 65 should get a bone-density test and get a FRAX score only if the doctor is concerned about their risk factor profile. Q: What about men? A: Men can wait until age 70, but then the advice is the same. If their T-score is in the osteopenia range and their FRAX score is high enough, they’re good candidates for treatment Q: The theme of this year’s World Osteoporosis Day—October 20th—was “Don’t miss the signs of a breaking spine.” Why do spinal fractures often go undiagnosed? A: Sometimes the fractures are slow and occurmicron bymicron. Nerve endings aren’t that involved. People will notice that the shape of their back or their height has changed, and they’ll get an X-ray and see these fractures. That’s not un-common. But they Food or Nutrient Calcium would not have been painful discrete events. They don’t hurt. That’s fortunate, but unfortunate-ly, the interven-tion is some-times delayed because people are unaware of them. -Fruits & Vegetables Exercise (weight-bearing) Q: Are hip frac-tures a bigger problem? A: Oh yes, because they require surgery Vitamin A retinol (as acetate or palmitate) Vitamin D Protein Bicycling or Indoor cycling Any weight-bearing exercise is good for your bones. Here are a few high-and low-impact examples. Exercise that isn’t weight-bearing may be good for your heart and waistline, but won’t help your bones. HIGH-IMPACT Dancing High-impact aerobics Hiking Using elliptical training machines Low-impact aerobics Jogging or Running Jumping rope Stair climbing Tennis LOW-IMPACT Using stair-step machines Fast walking on a treadmill or outside NON-WEIGHT-BEARING Swimming Water aerobics Stretching and fl ex-ibility exercises Deep-water walking nd death. That’s ven true for wrist actures. A recent udy found that eople who’ve had rist fractures start lose their overall IT! physicians are not recognizing the need for treatment. So I’m hoping that this condition will b IT! physicians are not recognizing the need for treatment. So I’m hoping that this condition will be taken more seriously by phy-sicians treating women and men in their 70s and 80s and 90s. And that they don’t jump on the treatment bandwagon so early with people in their 50s. Q: Should all women get their bone density measured? A: Most don’t need it until they’re 65.Women under 65 should get a bone-density test and get a FRAX score only if the doctor is concerned about their risk factor profile. Q: What about men? A: Men can wait until age 70, but then the advice is the same. If their T-score is in the osteopenia range and their FRAX score is high enough, they’re good candidates for treatment Q: The theme of this year’s World Osteoporosis Day—October 20th—was “Don’t miss the signs of a breaking spine.” Why do spinal fractures often go undiagnosed? A: Sometimes the fractures are slow and occurmicron bymicron. Nerve endings aren’t that involved. People will notice that the shape of their back or their height has changed, and they’ll get an X-ray and see these fractures. That’s not un-common. But they Food or Nutrient Calcium would not have been painful discrete events. They don’t hurt. That’s fortunate, but unfortunate-ly, the interven-tion is some-times delayed because people are unaware of them. -Fruits & Vegetables Exercise (weight-bearing) Q: Are hip frac-tures a bigger problem? A: Oh yes, because they require surgery Vitamin A retinol (as acetate or palmitate) Vitamin D Protein Bicycling or Indoor cycling Any weight-bearing exercise is good for your bones. Here are a few high- and low-impact examples. Exercise that isn’t weight-bearing may be good for your heart and waistline, but won’t help your bones. HIGH-IMPACT Dancing High-impact aerobics Hiking Using elliptical training machines Low-impact aerobics Jogging or Running Jumping rope Stair climbing Tennis LOW-IMPACT Using stair-step machines Fast walking on a treadmill or outside NON-WEIGHT-BEARING Swimming Water aerobics Stretching and fl ex-ibility exercises Deep-water walking nd death. That’s ven true for wrist actures. A recent udy found that eople who’ve had rist fractures start lose their overall ability ability to get around and do their activities over the following six to seven years. It’s an indicator of declining health. Q: Are hip and spinal fractures equally preventable? A:With diet and exercise, yes. With drugs, it depends. Some drugs lower risk of spine fracture only, whereas others lower risk of fractures at all sites. Bisphosphonates like Fosomax, Actonel, and Reclast—the once-a-year injection—have powerful ef-fects on the spine and hips. Drugs like Evista and some of the weaker bisphosphonates, like Boniva, just lower spine fractures. and longer hospital stays and then more time in a rehab institution, etc. Hip frac-tures cost about $30,000 each in direct medical costs. But spinal fractures are also associated with increased risk of declining health THE BOTTOM LINE Shoot for This Much Every Day 1,000 mg if 19 to 50 1,200 mg if over 50 400 IU if adult up to age 60 800 to 1,000 IU if over 60 At least 60 grams (women) At least 80 grams (men) At least 11 servings a day 30 minutes or more 2,330 IU (women) 3,000 IU (men) (More is okay only if it’s from beta-carotene.) Q: C Can bisphosphonates cause hip fracture? A: There may be a slight increase in the risk of an unusual kind of hip fracture, but it pales beside the risk of having a fracture from untreated osteoporosis.We need to keep it in perspective. It’s similar to What You Need to Know To protect the prostate, men shouldn’t exceed 1,500 mg a day. Adults 60 and younger may need more than 400 IU a day, but evidence is hard to come by because fractures are rare in younger people. These levels are for a typical 130 lb. woman or 175 lb. man. Rule of thumb: Your target protein in grams is roughly half your weight in pounds. There’s no better way to neutralize excess acid. To get or stay trim, you’ll need 60 to 90 minutes a day. The outdated Daily Value (DV) for vitamin A that’s used on labels (5,000 IU) is too high. the fear that the bisphosphonates could cause jaw osteo necrosis—a rare condition involving bone lesions that fail to heal. In both cases, the risk is minuscule com-pared with the risk of not treating osteoporosis. Q: But there’s quite a bit we can do before drugs are on the table? A: Yes. The take-home message is that diet and exercise have real impact on both bone and muscle health. NUTRITION ACTION HEALTHLETTER ■ NOVEMBER 2010 7 Photo: © PinkShot/fotolia.com.