Evangeline Holtz was only 19 when her doctor told her she had the bones of a 70-year-old. ‘When I first found out, I was really stressed,’ she says. Holtz had attended ballet school since she was 10, and had dieted to keep her weight down: At five feet six inches, she weighed only 98 pounds. The combination of low caloric intake and high physical output had led to a diagnosis of osteopenia, or reduced bone mass. This is a precursor to full-blown osteoporosis, the potentially crippling disease that leads to fragile bones and fractures, especially of the spine, wrist or hip.
So Holtz quit dancing and enrolled in English literature at the University of British Columbia, where, she says, ‘I’m using my brain instead of my body.’ While dancing, Holtz had eaten very little dairy. Now, she says, ‘I take calcium supplements, I eat tons of yogurt and I drink tons of milk.’ As well, she stretches, runs and lifts light weights. Now 22, Holtz weighs about 120 pounds, and her most recent bone density scan showed that her condition was stable. But Holtz is taking no chances for now: She avoids sports such as snowboarding, skating, roller-blading and wakeboarding. ‘If I broke my leg, I would take three to four times as long to heal as another person would.’
While it’s true that osteoporosis is a disease that mainly affects women over the age of 50, that doesn’t mean younger women, including teens, can ignore the risks. When it comes to osteoporosis, says Dr. Angela Cheung, a researcher for the University Health Network in Toronto, ‘it used to be that the focus was on older people.’ But in fact we need to build bone mass when we are young, and maintain it as we age. ‘That means eating well and being physically active.’
Half the battle: Calcium and D
‘Bone is a living tissue,’ says Susan Whiting, a professor of nutrition at the University of Saskatchewan. ‘It needs the same nutrients as other tissue, but it also needs calcium and vitamin D.’ To be sure of getting a balanced diet, Whiting advises following Canada’s Food Guide.
While this may seem like common sense, the journal Canadian Family Physician raised a major concern in 2003: Stressing that maximizing bone mass early in life can prevent or delay the onset of osteoporosis, it pointed out that about 60 percent of girls aged 13 to 17 consume less than the recommended amount of milk and milk products. Teenagers need calcium to grow a healthy skeleton; as we age, calcium maintains our bones.
As for vitamin D, it used to be thought that its main role was to help the body absorb calcium. However, it is emerging as an important player in its own right. Suggested daily intakes are under review by Osteoporosis Canada (see current guidelines below); meanwhile, Health Canada recommends 200 IU for those under 50 and the Canadian Cancer Society recommends 1,000 IU in the fall and winter.
According to Reinhold Vieth, a University of Toronto professor: ‘More vitamin D tends to slow the chewing away of bone, and improve muscle and nerve function.’ In Canada, it’s difficult to get all the vitamin D we need from the sun, so Health Canada recommends we look to food fortified with vitamin D or to supplements.
The other half: Exercise
Darien Lazowski-Fraher is a London, Ont.-based physiotherapist and co-author of Body Basics for Bones. She says that to build bones and keep them healthy, women need ‘high-impact, weight-bearing exercise. Teenagers should be running, jumping, skipping, and playing volleyball, basketball or tennis. For adults, brisk walking, running or jogging works. Older adults can do sports that don’t have a high fall risk.’ And while swimming is good for strengthening your muscles, it doesn’t build up your bone strength.
Janet Gagnier is at high risk for developing osteoporosis because her mother has the disease. The 51-year-old Halifax resident had her first bone scan about five years ago and it showed some reduction of bone mass. Her most recent scan indicated she was ‘on the fringes of osteoporosis.’ So Gagnier takes vitamin D and calcium supplements, and goes to the gym four or five times a week. ‘I don’t want to break my hip at 70,’ she says.
It’s a real worry, given that about 1.4 million Canadians have osteoporosis. The disease caused more than 28,000 hip fractures from April 2005 to April 2006; 20 percent of these people died as a result and half of those who survived became disabled.
We can’t detect osteoporosis ourselves, but a bone mineral density test can determine what your bone mass is and how likely you are to break a bone. Your risk’low, medium or high’will determine whether you need to change your lifestyle and diet, or whether you need prescription medication. On the horizon is a new way of testing for bone density that could make the detection of osteoporosis even easier than it is now: In March 2007, a Dutch team of researchers reported that they’d figured out how to use software to analyze routine dental X-rays to identify women at risk.
Fortunately, we are learning more and more about what we can do at various stages of our lives to prevent osteoporosis, and this increasing knowledge is bearing fruit: The number of hip fractures among Canadians is less than it was five years ago’down 13 percent.
Risk factors for osteporosis
‘ A family history of the disease
‘ Long-term use of steroids
‘ Loss of menstrual periods in younger women
‘ Having had a low-trauma fracture (a fracture that results from a fall from standing height or less’usually the wrist, arm or hip)
‘ Body weight of less than 125 pounds
‘ Low calcium intake
‘ Drinking more than four cups of coffee a day
‘ Drinking more than two alcoholic drinks a day
What you should do
Teens up to 18:
Move: Exercise for 1 hour daily
Watch your diet: Calcium: 1,300 mg’; Vitamin D: 200 IU*’
Move: Exercise for 1 hour 3x a week
Watch your diet: Calcium: 1,000 mg’; Vitamin D: 400 IU*’
Get tested: At 50, women should have a bone scan if they have 1 major or 2 minor risk factors (see above) and have not yet been tested
Move: Exercise for 1 hour 3x a week
Watch your diet: Calcium: 1,500 mg’; Vitamin D: 800 IU*’
Get tested: At 65, all women should have a bone scan