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I'm a 38-year-old woman. Should I be worried about osteoporosis? Add to ...

The question

I'm a 38-year-old woman. Should I be concerned about osteoporosis and what can I do?

The answer

An excellent question as it highlights the very importance of thinking about osteoporosis now - so you can be proactive to take steps to protect yourself and keep your bones healthy for the future.

Osteoporosis is a disease in which bones become thin, brittle and lose their normal structure. This can increase the risk of fracture - mostly of the spine, wrist and hip.

In Canada, one in four women and one in eight men over 50 suffer from osteoporosis. Osteoporosis Canada cites that of the 30,000 fractures/year in Canada, 70-90 per cent of fractures are related to osteoporosis and individuals suffering from a hip fracture can have more than a 20 per cent chance of dying within the next year.

The impact upon the individual, and their famiy can be devastating and can reduce quality of life by limiting mobility, decreasing independence, and can lead to chronic pain and disability.

Osteoporosis develops over time, so the promising news is that you can start to make some changes now that may help to preserve your bone health. Bones have usually reached their peak bone mass for women by their late teens and for men by their early 20s. Bone is constantly renewing itself by building and repairing itself over time. In our mid-30s and onwards, this process becomes less efficient and bone can become fragile as a result. For women, with the decrease in estrogen at menopause, bone loss is accelerated - that's why there is such a big emphasis on osteoporosis at this time.

At your age, consider the following risk factors for osteoporosis. While you cannot change factors like your family history, this list can help to identify areas in your life that you may be able to modify such as smoking, calcium intake and alcohol consumption.

Modifiable Risk Factors:

1. Weight: Do you weigh less than 132 lbs (60kg)? Is your current weight more than 10% below what your weight was at age 25?

2. Calcium intake: Do you have sufficient intake of calcium in your diet?

3. Lifestyle factors: Do you smoke? Do you drink more than 2 alcoholic beverages daily?

Non-modifiable RFs:

1. Steroid use: Have you ever used corticosteroid (i.e. prednisone) therapy for longer than 3 months consecutively?

2. Medical conditions: Do you have a condition that may affect absorption of nutrients such as: inflammatory bowel disease, cystic fibrosis, celiac disease or kidney disease? Do you have a medical condition that effects bone strength such as hyperthyroidism or Cushings disease?

3. Do you have a family history of first degree relative with osteoporosis or do you have a parent who had a fracture related to osteoporosis?

4. Did you go through menopause before age 40?

If you answered yes to any of these questions - consider the following changes and a visit your doctor to discuss what else you can do to keep your bones healthy.

1. Ensure your calcium intake is sufficient: The recommended daily amount of calcium for osteoporosis prevention is 1000mg/day for men and women aged 19-49 and 1200-1500mg/day for those over 50. Easily absorbable calcium can be found in dairy products and non-dairy products such as soy drinks, orange juice, fish (salmon, sardines), and legumes. If you are unable to get enough calcium in your diet, a supplement can be helpful to reach your target. It is also important to note that there are foods that can deplete calcium stores including excess caffeine (i.e. more than 4 cups of coffee/day) and high salt foods.

2. Vitamin D: A fat soluble vitamin that helps with absorption of calcium, vitamin D is a very important factor to keep your bones healthy. Exposure to sunlight is an important source of vitamin D, so unfortunately due to our long winters - Canadians are at risk of seasonal vitamin D deficiency. Foods that contain vitamin D include: dairy products, soy drinks, orange juice, fatty fish, egg yolks, and cereal. If you are otherwise healthy and do not have any other conditions that would limit absorption of nutrients, the recommendation for vitamin D is: age 19-49 - 400-1000IU/day and for over 50: 800-2000IU/day.

3. Exercise: Weight bearing and walking can help build and maintain bone strength, and improve balance, coordination and posture which can in turn then reduce the risk of falls.

4. Quit smoking and reduce alcohol consumption.

For more information on what you can do to prevent osteoporosis for yourself and your loved ones, an excellent resource is Osteoporosis Canada.

Send family doctor Sheila Wijayasinghe your questions at doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Wijayasinghe.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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