Osteoporosis Prevention

Osteoporosis is a “silent” disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, or fractures, occur typically in the hip, spine, and wrist. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity. Women are four times more likely than men to develop this debilitating disease.

Five Steps to Bone Health and Osteoporosis Prevention:
• Get your daily recommended amounts of calcium and vitamin D
Many women and young girls consume less than half the amount of calcium recommended to grow and maintain healthy bones. Adults under age 50 need 1,000 mg of calcium daily, and adults age 50 and over need 1,200-1500 mg of calcium daily. If you have difficulty getting enough calcium from the foods you eat, you may take a calcium supplement to make up the difference. Calcium citrate is absorbed when taken with Vitamin D or Magnesium.

• Vitamin D - Vitamin D is needed for the body to absorb calcium. Without enough vitamin D, you will be unable to absorb calcium from the foods you eat, and your body will have to take calcium from your bones. Vitamin D comes from two sources: through the skin following direct exposure to sunlight and from your diet. According to the National Osteoporosis Foundation (NOF) recommendations, adults under age 50 need 400-800 IU of vitamin D daily, and adults age 50 and over need 800-1,000 IU of vitamin D daily. There are two types of vitamin D supplements. They are vitamin D3 and vitamin D2. Previous research suggested that vitamin D3 was a better choice than vitamin D2. However, more recent studies show that vitamin D3 and vitamin D2 are equally good for bone health. Vitamin D allows calcium to leave the intestine for absorption, and works in the kidneys to reabsorb the calcium that would otherwise be excreted.

• Engage in regular weight-bearing exercise
Exercise is also essential to good bone health. If you exercise regularly in childhood and adolescence, you are more likely to reach your peak bone density than those who are inactive. The best exercise for your bones is weight-bearing exercise such as walking, dancing, jogging, stair-climbing, racquet sports and hiking. If you have been sedentary most of your adult life, be sure to check with your healthcare provider before beginning any exercise program.

• Avoid smoking and excessive alcohol
For men, alcoholism is one of the leading risk factors for osteoporosis. In men and women, excess consumption of alcohol reduces bone formation and interferes with the body’s ability to absorb calcium.

• Talk to your healthcare provider about bone health
Speaking with your healthcare professional about osteoporosis will help you better understand your own risk for the disease as well as available prevention or treatment options. Listed below are several questions that are intended to help you discuss osteoporosis with your healthcare professional:
• Based on my medical history, lifestyle and family background, am I at risk for osteoporosis?
• How do I know if someone in my family suffered from osteoporosis? (What physical signs or symptoms should I be looking for?)
• Am I currently taking any medication that puts me at higher risk for developing osteoporosis?
• How do I best prevent (or treat) osteoporosis?
• How do I know if my bone density is low?
• How much calcium is right for me? How do I best obtain this calcium?
• Should I engage in exercise? What kind of exercise is best? How often should I exercise?
• How do I know if I have fractured a bone in my spine?
If you have osteoporosis or if your healthcare provider believes you are at high risk for the disease, you may want to ask the following questions:
• What medications are available to help me?
• What are the benefits/side effects of these medications? Will these medications interact with other medications I am already taking for other conditions?
• How do I know that my prevention or treatment program is effective?
• Do any of the medications I am taking for other conditions cause dizziness, light-headedness, disorientation or a loss of balance that could lead to
• When appropriate, have a bone density test and take medication

Osteoporosis testing is performed by measuring bone mass using a dual energy x-ray absorptiometry machine (DXA). DXA is the best method of obtaining an individual’s bone density which is critical to prevention, diagnosis and treatment of osteoporosis. While the use of DXA scans is recognized the World Health Organization, the US Surgeon General and the Centers for Medicare and Medicaid Services, as the gold standard for the testing for osteoporosis, only about one in four Medicare women receive their DEXA scan every two years. Without early diagnosis and treatment, osteoporosis can lead to debilitating fractures, loss of mobility, permanent disability, costly nursing home stays, and even death .A recent study by Kaiser Southern California’s Healthy Bones program found that increased utilization of DXA testing and subsequent treatment resulted in a 37% decrease in hip fracture rates and a $30.8 million savings among its 3.1 million members in one year alone. Patient access to DXA testing is threatened as inadequate reimbursement forces more physicians to stop providing this critical preventative service. Medicare reimbursement has been reduced by 50% since 2006 and more budget cuts are scheduled for 2010. More information regarding this issue can be attained at http://www.nof.org.

Information from the National Osteoporosis Foundation: www. NOF.org and ACNM.org

For more info on risk factors of osteoporosis: http://www.mayoclinic.com/health/osteoporosis/DS00128/DSECTION=risk-factors

Overweight and Pregnant

Women want to be healthy, and are especially concerned about their health when trying to conceive or when already pregnant. What can an individual do if she is starting out her pregnancy overweight? A pregnant woman’s overall health and well-being has a direct impact on her developing baby. It becomes a challenge when a woman starts out her pregnancy carrying more weight than is healthy for her, let alone the impact placed upon her baby.

What is too much weight?
A healthy weight has a wide definition range and depends on the individual’s physical activity, body type and overall body frame. But, there is a point where that extra weight begins to have a serious impact on not only your health, but on your baby’s health and well-being as well.
A common tool used in the medical industry is the Body Mass Index (BMI). Your BMI is an objective scientific measure that uses your weight and height. You can calculate your BMI by dividing your weight in kilograms by the square of your height in meters. (BMI = Kg/ (m) 2).

One variable the BMI fails to consider is lean body mass. It is possible for a healthy, muscular individual with very low body fat to be classified obese using the BMI formula. For example, it you are a trained athlete, your weight based on your measured percent body fat would be a better indicator of what you should weigh.

If your BMI is below 20:
This indicates a lean BMI, which means you have a low amount of body fat. If you are an athlete, this can be desirable. If you are not an athlete, a lean BMI can indicate that your weight may be too low which may lower your immunity. If your BMI and body weight are low, you should consider gaining weight through good diet and exercise habits, to increase your muscle mass.

If your BMI is between 20 and 22:
This indicates the ideal, healthy amount of body fat, which is associated with living longest, and the lowest incidence of serious illness. Coincidentally, it seems this ratio is what many individuals perceive to be the most aesthetically attractive.

If your BMI is between 22 and 25:
This is still considered an acceptable range, and is associated with good health.

If your BMI is between 25 and 30:
You are considered “Hefty” and should find ways to lower your weight, through diet and exercise. You are at increased risk for a variety of illnesses at your present weight. You should lose weight by changing your diet and exercising more.

If your BMI is over 30:
This indicates an unhealthy condition, your excess weight is putting you at risk for heart disease, diabetes, high blood pressure, gall bladder disease and some cancers. You should lose weight by changing your diet and exercising more.

A BMI of 40 or more is very hard for anyone to live with. It can be even more difficult if you become pregnant when carrying that much weight.

Risks for Your Baby
If you start a pregnancy carrying a lot of extra weight, there is an increased risk that you will develop diabetes and blood pressure problems. Diabetes may make your baby grow larger, which makes it more difficult to have a normal birth. It may also make it more likely that your child will develop diabetes later in life. High blood pressure during pregnancy can increase the risk that your baby will be born too early and can have adverse affects on the placenta’s function.

Weight gain when Overweight
If you have a BMI of more than 40, you can go through your entire pregnancy and gain very little, if any weight without any impact on your developing baby. If your BMI is less than 40 but more than 30, try to gain no more than 15 pounds. New studies have shown that women with a BMI above 30 are healthier and have healthier babes if they limit their weight gain during pregnancy. Limiting weight gain during pregnancy is not easy. It will take a lot of attention and work on your part. It also helps to have a good coach, support system or even a nutritionist. You need strong support!

It is recommended that you start exercising during pregnancy if you have not exercised, it IS safe and very beneficial for you and your baby. For example, It is perfectly safe for you to walk 30 to 60 minutes every day. Wear comfortable shoes and clothes. Open your front door and walk away from your house for 15 minutes as fast as you can. If you can sing while you walk, you are not walking fast enough. Swimming is also an excellent cardio work out!

Eating Healthy in Pregnancy
You can be very healthy throughout your pregnancy without eating any extra food. The most important thing is that your food choices are healthy and your diet meets all of your nutrition needs.

Some Tips for Making This Work:
_ Ask your health care provider if you can be seen more frequently during your pregnancy. At each visit, you will be weighed and will be able to talk with your provider about diet, exercise, and any other challenges you are facing. It is also good to get a pat on the back and encouragement for all the work you are doing!
_ Keep a daily log of all the food you eat and the exercise you have done. It is a great way to make sure you are getting the nutrition you need. Be sure to include all of the fluids you drink too.
_ Ask a friend to walk or exercise with you. Support is key.
_ Everyday, take a few minutes and focus on your baby. You are creating a healthy baby. You can do this!

Every Day, Make Sure That You Eat:
_ 6 servings of whole grain foods like bread or pasta. By reading the label you will know that you are really getting ‘‘whole’’ grain and not just brown-colored bread or pasta (1 slice of bread or half a cup of cooked pasta is a serving).
_ 3 servings of fruit: Fresh, raw fruit is best (1 small apple or half a cup of chopped or cooked fruit is a serving).
_ 5 or more servings of vegetables: Fresh, raw vegetables are best (1 medium-sized carrot or half a cup of chopped or cooked vegetables is a serving). Avoid butter, margarine, and fatty salad dressing. If you would like a topping on your vegetables, use nonfat salad dressing or nonfat yogurt.
_ 3 servings of protein- OR iron-rich foods, like lean meat, fish, eggs, or nuts (a piece of meat or fish the size of a pack of cards is a serving).
_ 1 serving of vitamin C–rich food each day—like oranges, grapefruit, strawberries, sweet peppers, mustard greens, or tomatoes (1 small orange is a serving).
_ 3 servings of calcium-rich food—like nonfat milk, nonfat yogurt, or mustard greens or chard (1 cup of milk or yogurt is a serving).
_ 6 to 8 large glasses of water. If you do not like the taste of water, add a squirt of lemon juice or a splash of your favorite fruit juice to the glass of water. You do not need to drink anything other than water or nonfat milk when you are pregnant.

You can be very healthy throughout your pregnancy by making healthy food choices without consuming extra calories. The most important thing is to maintain a healthy pregnancy for your baby and your overall health.

Journal of Midwifery & Women’s Health _ http://www.jmwh.org 153
_ 2009 by the American College of Nurse-Midwives 1526-9523/09/$36.00 _ doi:10.1016/j.jmwh.2008.12.013
Issued by Elsevier Inc