Excerpt from Chapter 1:
The Silent Crippler

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Strong Women, Strong Bones: Everything You Need to Know to Prevent, Treat, and Beat Osteoporosis, by Miriam Nelson with Sarah Wernick (Perigee, 2001) Order from Amazon.com

I do a lot of lectures at schools. I ask kids what someone with osteoporosis looks like, and they say, “An old lady all hunched over.” Then I tell them that I have osteoporosis, and their jaws drop. I'm 34 and very athletic; I look like the picture of health.

I was diagnosed at age 27. I was a competitive runner. I started having stress fractures in my feet and even in my femur. I broke my wrist three times - once I broke both of my wrists at the same time. I knew something wasn't right.
– Jill

• • •

Perhaps you have osteoporosis or bone loss already. Maybe you're wondering about your bones because your grandmother fractured her hip, or your mom is developing a “dowager's hump.” You're wise to be concerned. Twenty-eight million Americans, mostly women, suffer from osteoporosis - dangerous thinning of the bones. When you have osteoporosis, your bones become so fragile they could break from a minor fall, from lifting a baby out of a crib, or even from an exuberant hug.

Though the obvious problems usually occur later in life, we now know that the invisible damage begins earlier - much earlier than most of us realize. For Jill, it probably started when she was in college. “I was a Division 1 track and cross-country runner on scholarship,” she says. “My diet was well-rounded, but I was obsessive about exercise.” A woman's estrogen levels can drop when she over-exercises or under-eats. One sign of low estrogen is missed periods. Jill didn't have regular menstrual periods for years.

Fortunately, most young women have normal cycles and enjoy the natural protection of estrogen, which plays a vital role in bone health. But as our estrogen production slows, bone loss begins. Starting around age 35, we lose up to one percent of our bone mass each year. These losses accelerate rapidly after menopause.

An Insidious Disease

Osteoporosis is insidious because you can't see or feel what's happening. Most people who have the disease don't know it. And then a bone breaks. Each year 430,000 Americans wind up in the hospital because of fractures related to osteoporosis. Hip fractures - which represent about 300,000 of that total - are devastating. One victim in five dies within a year, and half are never able to live independently again. Most of us know someone who has suffered a hip fracture. But you may be surprised to learn that complications of this injury kill even more women every year than breast cancer. Preventing osteoporosis is really a life-and-death matter, like preventing cancer and heart disease.

Hip fractures are just the most obvious part of the problem. Millions of women suffer distressing symptoms that they don't connect to fragile bones. A woman may not realize that her chronic back pain comes from crush fractures in her spine. Fragile vertebras have crumbled under the ordinary stresses of everyday life. Osteoporosis can make a woman look old before her time - but she may have no idea that her slumped posture and protruding tummy are caused by fractures in her spine.

And then there's the emotional fallout. Katie, diagnosed with severe bone loss at age 54, fell into a deep depression:

With support from her husband, Katie began an exercise program and improved her diet; her doctor prescribed medication to help her bones. “It's still a challenge,” says Katie, “but it feels really good to make my body stronger.”

As a woman, you have one-in-three odds of suffering from osteoporosis in your lifetime. But you can beat those odds. Medical experts now consider osteoporosis a preventable disease. And it's treatable. Thanks to new findings about nutrition and exercise, as well as new medications, you can protect yourself - provided you know how.

Myths About Osteoporosis

Some women don't give a thought to osteoporosis - even though they really should. Others are terrified, but uncertain about what to do. Or they may think they're doing everything possible to prevent osteoporosis. They diligently exercise and carefully watch their diet - but the measures they've adopted are not the most effective ones.

Do you still believe these common myths about osteoporosis?

Myth #1: Osteoporosis Is An Old Lady's Disease.

Women in their twenties and thirties can get osteoporosis. Fortunately this doesn't happen often; most early victims of the disease have significant risk factors such as prolonged use of steroid medications or lengthy periods of eating disorders. Ironically, many of these women are dancers or athletes, who look healthy and fit. The bones we have later in life reflect what we did as kids, teens, and young adults. So in a very real sense, osteoporosis is a disease that starts in childhood.

Myth #2: After Menopause, Women Can Prevent Osteoporosis By Consuming Calcium-Fortified Foods and Beverages and Taking Calcium Supplements.

Many women religiously drink milk, buy calcium-fortified cereal, and take a calcium supplement just to be sure. If they're premenopausal, extra calcium can help build strong bones. But simply upping calcium consumption has never been shown to increase bone density or prevent fractures in older women. Add vitamin D to that calcium, and the effects are dramatic: bone density increases significantly and fractures are reduced by 50 percent. That's because vitamin D is needed to absorb calcium and turn it into bone, and many postmenopausal women don't get enough. New research suggests that other nutrients are important too.

Myth #3: Walking Is the Best Exercise for Preventing and Treating Osteoporosis.

Walking is a wonderful exercise - for the heart. But no study has ever shown that a middle-aged or older woman can increase her bone density by taking up walking. The light impact of walking provides only mild stimulation to bone. If you've been walking for decades, that can add up. Women with a lifelong habit of regular walking have higher bone density - and a 30 percent lower fracture rate - than their sedentary age-mates. However, the short-term effects of walking on bone are minor. Even a yearlong walking program has very little effect.

Please don't think I'm criticizing walking! On the contrary, it's one of my favorite physical activities. I strongly encourage you to develop a walking habit - it will help retard further bone loss and has many other health benefits. Similarly, swimming and bike riding are terrific exercises for the heart. But because they're low impact and don't involve weight bearing, they do very little for your bones. Again, I'm not suggesting that you give up these enjoyable activities. But if you want to prevent osteoporosis and fractures, your exercise program should include more.As you probably know by now, weight lifting isn't just for people who want to look like Ms. Olympia or Arnold Schwarzenegger.

My research and numerous other investigations have shown that with just two or three strength-training sessions per week, women can halt bone loss and even regain bone density. And they do not develop bulky muscles! On the contrary, they usually become trimmer and shapelier. We're also learning that higher-impact activities, such as jumping and stair climbing, can be very helpful for bone - provided they're done carefully. Very important is balance training to prevent falls. Think about it: If your bones are fragile, the last thing you want is to fall. Our balancing ability usually declines with age, so falling becomes a significant risk. The combination of exercises that improve both bone density and balance can dramatically reduce your risk of fractures from osteoporosis.

Myth #4: Once You've Lost Bone, You Can Never Get It Back.

The latest treatments can actually restore bone. Even small gains in bone density can make a meaningful difference in your chance of a fracture. Hormone replacement therapy and newer medications can reduce the odds by an astonishing 50 to 75 percent. And there's evidence that a combination of medication, exercise, and nutritional measures is even more effective.

Myth #5: Men Can't Get Osteoporosis.

Alas, they can. An estimated two million men have this disease, which is tragically undertreated in men. A man is far more likely to suffer an osteoporosis-related fracture during his lifetime than he is to get prostate cancer. Yet men - and even their doctors - are largely unaware of the problem. A Gallup survey of men found that fewer than 2 percent had been told by their doctor that they may be at risk for osteoporosis. This book is written mainly for women, but men can follow the program and help their bones too.

The Strong Women, Strong Bones Program

No matter what your age, no matter what your starting point, this program will help you improve your bones. Even if you've already had significant bone loss or fractures, it's not too late. The Strong Women, Strong Bones program combines the three essential measures for preventing and treating osteoporosis: nutrition, physical activity, and (when appropriate) medication. I want to emphasize that these elements work most powerfully when used together. For instance, if you're already taking hormone replacement therapy, you can further reduce your risk of fractures by doing strength training as well.

Nutrition

You probably watch your diet, but it might need minor adjustments for optimal bone benefits. Most women find that when they make changes for the sake of their bones, they end up eating better for overall health. Calcium gets all the attention, but it's just one of the key nutrients for healthy bones. Vitamin D is essential - perhaps even more important than calcium. The best diet for bones also includes plenty of fruits and vegetables. We now know that the nutrients responsible for this benefit include vitamin K, vitamin C, magnesium, potassium, and possibly other vitamins and minerals. And we're beginning to suspect that soy has special promise for bone too.

Physical Activity

I hope you're already physically active. If so, you can continue the exercise you enjoy. But you may not be doing everything possible for strong bones. This book will help you fill in the gaps. And if you're currently sedentary, the program will ease you into a more active, healthier lifestyle. Exciting new research shows that just two minutes a day of vertical jumping - yes, leaping up and down - can produce significant improvements in bone. I know you've heard warnings about the dangers of high-impact activities for joints, and of course, jumping isn't appropriate for everyone. But healthy, fit women under age 50 can benefit from jumping if they follow appropriate cautions. And different higher-impact activities, such as stair climbing, are safe for most women. The Strong Women, Strong Bones program includes vertical jumping where appropriate, plus a combination of other exercises that have proven value for bone.

Medication

If you're like me, you'd probably rather not take medication. But this is a very beneficial part of treatment for women with bone loss. Until just a short time ago, options were quite limited. But several powerful new medications have changed that. One new drug not only builds bone - it also decreases the risk of breast cancer.

How This Book Will Help You

It's easy to take our bones for granted, especially when we're young and menopause seems far away. But our skeleton has to last a lifetime. Strong Women, Strong Bones will give you all the information you need to take charge of your bone health. Here's what the book contains:

The Latest Scientific Information

Women tell me that they're more motivated to make lifestyle changes when they understand the reasons behind them. This is especially important for a disease like osteoporosis, which advances invisibly. Symptoms rarely appear until bone loss has become significant. So you need to know what's happening under the skin before it's too late.

• Chapter 2 describes the process by which bone is formed - and the many factors that influence that process.
• Chapter 3 explains how osteoporosis develops, and tells you the earliest signs to watch for.

The Essential Tests

We're much more fortunate than our mothers and grandmothers. Osteoporosis struck earlier generations of women without warning. But we have resources that can alert us to the danger long before we fracture a bone.

• Chapter 4 will help you figure out if you're at special risk for bone loss.
• Chapter 5 explains how bone density testing works and why this exam is every bit as important as regular mammograms. The best bone density tests predict fractures more successfully than cholesterol levels predict heart attacks or blood pressure predicts stroke. Yet these tests are underutilized, and insurance doesn't always cover them. As a result, less than 10 percent of people with significant bone loss are aware of their problem. You'll find out if you need to be tested, and you'll learn how to make your case with your HMO or insurance company.
• Chapter 6 looks at a forgotten factor in osteoporosis: falls. You may be surprised when you take the balance tests in this chapter! Poor balance isn't just a problem of the elderly. Most of us begin to lose our balancing ability well before age 50. Fortunately, there's a lot you can do to protect yourself, from simple balance exercises to fall-proofing your home.

A Plan for Action

The next three chapters get down to work.

• Chapter 7 helps you evaluate your diet and make changes. The chapter includes five complete daily menus, showing how anyone can follow a bone-boosting diet - even women who are watching their weight or who don't eat dairy foods.
• Chapter 8 provides complete instructions for a comprehensive exercise program designed to strengthen your bones. The program features weight bearing aerobic exercise; strength training; vertical jumping (if appropriate); balance exercises; and stretching. That might sound like a lot, but once you master the moves, it takes less than three hours a week. You'll learn how to devise customized workouts that are safe, effective, and convenient.
• Chapter 9 describes all currently approved medications for preventing and treating osteoporosis, including hormone replacement therapy, Fosamax, Evista, and calcitonin. No single option is right for everyone. I'll also discuss many unproven treatments that women have questions about.
• Chapter 10 is a mini-workbook that will help you pull everything together. I'll walk you through a one-hour-per-year plan for setting goals and staying on track.

The book has these additional features:

• Chapter 11 discusses osteoporosis in men, and explains how men can adapt the program in this book.
• Chapter 12 provides answers to frequently asked questions.

Appendices include a resource list, a glossary, and a bibliography. Osteoporosis is not an inevitable part of getting older. The Strong Women, Strong Bones program is designed to prevent bone loss and fractures. But it does so much more than that. The same measures that help your bones also improve your health - and your emotional well being - in many other ways.