Beautiful Bones without Hormonesby Leon Root, Betty Kelly Sargent
"Save your bones, save your life." That's Dr. Leon Root's motto after thirty-five years as an orthopedic surgeon. Today, forty-four million Americans suffer from osteoporosis or osteopenia. Having seen scores of people lose their independence and their lives to osteoporosis-related fractures, Dr. Root has become a crusader against this silent killer. Dr. Root's plan is the first and only one written since the Women's Health Initiative Study, which questioned the safety of hormone replacement therapy. His simple, all-natural approach consists of an easy-to-follow diet and exercise program that will safeguard anyone's bones against the incurable-and wholly preventable-disease of osteoporosis.
No other book on the market comes close to providing the comprehensive, up-to-the-minute information and advice Dr. Root and Betty Kelly Sargent give in Beautiful Bones Without Hormones.
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Beautiful Bones Without Hormones
By Leon Root
The Penguin Press
Chapter OneWhat Is Osteoporosis, Anyway?
We are in the midst of a global eoporosis epidemic, and most of us don't even know it. For more than one half of the U.S. population over the age of fifty, osteoporosis and low bone mass are a major threat to health and longevity. The fact is that right now, 44 million of us are living with low bone mass (osteopenia, the bone-thinning condition that leads to osteoporosis) or with osteoporosis itself. I was shocked to learn that more than 200 million people worldwide are suffering from this condition, and as the global population continues to age the problem will get even worse. Just take a look at some of these startling statistics recently released by the National Osteoporosis Foundation (NOF):
For the average American woman, the risk of developing osteoporosis is greater than her risk of developing breast cancer and endometrial cancer combined.
More women die from osteoporosis-related hip fractures each year than from uterine cancer and breast cancer combined. Most of these deaths can be prevented.
One out of two women will have an osteoporosis-related bone fracture in her lifetime.
One out of every eight men will have an osteoporosis-related bone fracture in his lifetime.
2002:Forty-four million men and women over fifty in the U.S. are currently suffering from low bone mass, 68% of whom are women.
Ten million of these people already have osteoporosis.
2010:Fifty-two million American men and women over fifty will have low bone mass.
Twelve million of these men and women will have osteoporosis.
2020:Sixty-one million Americans in this age group will have low bone mass.
Fourteen million of these people will have osteoporosis.
Seventeen billion dollars is spent in the U.S. each year on osteoporosis-related fractures.
Osteoporosis is responsible for more than 1.5 million fractures annually, including:
300,000 hip fractures
700,000 vertebral fractures
250,000 wrist fractures
300,000 fractures at other sites
Bone health must be considered a top priority for all Americans, as well as everyone over the age of fifty throughout the world.
What I find so disturbing in all this is that so many men and women know so very little about the dangers of osteoporosis. Let me tell you about a patient I have been treating for many years, named Mildred. When she first came to see me she was a feisty, funny, exceptionally bright and alert woman. She was a widow and surrounded herself with friends, most of whom shared her love of working for political causes. Ten years ago, when she was sixty-eight, she fell and broke her wrist. Fortunately, I was able to set the fracture and it healed without complications. Because of her age I suggested she get a bone density test, and much to her surprise, it revealed that she had significant osteoporosis. I urged her to stop smoking, take calcium supplements, and get more exercise. "Thanks," she said. "I appreciate your advice, but I'm just too old for all that." As you might imagine, things got worse. About two years after the wrist fracture, she fell and fractured her pelvis and lower spine. This time she was hospitalized for four weeks and had to spend three months after that at home, in terrible pain. Finally she was able to walk again, with a cane. This time I was able to get her to stop smoking. Then, about a year and a half later, Mildred slipped on a wet floor, landed on her back and fractured her sacrum and compressed four lumbar vertebrae. Again she was hospitalized for several weeks, and when she was finally allowed to go home, she was confined to bed rest and had to be on constant medication for pain. She was not even able to walk to the bathroom. It was six months before she could leave her home, and she was still in a great deal of pain. By this time she had lost two inches in height, was severely bent over, and could not walk without a walker, much less a cane. Mildred is no longer the lady I knew. She tries to be optimistic, but I can see that this is an enormous effort. She tires easily now, and though she still has a few close friends who help her out, she has had to give up all of her political activities. I mourn the loss of the woman I knew. Osteoporosis was the culprit here, and because she chose to do nothing to treat it, her life will never be the same.
Even more troubling is that most people in the highest risk group, namely postmenopausal women, are not getting adequate information about osteoporosis, nor are they getting advice on how to prevent and treat it. It is estimated that fewer than 30% of women with osteoporosis have been diagnosed with the disease, and of these women, fewer than 15% are receiving treatment. The tragedy is that osteoporosis is usually preventable and treatable, and the earlier you start taking steps to prevent or treat this crippling disease, the better. This is why I strongly recommend that you get a bone density test right now if you are in any of the high-risk groups for osteoporosis. What happened to Mildred need not happen to you. As the saying goes, an ounce of prevention is worth a pound of cure.
There are several types of bone mineral density (BMD) tests available. The tests are simple, painless, and the cost is usually covered by medical insurance. I'll tell you all about who is at risk and why, and describe the types of Bone Mineral Density (BMD) tests in Chapter 2. The sooner you know what your risk factors are, the sooner you and your doctor will be able to decide on the best course of action. In the meantime, the safest and most effective thing that you can do for bone health is to make sure that you're getting lots of calcium in your diet every day. Most people don't get nearly the amount of calcium their bones need each day to stay healthy. I'll tell you how to do it in the following chapters. For now though, if you are over fifty, try to make sure you are getting 1,500 milligrams of calcium in your diet daily. This little step, along with a simple and gentle exercise regimen, will go a long way toward restoring your beautiful bones to optimal health.
What exactly is osteoporosis? It is "a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture," according to the new definition that the National Institutes of Health came up with in March 2000. It affects our entire skeletal system, and it is characterized by compromised bone strength, which means your bones are less dense than they should be in order to do their three primary jobs: 1) support your body; 2) protect your delicate internal organs, and 3) serve as a storeroom for calcium and other essential minerals you need to stay healthy.
Bone is a living, self-regenerating tissue. It is made up in large part of collagen, a protein giving bone a soft framework, and calcium phosphate, a mineral that makes this framework hard and gives it strength. It is the combination of this protein and mineral that makes bone strong, yet flexible enough to withstand stress. Our body achieves its peak bone mass (maximum bone density and strength) by the time we are between twenty-five and thirty, and it does a pretty good job of keeping bone mass at its peak by working out a precise balance between resorption, the removal of old bone, and formation, the addition of new bone. When we are children and teenagers, bone is being added faster than it is being removed, but sometime between the age of twenty-five and forty the process starts to reverse, and resorption (removal) slowly begins to exceed bone formation. In other words, our body begins to lose more bone mass than it can replace. Usually, the rate of loss at the beginning of this process is from 0.5 to 1% a year. When resorption occurs too quickly, or formation occurs too slowly, low bone mass starts to occur and, over time, if this imbalance persists, will lead to full-blown, debilitating osteoporosis. Osteoporosis is more likely to develop in people who did not reach optimal bone mass during their bone-building years. Therefore, the prevention of osteoporosis should start as early as in your late teens. Men and women are both affected by this loss, but when a woman reaches the age of menopause her bone loss accelerates from about 3% up to 7% a year.
Think of it this way: If you have been diagnosed with low bone mass or density, this means that your bones have less mineral per square inch than they should, when measured against the typical bone mass of a healthy, thirty-year-old Caucasian person. If your diagnosis shows that your bones are only somewhat less dense than normal, you probably have a condition called osteopenia, meaning that on your bone density test, your T-score was between -1 and -2.5 standard deviations below what your normal bone density was when you were about thirty. On the other hand, if your T-score is below -2.5 you have full-blown osteoporosis. Both of these conditions indicate that the structure of your bone tissue has begun to deteriorate, making your bones more fragile and susceptible to fractures. Osteoporosis is a progressive disease, and as I've said, the scary thing is that there are usually no symptoms until a fracture occurs. Often, for example, I'll be treating a woman for a broken wrist and she'll say to me, "I just can't believe it. I had no idea anything was wrong. Why didn't I have any warning that this could happen? I thought I was perfectly fine." This is why osteoporosis is often referred to as the "silent thief." It just sneaks up on you like a thief in the night and steals from your precious bones.
Hormone Replacement Therapy: Yes, No, Maybe
Before going on about osteoporosis in general, I would like to pause to take a look at the effects of hormone replacement therapy on bone health. Hormone replacement therapy provides women with the female hormones, especially estrogen, that decrease dramatically after menopause. When the hormone estrogen is given alone, it is usually referred to as estrogen replacement therapy (ERT). When estrogen is combined with progesterone (the hormone that prepares the uterus for pregnancy each month) it is generally called hormone replacement therapy (HRT). When a woman reaches perimenopause, the transition period leading up to menopause, her hormone levels start to fluctuate, often causing uncomfortable symptoms like hot flashes, mood swings, and interrupted sleeping patterns. Once her hormone levels have fallen dramatically and her periods have stopped for a year, she is considered to be in menopause.
One thing we have known for a while now is that HRT does help prevent bone loss in postmenopausal women. After menopause, when the level of natural estrogen in a woman's body has dropped significantly, her bone loss often accelerates dramatically, to as high as 7% per year, and continues at this rate for the next three to five years. One surefire way to deal with this problem is to replace the estrogen her body was losing with supplemental hormones (HRT). For many years this was the only FDA-approved drug treatment for preventing and treating osteoporosis. Then, in July 2000, when the preliminary results of the federally funded Women's Health Initiative (WHI) study questioned the safety of HRT because of a slight increase in the risk of breast cancer, all bets were off, at least for many of the women taking hormone supplements. In this study, 16,000 randomly selected women, ages fifty to seventy-nine, from all over the U.S., agreed to take part in a long-term effort to learn more about what women can do to stay healthy longer. The study was scheduled to be completed in 2005. The factors to be examined were diet, exercise, calcium supplements, and HRT. The press release in July 2000, which reported a slight increase in the risk of breast cancer, heart attack, and stroke in women on HRT, referred to only the hormone therapy part of the study. The rest of the study is continuing and the results have not yet been announced as of February 2004.
Here's how this particular part of the WHI study worked: Thousands of the participating women were randomly given Prempro, a specific conjugated estrogen and progesterone combination, which at the time was the most widely used hormone treatment, while the others were given a placebo (a sugar pill). Neither the participants nor the doctors conducting the test knew which women in the study were receiving the hormone and which were receiving the placebo.
The hypothesis for this part of the study was that women taking Prempro would show a decrease in coronary heart disease. The researchers also looked at the effect of HRT on breast cancer, stroke, venous thrombosis (blood clotting), colon cancer, and bone fractures.
This study was different from most drug studies because it was designed to help researchers learn about the long-term effects of HRT. Most drug studies look only at the short-term effects of a drug on a particular disease. In other words, the WHI study was designed to try to find out if HRT would help women stay "heart healthy" longer. The minute it became clear that the answer was no, the study would be stopped. The investigators had also agreed that if a significant increase in breast cancer or any of the other secondary diseases they were looking at showed up, the study would be stopped.
After a five-year follow up, the evidence indicated that in 10,000 healthy postmenopausal women who took Prempro for a year, there would be eight more cases of breast cancer (0.08%) than in the similar group not taking Prempro. Looking at the data in this way for the other outcomes, the 10,000 women taking Prempro would have eight extra strokes, eighteen extra pulmonary emboli (blood clots), and seven extra coronary events (heart attacks). However, these same women would have six fewer cases of colon cancer and five fewer bone fractures. There were no differences between the two groups in deaths from any cause. The breakdown would look like this:
Does This Mean That Hormones are Bad?
Not necessarily. Whether or not to take HRT is a highly personal decision based on the medical history and personal philosophy of each and every postmenopausal woman. It is definitely a question that every postmenopausal woman should discuss with her doctor, then weigh the pros and cons and come to her own decision. After the findings of the WHI study, HRT is being prescribed with much more caution these days, but this does not mean that it is absolutely wrong for every woman in every case. What this study showed is that the two products in Prempro should not be given to women to prevent heart disease, stroke, blood clots, or breast cancer.
Excerpted from Beautiful Bones Without Hormones by Leon Root Excerpted by permission.
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Meet the Author
Dr. Leon Root is an orthopedic surgeon at the Hospital for Special Surgery in New York, where he also serves as the Director of Rehabilitation Medicine and Director of the Back School Program. A Professor of Clinical Orthopedics at the Weill College of Medicine, Cornell University and a frequent guest on national media, he lives in New York City. Veteran book and magazine editor Betty Kelly Sargent's work has been published in many magazines, including Cosmopolitan (where she served as the book editor for fifteen years) and Ladies Home Journal.
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