Cover image for Beautiful bones without hormones : the revolutionary new diet and exercise program to reduce the risk of osteoporosis and keep your bones healthy and strong
Beautiful bones without hormones : the revolutionary new diet and exercise program to reduce the risk of osteoporosis and keep your bones healthy and strong
Root, Leon.
Personal Author:
Publication Information:
New York, N.Y. : Gotham Books, [2004]

Physical Description:
xv, 351 pages : illustrations ; 24 cm
General Note:
Includes index.
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RC931.O73 R66 2004 Adult Non-Fiction Open Shelf
RC931.O73 R66 2004 Adult Non-Fiction Open Shelf
RC931.O73 R66 2004 Adult Non-Fiction Non-Fiction Area
RC931.O73 R66 2004 Adult Non-Fiction Open Shelf
RC931.O73 R66 2004 Adult Non-Fiction Open Shelf

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Dr. Leon Root, world-renowned orthopedic surgeon and author of the bestseller Oh, My Aching Back, presents a 100% natural, HRT-free diet and exercise program for increasing bone density and reducing the risk of osteoporosis.“Save your bones, save your life.” That’s Dr. Root’s motto after thirty-five years in practice. 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 your bones against the incurable—yet almost always preventable—disease of osteoporosis. The book includes: * A Fourteen-Day High-Calcium Diet (with foods you love), including variations for children, vegetarians, and the lactose intolerant, with an emphasis on forming healthy habits for a lifetime. * A breakdown of the amount of absorbable calcium in common foods * More than sixty simple, calcium-rich recipes for delicious—not “diet”—meals, including calorie counts and nutritional information * A fully illustrated, twenty-minute exercise routine that you can do at home * Cutting-edge information on recent breakthroughs in drug treatment for osteoporosis * An extensive glossary, plus a list of organizations and Web sites to help you beat osteoporosis No other book comes close to providing the comprehensive, up-to-the-minute information and advice Dr. Root gives in Beautiful Bones Without Hormones.

Author Notes

Leon Root was born in Jersey City, New Jersey on June 15, 1929. He received a bachelor of science degree from Rutgers University in 1951 and a medical degree from New York Medical College in 1955. He joined the Hospital for Special Surgery in Manhattan in 1967. Three years later he was made chief of pediatric orthopedics, a post he held for 27 years. While there, he created an ambitious program to screen children for disorders of the bones and joints.

He wrote several books during his lifetime including No More Aching Back: Dr. Root's New Fifteen-Minute-a-Day Program for a Healthy Back and Beautiful Bones Without Hormones: The All-New Natural Diet and Exercise Program to Reduce the Risk of Osteoporosis and Keep Your Bones Healthy and Strong written with Betty Kelly Sargent. He died from complications of a low blood count on September 21, 2015 at the age of 86.

(Bowker Author Biography)

Reviews 1

Publisher's Weekly Review

Hippocrates said, "Let food be your medicine, and medicine be your food." Root, an orthopedic surgeon, agrees with this advice and presents compelling evidence as to why it's true. Osteoporosis, often called "the silent killer," affects both men and women. And it's common: "more than twice as many Americans die from complications resulting from hip fractures [due to osteoporosis] than from car accident fatalities." Root describes the disease and offers illustrations to emphasize its impact on the body. He explains who is at risk and why and includes ways to reduce risk factors. Although osteoporosis is commonly considered "a little old lady's disease," the author points out that the average American woman now lives at least one-third of her life after menopause. Thus, she'd be wise to prepare for that stage of life. This is a practical, how-to book that lists the new bone-building medications available and provides readers with a 14-day, healthy, high-calcium diet; a seven-day, healthy, high-calcium diet for vegetarians; and one for the lactose-intolerant as well. Part three reminds readers that "bones need exercise like babies need love," and affords an illustrated exercise regime as well as a chapter on the safest aerobic and alternative therapies. The coup de grace is the cookbook at book's end. With recipes for The Famous French Croque-Monsieur Sandwich and Macaroni and Cheese, calcium never looked so good. Agent, Fredrica Friedman. (May) Forecast: May is Osteoporosis Awareness Month, which could help this handbook get media coverage. (c) Copyright PWxyz, LLC. All rights reserved



Introduction OSTEOPOROSIS IS A KILLER. At the very least, it can be a crippler. When your bones become too weak or too brittle to handle the stresses of everyday life, they begin to break down internally and then to just plain break, often when you least expect it. There you are, walking down a sidewalk in February, you slip and fall on a patch of snow-covered ice, and wham, you've fractured your arm and you have to flag down a neighbor to help you back into the house. Or maybe you slip in the shower, twist around to keep from falling, and guess what? You have a broken hip even before you hit the tile. This is often how my patients discover they have osteoporosis. There's no warning, there are no symptoms, they are just going about their lives, doing the things they've done hundreds of times before, and suddenly the smallest fall or misstep occurs and they end up with a broken bone, a fractured hip, a collapsed spine. Right now, forty-four million people in the U.S. have mild osteopenia, or thinning bones, and 10 million men and women have full-blown osteoporosis. While it is true that women are more susceptible to this condition than men, you might be surprised to learn that one out of every four American men over sixty-five will suffer a broken bone in his lifetime because of osteoporosis, and one third of all men over seventy-five currently have osteoporosis. We have long known that in women, estrogen helps protect bones. Since osteoporosis is often associated with postmenopausal women, it seems reasonable to assume that the decreasing level of estrogen that accompanies menopause is a primary cause of the problem. Yes and no. Certainly, estrogen plays an important role in keeping our bones healthy, but estrogen is by no means the only route to strong, healthy bones. It is the alternatives to estrogen that I want to concentrate on in Beautiful Bones without Hormones. Here's how it used to work: Often, when women began menopause (somewhere between forty-five and fifty-five) they would also begin a regimen of hormone replacement therapy (HRT). For a long time, HRT was the only U.S. Food and Drug Administration (FDA)-approved drug for the treatment of osteoporosis, and one of its clear benefits is bone health. Other treatments for keeping bones strong included calcium supplements, exercise, and a newer batch of drugs that the FDA later approved for stopping bone loss called bisphosphonates. (I'll discuss these in depth in Chapter 4.) Then, when a recent study by the Women's Health Initiative (WHI) was halted because of evidence that HRT can slightly increase a woman's risk of developing cancer, hundreds of thousands of women stopped taking HRT. It is these women, as well as every American man and woman-especially those over the age of fifty, 55% of whom already have osteopenia-that I want to address and help by writing this book. Incidentally, the FDA now refers to HRT as HT (the word replacement has been taken out) and to estrogen replacement therapy (ERT) simply as ET. Because most people are not aware of this change I will continue to refer to them as HRT and ERT. The good news is that you can prevent osteoporosis, reverse bone loss, strengthen weak bones, and even build new bone naturally-without HRT. The solution lies in understanding how bones are formed and what you need to do to keep them healthy and strong. I'm reminded of the famous line from Julius Caesar, "the fault, dear Brutus, lies not in our stars, but in ourselves." Osteoporosis is almost always fixable if we take the trouble to find out what causes it and what we can do to prevent it. Quite simply, preventing osteoporosis depends on what you eat and what you do. What you need to eat is a diet high in absorbable calcium, and I have developed a diet plan that is simple to follow, delicious and provides generous amounts of absorbable calcium every day. What you need to do is follow an easy, twenty-minute-a-day, weight- bearing and muscle-building exercise plan to keep both your bones and your body fit and flexible. My interest in osteoporosis developed as a result of over thirty-five years as a practicing orthopedic surgeon at the Hospital for Special Surgery in New York City, a professor of clinical orthopedics at the Joan and Sanford Weill Medical College of Cornell University, and as the director of the Rehabilitation Department at the Hospital for Special Surgery. I have treated countless patients with collapsing spines, fractured wrists, and broken hips from osteoporosis. I'm sad to say that I've seen many people die from this crippling affliction, deaths that in most cases could have been prevented. I've also seen many treatments for osteoporosis over the years and learned that there is no single magic cure, but if you are willing to take your fate into your own hands by learning about osteoporosis and doing what you need to do to prevent it, you can keep your bones healthy and strong and often even reverse some of the crippling effects of osteoporosis. In the following chapters I'll tell you everything I've learned about this "silent killer" in my practice. I'll explain just what the disease is and help you evaluate your own risk of developing it. I'll teach you how to separate fact from fiction when it comes to diagnosing and treating the disease, and I'll give you the complete lowdown on all the new and sometimes amazing drugs now on the market, some of which can actually reverse bone loss. I'll let you in on the dietary secrets that I believe can change your life, and I'll give you the simple exercise plan that I follow every day that has kept me standing straight and feeling great for many years. Keep in mind that if you have or have had any special health problems, you must consult your doctor and seek his or her advice before starting any diet and exercise regimen. Everybody and every body is unique, so it is essential for you to work closely with a doctor who understands your particular medical history and individual needs. I believe that knowledge is power, and I want to share my knowledge with you so that you will have the power to keep your beautiful bones beautiful, to stand tall, to move with grace and ease, and to live a full, rich, and healthy life, a life that otherwise might be compromised by the development of bone-crushing osteoporosis. -LEON ROOT, M.D. Chapter One What 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. It doesn't mean that they are bad drugs or that they cause these diseases, it simply means that this particular combination of hormones, over time, may (according to this study) increase the chances of developing breast cancer, stroke, blood clots, or heart attack. Another study by the National Cancer Institute published in the Journal of the American Medical Association in July 2002 showed that women who take estrogen alone, without progestin, were at a high risk of developing ovarian cancer. This study found that taking estrogen (without progestin) for ten years increased the risk of ovarian cancer by 60%. Women who took estrogen alone for twenty years would triple their risk of developing ovarian cancer. On the other hand, some preliminary studies indicated that HRT may be helpful in preventing Alzheimer's disease, though very recently this finding has been disputed. The Nurses' Health Study, an observational study in which tens of thousands of nurses reported on their health and hormone use findings, contradicted some of the findings of the WHI study. The nurses study found that hormone users had a 30% reduction in heart attacks, and that HRT may have a positive effect on macular degeneration, which is an age-related loss of vision. The reason for this discrepancy is still unclear. What is clear, though, is that there are some positives to hormone therapy. It can relieve the symptoms of menopause, it can keep a woman's skin looking younger, and it helps lower the risk of colon cancer, bone fractures, and perhaps even macular degeneration. But another study of 140,584 women, presented in April 2003 by Dr. Elizabeth Barrett-Connor of the University of California at San Diego, found that when postmenopausal women stopped taking estrogen, they rapidly lost their protection against hip fracture. Then, on June 25, 2003, a follow-up report on the WHI study was published, and this concluded that compared with women not on hormones, those who take estrogen and progestin tend to develop breast tumors that are harder to spot, and because these tumors are therefore discovered at a more advanced stage, they are harder to cure. In this follow-up study of the 8,506 women on hormones, 199 developed invasive breast cancers, compared with 150 cases in the 8,102 women taking placebos. All of the women in the study had yearly mammograms. Of those using hormones, 25.4% had cancers that had begun to spread to other parts of the body, while this was the case with only 16% of the women taking the placebo. What's more, after one year of treatment, 9.4% of the women in the hormone group had abnormal mammograms, compared with 5.4% in the placebo-taking group. A second, alarming report found that the combination of estrogen and progestin increased the risk of breast cancer even when the progestin was given in a sequential manner-that is, only on certain days of the month, instead of every day as with Prempro. It had been thought that sequential progestin might be safer than taking it every day, but that no longer appears to be the case. This second report, based on a study directed by Dr. Christopher Li of the Fred Hutchinson Cancer Research Center in Seattle, corroborated the previous finding that women who took estrogen alone had no increased risk of breast cancer, even if they took it for twenty-five years. The problem, though, is that estrogen dramatically increases the risk of uterine cancer, so only women who have had hysterectomies are advised to take unopposed estrogen. It appears to me that the dangers of HRT have increasingly begun to outweigh the benefits. As I suggested before, what it really comes down to is this: Each woman should talk with a doctor who knows her complete medical history, and together they should decide whether HRT is right for her. Many doctors who formerly advocated the use of HRT now recommend it only for women with very severe symptoms of menopause, such as nearly unbearable hot flashes, and then for only a short period of time. For our purposes here, however, I'm going to talk about how to prevent and treat osteoporosis without hormone therapy, since there is so much controversy about the long-term safety of the hormone medications currently available on the market. Let's Bone Up On Bones Our skeletons are made up of two types of bone tissue: trabecular bone and cortical bone. Trabecular bone makes up the interior of the bones of the vertebra, and some is also found in the ends of long bones. It looks like a honeycomb consisting of a system of struts and arches. It is often called "spongy" or "cancellous" bone because of its latticelike structure. Trabecular bone is filled with bone marrow. It accounts for about 20% of the bone in our body, and has a high metabolic rate. Cortical bone surrounds the trabecular bone and accounts for the remaining 80% of the bone in our bodies. It is solid, dense, and strong, and gives the long bones in our hips, legs, and forearms their strength. It forms the outer layer of the long bones and has a slow metabolic rate so it is broken down and replaced (remodeled) much more slowly than trabecular bone. If you were to look at a cross section of healthy, dense bone, it would look a little like a latticework, or perhaps Swiss cheese, with lots of solid cheese and a few holes. If you were to look at a cross section of the bone of someone with osteopenia or osteoporosis, it would also look like Swiss cheese, but with lots of holes and very little cheese. From the outside both bones would probably appear to be healthy, but if you were able to see what was going on inside the trabecular part of the second bone, you'd be able to tell right away that the bone is thin, brittle, and weak. Bone mass and bone density are closely related. When bone mass decreases, bone strength decreases, and fractures are likely to happen with even the slightest amount of external force. Sometimes simply bending over to pick up the newspaper, or even coughing, can cause a fracture. Why Do Bones Break Down? The remodeling process I've been talking about requires the action of two types of bone cells, osteoblasts (bone builders) and osteoclasts (bone removers). As I've mentioned above, during childhood, the activity of the osteoblasts, the builders, outdoes that of the osteoclasts, the removers, so that young bones can grow in size, weight, density, and strength. Between the ages of twenty-five and thirty our bones have reached their maximum density, and the rapid rate of growth begins to slow down and eventually reverse. Resorption (bone loss) slowly begins to overtake formation, and the gradual process of bone thinning begins. I'll explain more about this in Chapter 5, "The Calcium Revolution," but do remember that one of the best ways to ensure long-term bone health is to make sure that you achieve optimal peak bone mass during the growth years. This means that as a young person you need to have lots of calcium and vitamin D in your diet, and do weight-bearing exercises regularly. Even if you missed out on building healthy bones as a child and teenager, it is never too late to start, but if you are a parent it is important to remember that the stronger the bones your children build today, the longer and healthier their lives are apt to be. We'll talk more about this in the section on Kids and Calcium on page 308. Different Types of Osteoporosis Osteoporosis is divided into two basic categories: primary and secondary. Primary osteoporosis occurs when bone loss is due to a problem within the bone itself, usually as the result of a disruption in the normal bone remodeling (removal) cycle. Secondary osteoporosis refers to diseases in other parts of the body that also cause bone loss. In this case the bone loss is secondary to some other disease. There are three types of primary osteoporosis: Type I: Postmenopausal osteoporosis (PMO) Obviously this affects only women, because it is mainly associated with the loss of estrogen that occurs after menopause. It primarily affects the trabecular (porous, spongy) bone in the vertebrae and in the wrist, where much of the metabolically active trabecular bone is located. It is because of this type of bone loss that many postmenopausal women will have a spine or wrist fracture within five to ten years of their last menstrual period. Type II: Age-related osteoporosis (sometimes called senile osteoporosis) This affects both men and women. It differs from postmenopausal osteoporosis in that bone loss occurs in the cortical areas of the skeleton as well as in the trabecular areas. Because of the loss in both types of bone, people with Type II osteoporosis also suffer fractures of the hip as well as the wrist and spine. In women, Type II osteoporosis usually shows up about ten years later than Type I, and it is thought to be caused by calcium and vitamin D deficiency as well as by the age-related changes associated with loss of estrogen and the malfunctioning of the remodeling process. Idiopathic osteoporosis: adult and juvenile The word "idiopathic" refers to a disease that arises spontaneously from an unknown or uncertain cause. In other words, doctors do not know the cause of the disease. This is the case with idiopathic osteoporosis. It is a rare form of primary osteoporosis, and when it occurs in children it is usually around the time of puberty. Fortunately, it often resolves itself after puberty, and the young adult goes on to live a completely bone-healthy life. When idiopathic osteoporosis occurs in adults, the bones become fragile and break, just as they do in people with Type I and Type II osteoporosis. But with these patients, we simply don't know what has caused the disease. Secondary osteoporosis is either caused by medications or medical conditions that affect the calcium balance or the microarchitectural integrity of the bones. Fewer than 5% of people with osteoporosis have secondary osteoporosis. Some of its most common causes include: Medications: corticosteroids, dilantin, phenobarbitol, lithium, aluminum antacids, gonadotropin-releasing hormone agonists, loop diuretics, methotrexate, excessive thyroid medication. Hereditary diseases of the skeleton: rickets, hypophosphatasia, osteogenesis imperfecta. Endocrine conditions and metabolic diseases: Cushing syndrome, asicosis, Gaucher's disease, hypogonadism, hyperparathyroidism, Turner's syndrome, Klinefeltner's syndrome, prolactinoma, diabetes mellitus, acromegaly. Other causes: pregnancy, early surgical menopause (removal of ovaries), exercise-induced amenorrhea, anorexia, bulimia malabsorption, cystic fibrosis, bone marrow diseases including myeloma, mastocytosis, and thalassemia, renal insufficiency, depression, spinal cord injury, systemic lupus hepatic disease, hypercalciuria, and rheumatoid arthritis. Treating secondary osteoporosis is more complicated than treating primary osteoporosis because you also have to consider the treatment for the underlying disease. If you have secondary osteoporosis, be sure to find a doctor who knows a lot about your primary disease as well as osteoporosis. Why We Get Osteoporosis Osteoporosis, which literally means "porous bones," is a degenerative disease. It is not necessarily a "normal part of aging," and it is not limited to postmenopausal women. What happens is that when our body stops getting the calcium that it needs (which does tend to happen more as we get older) it steals the needed calcium from our bones. Over a period of time, when our bones have lost more calcium than they can replace, osteopenia (thinning of the bones) develops. If not treated, this turns into full-blown osteoporosis. One way to look at this is that the process that leads to osteoporosis (calcium being leeched from bones) is actually the long-term negative result of a short-term coping mechanism. The secret to preventing osteoporosis is to give your body all the calcium (and vitamin D and exercise) it needs, so that it doesn't have to start this calcium-stealing process in the first place. Your body cannot survive without adequate levels of calcium, magnesium, phosphorous, and sodium. When the levels of these minerals and nutrients get too low in your blood, your bones (where these substances are normally stored) give them up to restore a healthy balance of them in your bloodstream. When your blood mineral levels are restored to normal, your body can go on functioning in a healthy way. Think of your bones as your favorite charity. Bones are givers. The most charitable of all our bones are those that have a high trabecular content, like the jaw, pelvis, wrist, and spine. Sometimes the first sign of systemic bone loss is receding gums. The wrist and vertebrae also tend to fracture before the hip, because they are composed largely of trabecular bone, while the hip has a thin outer layer of cortical bone. Contributing factors that make the development of osteoporosis more likely include lifelong patterns of inadequate nutrition, smoking, alcohol abuse, minimal exercise, depression, some medications, irregular periods, some surgeries, and exposure to toxins in the environment. Let's take a look at some of the recent statistics on osteoporosis in the U.S. and worldwide. In the United States In the United States, the highest percentages of osteoporosis occur in California, Florida, New York, Pennsylvania, and Texas. It is not surprising that these states also rank high in the proportion of older residents. Here are some more interesting statistics about the lifetime fracture risks for Americans: After the age of fifty, Caucasian women have a 40% chance of fracturing their wrist, hip, or spine in their lifetime, specifically: 18% chance of hip fracture 16% chance of spine (vertebral) fracture 16% chance of wrist fracture This is equal to the combined risk of developing breast, uterine, and ovarian cancer in the remaining years of their lives (Source: Melton, Chrischilles, Cooper, Lane, and Riggs, 1992) After the age of fifty, Caucasian men have a 13% risk of osteporatic bone fracture, specifically: 6% chance of hip fracture 4% chance of spine fracture 3% chance of wrist fracture (Source: Melton et al., 1992) For African-Americans, data is currently only available for the hip. The lifetime risk factor is: 5.6% for women 2.8% for men (Source: Cummings, Black and Rubin, 1989) These statistics are still being refined and will be discussed in more detail in the next chapter. What Are the Costs Associated with These Osteoporatic Fractures in the U.S.? * $38 million per day * $13.8 billion per year * 62% inpatient care * 28% nursing home care * 10% outpatient care Hip fractures account for about 63% of these costs and fractures at other sites for the remaining 37%. (Source: Ray, Chan, and Thamer, 1997) Worldwide Statistics It is interesting to see some of the worldwide statistics for the incidence of hip fractures related to osteoporosis: As the world population ages, the risk of a worldwide osteoporosis epidemic grows. People are living longer now, and the fastest-growing segment of the population is the oldest of the old, those people eighty-five and up. By the year 2050, the incidence of hip fracture will increase fourfold, from 1.66 million fractures in 1990 to 6.26 million fractures in 2050. The most significant increase is expected in Asia. Today, Asia accounts for 30% of all hip fractures. By 2050, Asia is expected to account for 50% of all hip fractures. What Does This Have To Do With Me? There is simply no question that we are facing a worldwide osteoporosis epidemic in the near future, and it is likely to affect you or someone you care about. Part of the reason that this is such a tragedy is that osteoporosis is frequently preventable and always treatable. My goal is to help you better understand this crippling disease. Right now, you can start taking the three simple steps to prevent this killer disease: 1. Eat right-to get adequate calcium and vitamin D into your diet. 2. Exercise-to keep your bone density at its maximum. 3. Get a BMD test if you are in any of the high-risk groups for developing osteoporosis. Prevention requires some concentrated effort on your part, but the payoff is enormous. Think of it. You can probably add years of healthy, active, pain-free living to your already increased life expectancy by making a few simple changes in your lifestyle. Even if you already have osteoporosis, there is so much you can do to treat it, and the prognosis is better now than it ever has been before. You can do it. You can live a healthier, happier, longer life. It is never too late to learn. It is never too late to begin. Osteoporosis Fact Osteoporosis-related broken bones affect more women than breast cancer, uterine cancer, and ovarian cancer combined. Osteoporosis Fact 74% of women between the ages of forty-five and seventy-five have never discussed osteoporosis with their doctors. Insurance Coverage Tip As of July 1998, Medicare covers Bone Mineral Density (BMD) tests for: 1. Women over sixty-five, especially those not on estrogen 2. Men and women whose X rays show previous spine fractures 3. Men and women on prednisone or steroids, or who are going to begin such treatment 4. Men and women diagnosed with primary hyperparathyroidism 5. Men and women being treated for osteoporosis to see if therapy is working Osteoporosis Fact Osteoporosis is 100% preventable . Osteoporosis is 100% treatable . Osteoporosis cannot be cured. Prevention is always the best treatment, so talk to your doctor and get a Bone Mineral Density (BMD) test now to see what you need to do to keep your bones healthy, strong, and beautiful. Osteoporosis Fact EVERY HOUR in the U.S.: * 150 osteoporatic fractures * 43 deaths from heart attack * 21 cases of diagnosed breast cancer * 10 deaths from stroke Osteoporosis Fact By the age of seventy to seventy-five, men and women are equally at risk of losing bone mass and developing osteoporosis. Remodeling Cycle of Bone = OSTEOCLAST CELL (OSTEOCLASTS CLEAR BONE) = OSTEOBLAST CELL (OSTEOBLASTS BUILD BONE) = OSTEOCYTE (MATURE CELL FOUND IN PROTECTIVE LINING OF BONE) STAGE 1: Resting Phase* A protective layer of cells lines the bone MATURE BONE CELL STAGE 2: Dissolving Phase * Osteoclasts invade OSTEOCLAST Osteoclasts invade the bone surface and create a tiny cavity by dissolving bone MATURE BONE CELL * Cavity created Once the cavity has been cleared, the osteoclasts die, leaving the exposed cavity MATURE BONE CELL STAGE 3: Remodeling Phase * Osteoblasts assemble OSTEOBLAST Osteoblasts assemble at the site of the exposed cavity created by the osteoclasts MATURE BONE CELL * Mineral movement into bone OSTEOBLAST Osteoblasts absorb systemic calcium and other minerals from the blood, forming crystals in the collogen NEW BONE New bone, which includes collogen and minerals, is being built in the cavity MATURE BONE CELL STAGE 4: Final Phase * Collogen and minerals harden into bone tissue OSTEOBLAST As the osteoblasts complete the work, they remain at the site and are alive, but they are no longer active NewBone Collogen and minerals harden into new bone tissue MATURE BONE CELL * Osteoblasts become mature bone cells MATURE BONE CELL Osteoblasts are transformed into mature bone cells, and become part of the new bone NEW BONE Osteoporosis Facts T-Score This score compares the bone mineral status of the patient to an average, healthy twenty- five- to thirty-year-old Caucasian subject of the same sex. Z-Score This score compares the bone mineral status of the patient to that of a person of the same age, sex, and ethnic background. Osteoporosis Fact One in four men over the age of sixty-five will break a bone because of low bone density. Osteoporosis Fact World Health Organization Standards for Diagnosing Osteoporosis Normal Bone Mass 1.0 SD (Standard Deviation) Mild Osteopenia 1.0 to -1.0 (minus 1.0) SD Moderate Osteopenia -1.0 (minus 1.0) to -2.5 (minus 2.5) SD Osteoporosis -2.5 (minus 2.5) SD or lower According to the WHI Study Per 10,000 Women on Prempro The Risk of * Blood clots increased by 18 * Heart attack increased by 7 * Stroke increased by 8 * Colorectal cancer decreased by 6 * Breast cancer increased by 8 * Hip fractures decreased by 5 Femur Cortical Bone Hard, compact DIAPHYSIS Trabecular Bone Porous, spongelike, filled with marrow cortical METAPHYSIS OR TRABECULAR BONE Healthy bone slice Osteoporatic bone slice Osteoporosis Fact The Number of Americans Affected Each Year Osteoporatic Fracture 1,500,000 Heart Attack 500,000 Stroke 225,000 Breast Cancer 184,000 Uterine, Ovarian, and Cervical Cancer 76,000 Osteoporosis Fact Due to the absence of gravity, astronauts experience bone loss at a rate of about 0.2% per month, even when they engage in two hours of exercise a day. Types of Primary Osteoporosis Type I: Postmenopausal Type II: Age-related (or Senile) Idiopathic: Adult Juvenile Differences Between Type I and Type II Osteoporosis Type I Type II Age 50-75 70 and up Sex Ratio (F-M) 6:1 2:1 Type of Bone Loss trabecular cortical and trabecular Site of Fracture spine, wrist hip, spine, wrist Rate of Bone Loss accelerated slow Calcium Absorption decreased decreased Osteoporatic Spine with Vertebral Fractures SPINE HIP WRIST HIP (Femoral Neck) WRIST 75% cortical bone 25% trabecular bone States with the Highest Percentages of Osteoporosis California 14 Florida 14 New York 14 Pennsylvania 14 Texas 13 (Source: National Osteoporosis Foundation, 1997) Yearly Hip Fracture Rates Per 100,000 People Thirty-five and Older Women Men USA (Rochester, MN) 319.7 177.0 USA (District of Columbia) Whites 231.8 82.0 Blacks 118.8 109.7 Finland 212.8 136.1 Norway (Oslo) 421.1 230.5 Sweden (Malmo) 237.2 101.4 Holland 187.2 107.9 United Kingdom (Oxford, Dundee) 142.2 69.2 Israel (Jerusalem) American/European-born 201.8 113.9 Native-born 168.0 107.5 Asian/African-born 141.7 109.2 Hong Kong 87.1 73.0 Singapore (total) 42.1 73.1 Indian 312.9 131.4 Chinese 59.0 106.1 Malay 24.2 35.4 New Zealand Whites 220.4 98.6 Maori 104.4 84.0 South Africa (Johannesburg) Whites 256.5 98.8 Bantu 14.0 14.3 (Source: Adapted from Melton et al., 1983) Excerpted from Beautiful Bones Without Hormones: The All-New Natural Diet and Exercise Program to Reduce the Risk of Osteoporosis by Leon Root, Betty Kelly Sargent All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

Table of Contents

Dr. Isadore Rosenfeld
Forewordp. xi
Introduction: What Women Should Do to Prevent Osteoporosis Now That the Safety of Hormone Replacement Therapy Has Been Questioned by the Women's Health Initiative Studyp. xiii
Part 1 Save Your Bones, Save Your Lifep. 1
1. What Is Osteoporosis, Anyway?p. 3
2. Who Is at Risk and Why: Assessing Your Riskp. 25
3. Separating Fact from Fiction: The Ten Most Important Things You Need to Know to Prevent Osteoporosisp. 48
4. The New Bone-Building Medications: Fosamax, Actonel, Didronel, PTH, and More--Which Ones Work, Which Ones Don't; The Risks, the Benefits; Which Drugs Not to Take Togetherp. 58
Part 2 The Dietary Secrets That Can Change Your Lifep. 71
5. The Calcium Revolution: The Truth About Calcium; Why It Is the Most Important Mineral in Your Body, and the Most Difficult to Absorbp. 73
6. Let the Sun Shine In: How Five to Fifteen Minutes of Sunlight a Day Guarantees All the Essential Natural Vitamin D You Needp. 99
7. Little Things Mean a Lot: All About the Other "Must-Have" Nutrients to Boost Calcium Absorptionp. 110
8. The Good, the Not So Good, and the Terrible: Which Foods to Eat; Which to Cut Down On; Which to Avoid Like the Plaguep. 131
9. The 14-Day, Healthy, High-Calcium Diet; The 7-Day, Healthy, High-Calcium Diet for the Lactose-Intolerant; The 7-Day, Healthy, High-Calcium Diet for Vegetarians: Healthy Eating Plans to Help You Maximize Calcium Absorption--Naturally--from the Foods You Eatp. 157
10. The Simple, Long-Term Eating Program to Maximize Bone Strength: Thirty Tips on How to Add Calcium to Your Everyday Dietp. 218
Part 3 Build Better Bones with Exercisep. 225
11. Bones Need Exercise Like Babies Need Love: The Simple Weight-Bearing, Muscle-Building Workout Program That Guarantees Resultsp. 227
12. The Safest Aerobic and Alternative Therapies: Walking, Swimming, Cycling, Dancing, Yoga, Tai Chi: Do They Help?p. 243
Part 4 The Cookbookp. 259
Sixty High-Calcium Recipesp. 261
The Yummy High-Calcium Cookbook for Kidsp. 308
Resources: Osteoporosis Organizations, Internet Sites, Food-Labeling Information, and Support Groupsp. 320
Sources for Help and Information on Related Conditionsp. 323
Glossaryp. 330
Acknowledgmentsp. 339
Indexp. 341
Recipe Indexp. 349