Osteoporosis is a condition in which bones weaken and are more likely to fracture (break). Fractures from osteoporosis can result in pain, disability, and sometimes death. Osteoporosis is a major health threat for an estimated 44 million Americans, 68 percent of whom are women. In addition to smoking, risk factors for developing osteoporosis include: • being thin or having a small frame • having a family history of the disease or of fractures after the age of 50 • being postmenopausal or having had an early menopause • having an abnormal absence of menstrual periods • using certain medications, including glucocorticoids, for a long time • not getting enough calcium • not getting enough physical activity • drinking too much alcohol.

Smoking and Osteoporosis

Cigarette smoking was first identified as a risk factor for osteoporosis more than 20 years ago. Recent studies have shown a direct relationship between tobacco use and decreased bone density. Analyzing the impact of cigarette smoking on bone health is complicated. It is hard to determine whether a decrease in bone density is due to smoking itself or to other risk factors common among smokers. For example, in many cases smokers are thinner than nonsmokers, tend to drink more alcohol, may be less physically active, and have poor diets. Women who smoke also tend to have an earlier menopause than nonsmokers. These factors place many smokers at an increased risk for osteoporosis apart from their tobacco use. In addition, most studies on the effects of smoking suggest that smoking increases the risk of having a fracture. Not all studies have supported these findings, but the evidence is mounting. For example: • The longer you smoke and the more cigarettes you consume, the greater your risk of fracture in old age. • Smokers who fracture may take longer to heal than nonsmokers and may experience more complications during the healing process. • Significant bone loss has been found in older women and men who smoke. • At least one study suggests that exposure to second-hand smoke during youth and early adulthood may increase the risk of developing low bone mass. • Women who smoke often produce less estrogen (a sex hormone) and tend to experience menopause earlier than nonsmokers, which may lead to increased bone loss. • Quitting smoking appears to reduce the risk of low bone mass and fractures. However, it may take several years to lower a former smoker's risk.

Osteoporosis Management Strategies

Quitting? There are some smokers who want to quit and some who will not and/or can not. So, while I (as always) encourage to quit, what do you do if that is not an option for whatever reason? Eat a well-balanced diet rich in calcium and vitamin D: Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Also, supplements can help ensure that you get adequate amounts of calcium each day. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) of elemental calcium for men and women, increasing to 1,200 mg for those over age 50. This is not what is often first noticed on the lable. When the label days 1,00-0 mg. of calcium for example, the amount of ELEMENTAL calcium is a fraction of that number. The density of the calcium and the bioavailability of the calcium is a BIG issue. The most common type of calcium found in retail outlets is calcium carbonate (essentially chalk). While there is nothing wrong with this product, it is less absorbed that calcium citrate- a better absorbed product. Calcium carbonate is less absorbed (especially as we grow older) but has MORE elemental calcium in it- it’s more dense. Calcium citrate is less dense (less elemental calcium) but is much better absorbed. My suggestion is to take calcium citrate in commercial products that already have Vitamin D in it such as Citracal. There should always be some Magnesium along with calcium. Most usually you will have to purchase it separately- although there could be some combination products around. Magnesium citrate of aspartate are my preferences. Too much magnesium will act as a cathartic and you could get diarrhea. Vitamin D plays an important role in calcium absorption and bone health.In addition, the benefits of Vit D as a cancer fighting agent are just being explored. Vitamin D can be obtained naturally through exposure to sunlight and through various foods and supplements. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Some people may need vitamin D supplements to achieve the recommended intake of at least 400 IU and better yet 800 IU (International Units) each day.

Exercise for your bone health: Like muscle, bone is living tissue that responds to exercise by becoming stronger. Weight-bearing exercise that forces you to work against gravity is the best exercise for bone. Some examples include walking, stair climbing, dancing, and lifting weights. Regular exercise such as walking may help prevent bone loss and will provide many other health benefits.

Avoid excessive use of alcohol: Chronic alcohol use has been linked to an increase in fractures of the hip, spine, and wrist. Drinking too much alcohol interferes with the balance of calcium in the body. It also affects the production of hormones, which have a protective effect on bone; and of vitamins, which we need to absorb calcium. Excessive alcohol consumption can also lead to more falls and related fractures. A glass (ideally) of red wine may be your best bet.

Talk to your doctor about a bone density test: Bone mineral density (BMD) tests measure bone density in various sites of the body. These tests can detect osteoporosis before a fracture occurs and can predict your chances of fracturing in the future. If you are a current or former smoker, you may want to ask your health care provider whether you are a candidate for a bone density test.

The Juvent machine, an expensive piece of technology (approx $2500) is a remarkable piece of equipment. A specially designed vibrating platform, it adjusts to your weight and requires that you stand on it 20 minutes a day. Most of the studies on this unit show reversal and treatment of osteoporosis with high quality bone. (One of the issues with medications to treat osteoporosis is just how well will the new bone being formed with prescription medication actually prevent fractures and reduce pain associated with osteoporosis.) The Juvent is OSHA approved. This means that the vibration (barely noticeable) will not damage your joints or harm your brain. (There are vibrational plates that are used for fitness in gyms that can do just that and I DO NOT recommend them.)

See if medication is an option for you: There is no cure for osteoporosis. However, there are several medications available for the prevention and treatment of the disease in postmenopausal women and men.Your doctor can help you decide whether medication might be right for you. Remember, however, that your physician may not have objective information about these drugs. Your doctor is most frequently deluged with information from the pharmaceutical company that produces the drug and that information is often seriously skewed in favor of prescribing the product while downplaying or confusing your doctor about the dangers.

First, many of the so- called “drugs for osteoporosis” have been associated with jaw bone disease (osteonecrosis) and there is no way to predict who is susceptible to this and it is NOT reversible. In addition, as I mentioned earlier in this discussion, there MAY be an association between these drugs and an increase in fractures of the femur (the biggest bone in the body) and bone pain. Next, they can cause a considerable amount of irritation to the esophagus where food is passed and might even cause ulceration and unbearable heartburn. They are NOT my first choice in the treatment of osteoporosis.

You should discuss with your physician the alkalization of your urine using potassium or other alkalinizing agents that are readily available. Studies suggest that alkaline urines help DECREASE bone loss and even restore healthy bone tissue. By the way, 5 servings a day of fresh vegetables, alkalinizes the urine.

Testosterone is an option for men, It can prevent bone loss and restore lost bone. However, you should be sure that your PSA (Prostatic Specific Antigen) which is a marker for prostate cancer is within normal limits and you must have your physician examine your prostate to be sure as sure as possible that you have NO prostate cancer. Next, your blood levels for testosterone ( the sex hormone that predominates in males and is found in much lower amounts in females) must be demonstrably low.Your doctor can then prescribe the right amount and type of testosterone.

Be sure that your doctor reviews any medication that you are taking to be sure that it does not predispose you to osteonecrosis. For example, Duilantin (DPH) used for seizures can do so. Antidpresssants (SSRI’s) can do so as well.

Teas have been shown to decrease the loss of bone. Taking 4-5 cups of tea (Black Tea is fine but Green TEA is MUCH better for most). Is simply a wonderful way to help your body and this case decrease bone loss.

In short, you need to “watch your bones” as a smoker. BE SURE to discuss this matter with your physician.