| Osteoporosis is a systemic
disease of the skeleton due to decreased bone mineral density, that
leads to decreased bone mass, deterioration of bone tissue, increased
bone fragility and increased risk of bone fracture. It is known
as the "silent" disease because most people do not know
they have it until they break a bone. Fractures occur with minimal
or no trauma. Advanced disease results in progressive functional
disability and impaired quality of life.
The Facts
Osteoporosis threatens the health and independence of approximately
28 million Americans. Osteopenia is the beginning of osteoporosis.
It is decreased bone mineral content. People with osteopenia are
at substantial risk of developing osteoporosis. Osteoporosis is
responsible for 1.5 million fractures annually (300,000 hip fractures,
700,000 vertebral fractures; 200,000 wrist fractures and 300,000
other fractures). It can occur at any age, but is most common in
women and in the elderly. One of every 2 women and one of every
8 men will suffer an osteoporosis related fracture in their lifetime.
White women over 60 have at least 2 times the incidence of fracture
caused by osteoporosis, than African-American women. Lifetime risk
of osteoporotic spine, hip, and wrist fracture is 40% for white
women and 13% for white men after age 50.
People who suffer a hip fracture have a 5-20% increased risk of
dying within the first year after the injury. Of those living independently
before hip fracture, 50% are unable to walk without assistance,
and 25% require long term nursing home care one year after injury.
Women experience hip fracture more frequently than men, but men
die more often within the first year after injury.A woman's risk
of hip fracture is equal to her combined risk of breast, uterine
and ovarian cancer.
The Bones
The skeleton has many functions. One is to store the body's calcium
and other essential minerals, such as phosphorus and magnesium.
The skeleton holds 99% of the body's calcium. The one-percent remaining
calcium is freed to circulate in the blood and is essential for
crucial bodily functions. Bones are constantly remodeling themselves.
Cells called osteoclasts dig holes into the bone, releasing small
amounts of calcium into the bloodstream that are necessary for other
vital functions. They then rebuild the skeleton first, by filling
in the holes with collagen and, then, by laying down crystals of
calcium and phosphorus.
There are two types of osteoporosis:
Type I, or high turnover, osteoporosis occurs in
25% to 30% of women between the ages of 50 and 75 due to the loss
of estrogen postmenopause. This results in a rapid depletion of
calcium from the skeleton.
Type II, or low turnover, osteoporosis results when
the process of reabsorption and formation of bone are no longer
coordinated meaning, bone breakdown overcomes bone build up. This
occurs with age to men and women alike to some degree.
Before age 40, the process of breaking down and building up bone
is a nearly perfectly coupled system, with one phase stimulating
the other. However, as we age this system breaks down and the two
processes become out of sync. The reasons for this are not clear.
Some individuals have a very high bone turnover rate while others
have a very gradual turnover, but eventually, the breakdown of bone
overtakes the build-up. Over time this thins the bones, and makes
them porous, causing the bones to be weakened and makes them more
likely to break.
Because these patterns of reforming and reabsorbing bone often
vary from patient to patient, experts believe a number of different
factors account for this problem. Important hormones, such as estrogen,
parathyroid, and vitamin D, as well as blood factors that affect
cell growth are involved in this process. Changes in levels of any
of these factors are thought to play a role in the development of
osteoporosis. Back
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Who Gets Osteoporosis?
Both men and women. Eighty percent of
the more than 28 million Americans who have osteoporosis are women.
Men start with higher bone density, have better calcium intake and
no period of rapid hormone change so they lose calcium at a slower
rate than women. Women can lose up to 20% of their bone mass 5-7
years after menopause. By age 65-70, men and women lose bone mass
at about the same rate and calcium absorption decreases. (ORBD-NRC
1997) Although the risk for osteoporosis in men is much lower than
in women, two million men have osteoporosis and three million are
at risk. After age 50, the disorder affects almost 30% of men.
Osteoporosis has its foundations in youth. Building
strong bones before age 35 is the best defense against osteoporosis.
Maximizing calcium intake in childhood, adolescence and pregnancy
is critical to good bone health later in life.
What are the Causes of Osteoporosis?
Menopause. The most common factor implicated
in the etiology of osteoporosis is a decline in estrogen level among
postmenopausal women. It is estimated that women lose 10% of bone
mass in the first 5 years after menopause. With estrogen reduced,
the balancing mechanism for calcium resorption is shifted, causing
greater bone loss.
Early menopause or surgical menopause caused by removal of ovaries
puts women at even a greater risk. Weak thigh muscles, shortness
and thinness, and poor balance increase the risk for osteoporosis
as well. Menopause before age 48, not getting enough exercise, not
getting enough calcium in your diet, osteoporosis in your family;
hyperthyroidism, smoking, alcohol abuse, small bone frame, fair
skin and use of steroids are all causes of osteoporosis.
Other risk factors that contribute to osteoporosis
include:
Asthma therapy. Recent studies show that the use
of asthma medications can cause osteoporosis, even in adolescent
girls.
Other medications. Many medications can create conditions
that reduce bone density. Long-term corticosteroids can cause calcium
loss. People taking these medications should increase their daily
intake of calcium and vitamin D. Other medications that affect bone
mineral density include anticonvulsants, heparin, thyroid hormones,
and Vitamin A.
Illness. Gastrointestinal disorders that cause
malabsorption can cause osteoporosis. Cancer, connective tissue
disorders, anorexia, bulimia, rheumatoid arthritis, prolonged inactivity
and chronic kidney disease can all contribute to osteoporosis
Cigarettes. Women and men who smoke, have a significantly
greater chance of spine and hip fractures than those who don't smoke.
Coffee. The risk of osteoporosis has been
associated with heavy caffeine consumption. One study found that
more than two cups of coffee or four cups of tea a day increased
the amount of urinary calcium output and the incidence of hip fractures.
Being Underweight. is a risk factor for osteoporosis
in both men and women.
Dietary Factors. Calcium and vitamin D deficiencies,
of course, contribute to osteoporosis. A recent Swedish study indicated
that high amounts of dietary vitamin A might reduce bone density.
High sodium intake interferes with calcium retention. The higher
the level of sodium the more calcium the body needs to meet its
daily requirements. Diets deficient in protein also increase the
risk for osteoporosis.
Too Much and Too Little Exercise. can also put people
at risk since they may have a lower amount of estrogen in their
bodies.
Lack of Sunlight. The photochemical effect
of sunlight on the skin is a primary source for vitamin D. Bone
formation peaks in the summer and bone breakdown increases in the
winter. People who avoid sun exposure to prevent skin cancer may
be at risk for vitamin D deficiency, particularly if they are elderly.
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How can you prevent Osteoporosis?
Exercise
Exercise is very important in slowing the progression of
osteoporosis. Low bone mass in childhood and adolescence raises
the risk of osteoporosis later in life " If you don't have
enough bone to begin with, you don't need very much destruction
to develop osteoporosis" said panel member Keith Hruska, MD
of Washington University School of Medicine. Physical activity should
start early in life, which will contribute to higher bone mass later
in life Exercise should begin in adolescence since bone mass increases
during puberty and reaches its peak between ages 20 and 30. Weight
bearing exercise, which applies tension to muscle and bone, encourages
the body to compensate for the added stress by increasing bone density
by as much as 2% to 8% a year. This is not suggested for the elderly
but is recommended for all women before menopause. For the elderly,
even moderate exercise (as little as an hour a week) helps reduce
the risk for fracture.
Hormone replacement therapy
Hormone replacement therapy is one of the best ways to keep
osteoporosis from getting worse, once it has started. And, if taken
at the time of menopause, in combination with calcium and vitamin
D, it can prevent osteoporosis. If hormone replacement therapy is
stopped, your bones start to lose calcium. The longer you take hormone
replacement therapy, the less likely you are to get osteoporosis.
Dietary Factors
Calcium
Calcium Supplements of calcium can help maintain
bone density and reduce the risk of fracture in both men and women.
A study in Yugoslavia showed that people who maintained a high calcium
intake during their lifetimes have fewer fractures and are less
at risk. Another study reported that calcium slowed bone loss in
portions of the hips where fracture is most serious. Calcium intake
is especially important in childhood and adolescence when the maximum
bone density is established.
Many researchers have suggested a higher calcium intake for postmenopausal
women since they have a lower level of estrogen. Experts recommend
that women after menopause need up to 1,500 mg. of calcium a day,
if not taking estrogen. Before menopause, experts suggest getting
1,200 mg. per day. A study showed that doses as low as 1000 mg/day
prevented bone loss during winter months (when bone loss is greatest)
in postmenopausal women who did not have osteoporosis. The best
source of calcium in the diet is from milk fortified with vitamin
D. Vitamin D helps your body absorb calcium. If you can't consume
enough calcium through your diet consult your local nutritionist
on which type of calcium supplement is good for you. A low intake
of calcium coupled with a high intake of nondairy animal protein,
is particularly associated with an increased risk of hip fractures
in women. Many studies suggest that calcium should not be restricted
to prevent kidney stones because it can promote osteoporosis.
Throughout the life cycle you have different calcium needs. The
National Osteoporosis Foundation recommends the following daily
calcium intakes:
· 1,300 mg. Ages 9-12
· 1,000 mg for adult men and women ages 19-50;
· 1,200 mg for men and women over 50;
· 1,300 mg for pregnant and lactating women younger than
18
. 1,000 mg. for pregnant and lactating women over 18
· 1,500 mg for post-menopausal women who are not on estrogen
replacement therapy.
Vitamin D
Vitamin D is an essential companion to calcium in maintaining
strong bones. It is manufactured in the skin using energy provided
by ultraviolet rays from sunlight and is necessary for the absorption
of calcium in the stomach and gastrointestinal tract. If you live
in a climate where there is little sunshine in the winter months,
you need to take Vitamin D in supplement form.
A study from France, by Marie C. Chapuy et al. published in the
New England Journal of Medicine , looked at the benefits of calcium
and vitamin D supplementations on hip and other fractures. They
studied 3,270 women, 69 to 100 years of age. For 18 months, their
diets were supplemented with a special calcium mixture plus 800
units of vitamin D3. At the end of the study, the number of hip
fractures were 43% lower and the number of nonvertebral fractures
were 32 % lower in the women treated with calcium and vitamin D
than those who received the placebo. This is a good reason to watch
your calcium and vitamin D intake. Another study reported in the
New England Journal of Medicine that lasted 3 years and involved
176 men and 213 women, 65 years or older reported similar results.
Magnesium
Magnesium is a key nutrient for the proper functioning of
the nerves and muscles. It is also necessary for the healthy maintenance
of bones. Magnesium is often coupled with calcium in supplements
because of its synergistic effects (it helps the body absorb the
calcium better). According to Mildred S. Seelig, PhD, ( a magnesium
expert from the University of North Carolina), more than half of
the body's magnesium is found in the bones. Calcium gives bones
their strength, while magnesium helps them maintain their elasticity
to prevent injury. This is a good reason to make certain to have
a good calcium-magnesium ratio in your daily diet.
Low levels of magnesium may contribute to thinning bones. According
to a 1998 study, magnesium supplements help suppress the cycle that
leads to bone loss. Experts suggest the level of magnesium needed
each day is about 400 to 800 mg. Magnesium should also be taken
at a 1:1 and 2:1 ratio of calcium.
The more calcium in the diet, the more magnesium needed. Calcium
given alone can induce magnesium deficiency. The most serious complications
from a deficiency of magnesium are heart conditions such as irregular
or rapid heartbeat Guy E. Abraham MD has data showing that magnesium
deficiency plays a significant role in primary post-menopausal osteoporosis.
Magnesium is involved in calcium metabolism and in the synthesis
of vitamin D, as well as in maintaining bone integrity. In the Medical
Tribune, Gustawa Stendig-Lindberg, MD, of the Sackler School of
Medicine at Tel Aviv University, reported that in postmenopausal
women, bone density drops by 1% per year. It is believed that magnesium
may halt the loss of bone because it aids in the transport of calcium
in and out of the cells. Magnesium also plays an important role
in converting vitamin D to its active form .
Boron
Boron, a trace mineral, has been making nutritional medicine
news very recently, and will likely be noted as the next essential
trace mineral. It appears to help maintain calcium balance, keeping
bones healthy and preventing osteoporosis. The most recent research
elucidates the positive health benefits of adequate dietary boron.
Researchers at the U.S. Department of Agriculture found that boron
plays a key role in calcium and magnesium loss by helping the body
synthesize both estrogen and vitamin D. This is good news for people
of any age who want to prevent osteoporosis, arthritis and other
bone weakening conditions.
The level of dietary boron needed is between 3 and 5 mg. daily.
It has been recommended that, because of its positive benefits,
the elderly and anyone at risk of osteoporosis should eat boron-rich
foods and further supplement boron at a level of about 1-3 mg. daily.
The highest concentration of boron in the body is in the parathyroid
glands, suggesting its tie to calcium metabolism and bone health.
Boron in fruits and vegetables is readily available and easily absorbable.
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Which is the best form of Calcium?
Calcium Citrate. There are many different sources
of calcium. Three important new studies from UT Southwestern Medical
Center at Dallas Researchers have shown that calcium citrate is
the better absorbed than any other calcium and is effective at preventing
osteoporosis in early post-menopausal women. Dr. Khashayar Sakhakee
and colleagues published their analysis of data from 15 previously
published randomized trials evaluating bioavailability (the amount
of calcium absorbed from a supplement, rather than the amount of
calcium a supplement contains) in the 1999 November - December issue
of the American Journal of Therapeutics. They reported that calcium
citrate was absorbed 22-27% better than all other forms of calcium.
A second study published in 1999, by Dr. Howard Heller, in the
November issue of the Journal of Clinical Pharmacology compared
the absorption of calcium citrate versus calcium carbonate. They
measured blood calcium concentration instead of urine calcium excretion
and found that calcium citrate was more effective.
The third study published in the December issue of the American
Journal of Therapeutic, by Dr. Lisa Ruml, also compared the effect
of calcium citrate vs. a placebo in preventing bone loss in early
post - menopausal women over a two-year period. During this study,
57 women in early post-menopausal (5 years into menopause) and six
mid- menopausal women (5-10 years into menopause) took either 800
milligrams of calcium citrate or a placebo daily.
Those taking calcium citrate averted bone loss by stabilizing the
bone density in their spine, in the top part of their thigh-bone
(a common sight for hip fracture) and in the small bone of the forearm.
Women taking the placebo had a significant decline, over the 2-year
period, in the densities of the spine and forearm but showed no
changes in their thighbone density.
These studies confirm the health benefits of calcium citrate. It
is the most well absorbed and most effective form of calcium to
prevent osteoporosis.
SOURCE: American Journal of Therapeutics 1999;6:303-311,313-321.
Journal of Clinical Pharmacology 1999;39:1-4.
Why Maxi Health Calcium products?
Our formulations are unique. They contains all the necessary
nutrients to ensure that you get what you need for bone health.
Maxi Health calcium products contain calcium citrate- the
most absorbed form of calcium
Manufactured under GMP Standards - strict Quality standards
& Good Manufacturing Practices.
Enzymax Base (Enzymax is a vital digestive enzyme complex
that aids in the absorption of your vitamins and minerals)
Strictly Kosher OU, Vegetarian
For more information about our calcium products click below:
Cal
Max - Calcium Citrate with Magnesium, Vitamin D and
Boron
Maxi
Cal - Calcium with Magnesium and Vitamin D (capsule)
Chewable
Calcium Complex - Chewable Calcium/Magnesium (vanilla
flavor)
CalciFizz
- Effervescent form of Calcium & Vitamin D (stawberry flavor)
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