Excess consumption of alcohol can also lead to bone loss, since it reduces bone formation and interferes with the body's ability to absorb calcium. Drinking more than three alcoholic drinks per day can cause rapid bone loss. Moderate consumption by itself does not raise the risk.
9. Avoidance of dairy products. Calcium is the key mineral that makes up the dense structure of bone. The effect of calcium on bone health is most crucial during youth, when bones are growing quickly. In fact, it is thought that calcium deficiencies in childhood can account for a 5 to 10 percent difference in peak bone mass and can significantly increase the risk for hip fracture in later life. Some studies say that less than 25 percent of adolescent females are actually getting the calcium they need each day through foods or supplements. This deficit comes at a critical time in a woman's life -- just before bone mass peaks. During menopause, especially in the first few years, calcium has a less dramatic effect since the rate of bone loss accelerates during this time. Still, getting ample calcium through foods and natural dietary supplements is vital to ensure the body has enough bone-building ability.
Calcium must be replenished daily through dietary measures or supplementation or the body will be deficient. Although the optimal level of calcium intake has not been clearly established, it is recommended that daily calcium intake be at least 1,200 milligrams (mg) in premenopausal women and 1,500 mg in postmenopausal women. (See Step 3, page 60, for specific information on how to boost calcium in the diet. In Step 5, page 98, we give specific information on increasing calcium in the diet with natural dietary supplements.)
Vitamin D is usually categorized as a fat-soluble vitamin, although it actually functions as a hormone in the body. Vitamin D helps to activate calcium and phosphorus (another key mineral for keeping bones strong) into the bloodstream. This is especially important as menopause approaches. When the body is depleted of vitamin D or has an insufficient supply, the blood levels of calcium and phosphorus plummet as well. Your body turns to the bones for replenishing this mineral and bone loss increases.
10. Irregular menstrual periods. Amenorrhea (the absence of menstrual periods) and other menstrual irregularities are also associated with an increase in fracture risk (see Understanding the Female Athlete Triad, page 3). Amenorrhea can occur because of strenuous exercise, and is common in female athletes, especially gymnasts and others who train hard but keep their body weight low. Women with amenorrhea experience significant reductions in estradiol, the primary form of estrogen. In most cases, amenorrheic premenopausal women have lower bone mineral density, particularly in the spine, than women who have normal menstrual cycles. The young female athlete who appears to be in top physical condition often has the highest risk of osteopenia and fracture, particularly if she experiences an eating disorder and loss of menstrual periods.
11. Thyroid problems. Too much thyroid hormone can cause bone loss. This condition occurs when the thyroid is overactive (hyperthyroidism) or when excessive thyroid hormone medication is used to treat an underactive thyroid (hypothyroidism). A blood test called thyroid-stimulating hormone (TSH) can monitor hormone levels accurately and help women get the right amount of thyroid medication.
12. Rheumatoid arthritis. This type of inflammatory arthritis is most common in young women. It causes joint pain, swelling, and stiffness and can do permanent damage to the joints. Rheumatoid arthritis, as well as the cortisone medications often used for treatment, both raise the risk of bone thinning and fractures.
Authors
Harris H. McIlwain, M.D., a board-certified rheumatologist, is the founder of the Tampa Medical Group. He has served as chairman of the Florida Osteoporosis Board since its inception five years ago. Town and Country has twice named him one of its Best Doctors in America.
Laura McIlwain Cruse, M.D., and Kimberly Lynn McIlwain, M.D., are rheumatologists and board-certified internists in Florida.
Debra Fulghum Bruce, Ph.D., has written more than 2,500 articles and 65 books on various health topics.
