Advice From Your Allergist on Osteoporosis
Osteoporosis is a disease in which bones become fragile. With decreased strength, bones have an increased tendency to break or fracture. The most common osteoporosis fracture sites are the small bones of the back (vertebrae), wrists, upper arms, pelvis and hips. Once a fracture occurs, there is greater chance for more fractures resulting in pain, loss of mobility and possible need for surgery.
Who gets osteoporosis?
Osteoporosis affects more than 25 million Americans. Older individuals, especially women who have reached menopause, are most at risk. In addition to gender, other factors increase the risk of osteoporosis. Some include: family history, race (Caucasians and Asians are at higher risk than African Americans), inadequate calcium and vitamin D intake, lack of physical activity, cigarette smoking, low body weight, excessive alcohol intake, and taking oral cortisone-like medications (glucocorticosteroids) or anti-seizure medications. Certain menstrual irregularities which are associated with estrogen deficiency also are associated with an increased risk for osteoporosis.
What does osteoporosis have to do with asthma?
Since asthma is an inflammatory disease of the lung, chronic anti-inflammatory medications are important for most patients with asthma. Cortisone-like medications (glucocorticosteroids) are the most potent anti-inflammatory medications to treat asthma. Long term use of systemic glucocorticosteroids (for example, prednisone) can be associated with adverse effects, including the promotion of osteoporosis. In contrast, inhaled glucocorticosteroids are effective in treating asthma and have few adverse effects. Thus, your allergist will always use the lowest effective dose of prednisone or other oral glucocorticosteroid, if it is required, and inhaled rather than oral medication whenever possible.
What can I do to help prevent osteoporosis?
- Calcium intake should be adequate.
The recommended dietary allowance is:
800 mg/day for 1-10 years of age
1200 mg/day for 11-24 years of age
1200 mg/day during pregnancy and lactation
1000 mg/day adults greater than 24 years of age
1500 mg/day for postmenopausal women
1500 mg/day for adults at risk of osteoporosis
Calcium is best absorbed if taken with meals in small amounts throughout the day. The most concentrated calcium sources are dairy products which sometimes contain Vitamin D. For example, one glass of skim milk has 302 mg of calcium and 85 calories. Low fat plain yogurt has 415 mg of calcium and 145 calories. Some people lack an enzyme to digest the milk sugar lactose. Therefore, they are lactose intolerant and may not be able to drink milk. Some of these individuals may be able to eat yogurt or hard cheese or acidophilus milk or milk products if the deficient enzyme, lactase, is added to the food. Good non-dairy sources of calcium include tofu (150 mg/4 oz), broccoli (freshly cooked, 136 mg/cup), collards (150 mg/cup), turnip greens (200 mg/cup), and sardines with bones (375 mg/3 oz).
If calcium consumption is inadequate, supplements are recommended. Attention must be paid to the amount of elemental calcium (the actual amount of calcium present) in these preparations. Taking more than 500 to 600 mg of calcium at one time or ingesting calcium with high fiber foods should be avoided as either reduces absorption. Supplements containing oyster shell, bone meal or dolomite should be avoided as they may contain lead or other toxic materials. Calcium supplementation should be discussed with your physician since excessive amounts may cause kidney stones.
- Make sure Vitamin D intake is adequate but not excessive.
The usual recommended amount is 400 International Units per day. Most multivitamins contain this amount. Doses up to 1000 IU have improved calcium absorption and bone metabolism, but higher doses are not recommended unless prescribed by a physician. Vitamin D is found in egg yolks, salt-water fish, liver, and most importantly, Vitamin D fortified milk.
Weight-bearing exercise is recommended. Examples of weight-bearing exercise are walking, hiking, stair climbing, jogging. The goal is to exercise every other day or four times a week. The length of time depends on the intensity of the exercise. For walking 45-60 minutes is recommended. If you have been inactive, consult your physician before beginning to create a program with gradually increasing activity.
- Avoid cigarette smoking.
- Avoid excessive alcohol use.
- If you are a woman and have reached menopause, consider estrogen replacement therapy if there are no reasons to avoid this medication.
- If you are a man taking oral glucocorticosteroids (for example, prednisone), a blood testosterone level may need to be measured to be certain the level is not low.
- Discuss osteoporosis with your physician or health care provider. If you have several risk factors for osteoporosis or you need daily prednisone to control your asthma, your physician may need to determine your bone density.
Where can I find more information about osteoporosis?
Additional information can be found in:
- Boning Up on Osteoporosis, A Guide to Prevention and Treatment, National Osteoporosis Foundation, 1997. (National Osteoporosis Foundation, 2100 M Street, M.W. Suite 602 Washington, D.C. 20037. Telephone: (202) 223-2226.
- Osteoporosis, A Harvard Health Publications Special Report. 1997. Write to Department OST, P.O. Box 380, Boston, MA 02117-0380.
This patient information piece is derived from Osteoporosis Management in the Steroid-Treated Asthma Patient, a joint venture of the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI). This joint project was supported through an educational grant from Merck & Co., Inc.