From Our Archives

Osteoporosis Prevention & Treatment
Exercise & Estrogen

  • Section 3
  • Medications that Prevent Bone Breakdown
  • Fluoride
  • Monitoring Osteoporosis Treatment Success

EXERCISE, CIGARETTE SMOKING, AND ALCOHOL

MedicineNet: How important are life style modifications in preventing or treating osteoporosis?

Dr. Truong: In addition to good nutrition with adequate calcium and vitamin D intake, regular exercise, stopping smoking, and curtailing alcohol consumption are very important in preventing and treating osteoporosis.

It is known that young men and women who exercise regularly generally develop stronger bones with higher bone density than those who lead sedentary lives. After 35 years of age, men and women start to lose bone. Adequate nutrition and regular weight-bearing exercise can slow this age-related bone loss.

Furthermore, regular weight-bearing exercises have been shown to increase bone density in both premenopausal and postmenopausal women. Regular exercise means exercising at least 30 minutes three to four times per week. Long term commitment to regular exercise is important, as the benefits of exercise on the bone are quickly lost once the person stops exercising.

The best exercises for the bones are weight-bearing exercises (exercising against gravity). Examples of weight- bearing exercises include walking, jogging, dancing, stair climbing, hiking, low impact aerobics, tennis, etc. On the other hand, swimming and stretching are not weight bearing exercises that may not have the same beneficial effect on the bones as weight-bearing exercises.

Prudent exercise is important to avoid injury to already weakened bones. In patients over 40 and in those with conditions such as heart disease, obesity, diabetes mellitus, high blood pressure, types and levels of exercise should be prescribed and monitored by their doctors.

Finally, extreme levels of exercise (such as marathon running) may not be healthy for the bones. Marathon running in young women that leads to weight loss and loss of menstrual periods can actually cause osteoporosis.

MedicineNet:Tell us more about other life style issues such as smoking, alcohol, and caffeine.

Dr. Truong: Smoking one pack of cigarettes per day throughout adult life can itself lead to loss of 5% to 10% of bone mass. Smoking cigarettes decreases estrogen levels and can lead to bone loss in women before menopause. Smoking cigarettes can also lead to earlier menopause and increase the risk of osteoporosis. Smoking cigarettes can also negate the protective effect of estrogen replacement therapy on bone in postmenopausal women. Therefore, nobody should smoke, regardless of the current condition of their bones.

Data on the effect of regular consumption of alcohol and caffeine on osteoporosis is not as clear as with exercise and cigarettes. More than two drinks of alcohol a day may increase bone loss. More than 2 cups of coffee daily can also cause bone loss. These effects do not seem to be as powerful as other factors. Nevertheless, moderation of both alcohol and caffeine is prudent.

ESTROGEN REPLACEMENT THERAPY

MedicineNet:Who should receive estrogen replacement therapy? What are the benefits and risks of estrogen replacement therapy?

Dr. Truong: As women enter menopause, the normal estrogen production by the ovaries decreases. Lower estrogen blood levels leads to accelerated bone loss and osteoporosis. This process occurs right after the onset of menopause and lasts for about 10 years. The bone loss can vary from less than 1% per year to above 5% per year, with an average of 2% per year. Estrogen replacement therapy (ERT) has been shown to prevent bone loss, increase bone mass, and prevent bone fractures. It is useful in both preventing osteoporosis in postmenopausal women and in treating women who already have developed osteoporosis.

Most hormone specialists (endocrinologists) now believe the benefits of ERT in postmenopausal women outweigh the risks, and are recommending ERT to postmenopausal women who do not have risk factors of taking long term estrogen.

MedicineNet:What are the other benefits of estrogen replacement?

Dr. Truong: The benefits of estrogen replacement include:

  1. Relief of menopausal symptoms of hot flushes, emotional irritability, and dryness and tenderness of the vagina.
  2. Reduction of risk of heart attack by lowering blood levels of LDL cholesterol (the "bad" cholesterol) and increasing the blood levels of HDL cholesterol (the "good" cholesterol).
  3. Increasing bone density in postmenopausal women and reducing bone fractures, thereby both preventing and treating osteoporosis.
  4. Possibly delaying onset of symptoms of Alzheimer's disease.