EXERCISE, CIGARETTE SMOKING, AND
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
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.
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
Dr. Truong: The benefits of estrogen
- Relief of menopausal symptoms of hot flushes, emotional irritability, and dryness and tenderness of the vagina.
- 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"
- Increasing bone density in postmenopausal women and
reducing bone fractures, thereby both preventing and
- Possibly delaying onset of symptoms of Alzheimer's