Though bones might seem static, in fact they're living, growing tissue. However, by the time people near age 30, old bone tissue generally dies off at a rate faster than new bone is added. Bone loss has begun.
Here's what you should know:
1. BONE IS ALWAYS CHANGING, BUT THE PROCESS SLOWS WITH AGE
People's bones are constantly "remodeling" to adjust to the current circumstances, said Dr. Bruce Seideman, an orthopedic surgeon and chief of the joint replacement service at St. Francis Hospital in Roslyn.
When more stress is put on them, they adjust to handle a bigger load, he said. And if bones are not stressed -- if a person is sedentary or weightless in space, for instance -- bones will get weaker.
Aging also makes bones weaken. "As we get older, the process of destruction in bone exceeds the process of bone creation," Seideman said. Then, bones are less able to handle stress and more likely to fracture, even from such simple occurrences as a minor fall or coughing.
2. BOTH SEXES ARE AFFECTED BY BONE LOSS
Osteoporosis refers to weakened bones, and "both men and women are affected by osteoporosis as they age, but women are more likely to develop symptoms from this bone loss," explained Dr. Nicholas Sgaglione, chairman of orthopedic surgery at North Shore-Long Island Jewish Medical Center in New Hyde Park and president of the Arthroscopy Association of North America.
However, while doctors have been paying more attention to osteoporosis in women, Sgaglione said, men have been left out. "Many men with osteoporosis may not be diagnosed until after a fracture has occurred," he said.
3. DIET AND EXERCISE ARE CRUCIAL FOR HEALTHY BONES
"Prevention of bone loss begins in childhood with consumption of a calcium-rich diet," Sgaglione said. "This leads to the greatest development of strong bone tissue for when we age and begin losing bone."
Besides such dairy products as milk, yogurt and cheese, calcium is also found in dark green vegetables such as kale and broccoli, canned sardines and salmon, tofu and almonds. It's also available as a supplement.
Sgaglione noted that older people often are advised to take calcium supplements, along with vitamin D, to help the body absorb the calcium. And, Seideman noted that calcium is part of the prenatal vitamin regimen that pregnant women take, helping to restore calcium levels that drop during pregnancy. For others, he said, "there is a wide range of opinion on dosing and effectiveness of vitamin D and calcium supplementation," with recommendations ranging from 800 to 1,200 milligrams of calcium and 600 to 800 international units of vitamin D daily.
"The best way to figure out the dose for an individual is to discuss it with your internist, pediatrician or gynecologist who knows all the details of your medical history," Seideman said. "This information can alter your dose."
As for exercise, weight-bearing exercises are the best for bones, Sgaglione said. That includes walking, jogging, tennis, dancing, weight lifting and any activity done on your feet that works bones and muscles against gravity. In this type of exercise, the bones adapt to the impact of weight and the pull of muscle by building more cells, which makes them denser and stronger.
4. BONE LOSS CAN BE TREATED WITH MEDICATION
For women, estrogen supplements can help decrease bone loss related to menopause, Sgaglione said, but they carry added risk for blood clots and certain cancers, making a conversation between doctor and patient critical.
Beyond estrogen, "other prescription medications may be started by your doctor to help slow bone loss, including bisphosphonates and hormonal analog bone-loss inhibitors," he said. However, he cautioned that "chronic use of bisphosphonates -- greater than 5 years -- has been shown to increase the risk of some fractures, and you should discuss the proper length of use of these medications with your doctor."
5. BONE SCANS ARE RECOMMENDED FOR OLDER WOMEN
Bone density scans check a person's risk for osteoporosis by using X-rays of the spine and hips to measure the mineral density of the bones.
"Every woman over the age of 65 should get a bone density scan . . . every two years," Sgaglione said. "Any person with risk factors for osteoporosis should get a bone density scan at an earlier age, in particular those patients who present with certain fractures."
Seideman noted that routine bone density scans should not be confused with whole-body bone scans, which are used to look for signs of bone damage in people with cancer.
Today is the ninth installment of a 26-week series in which Newsday presents Castle Connolly's list of top Long Island doctors.
Dr. Stanley Asnis
611 Northern Blvd.
Dr. James Capozzi
1300 Franklin Ave.
Dr. Richard J. D'Agostino
600 Northern Blvd., Ste. 300
Dr. David M. Dines
935 Northern Blvd.
Dr. Thomas Dowling
763 Larkfield Rd.
Dr. Samuel Kenan
300 Old Country Rd.
Dr. Craig L. Levitz
36 Lincoln Ave.
Dr. Ronald Lewis
Pediatric Orthopaedics of LI
205 E. Main St.
Dr. Thomas Mauri
611 Northern Blvd.
Dr. Carlos F. Montero
2920 Hempstead Tpke.
Dr. Daniel Rich
585 Plandome Rd.
Dr. Bruce Seideman
600 Northern Blvd.
Dr. Nicholas Sgaglione
611 Northern Blvd.
Dr. Raymond Shebairo
1575 Hillside Ave.
New Hyde Park
Dr. Barry G. Simonson
825 Northern Blvd.
Dr. Richard Tabershaw
375 E. Main St.
Dr. Jonathan Ticker
Orlin & Cohen Orthopaedic Assocs.
1728 Sunrise Hwy.
How they were picked
Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college, board chairman and president to help guide consumers to America's top doctors and top hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of top doctors and the medical leadership of leading hospitals.
Castle Connolly's physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. Its online nominations process -- located at castleconnolly.com/ nominations -- is open to all licensed physicians in America who are able to nominate physicians in any medical specialty and in any part of the country, as well as indicate whether the nominated physician is, in their opinion, among the best in their region in their medical specialty or among the best in the nation in their medical specialty.
Careful screening of doctors' educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers. The result -- Castle Connolly identifies the top doctors in America and provides the consumer with detailed information about their education, training and special expertise in their paperback guides, national and regional magazine "Top Doctors" features and online directories. Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors. (Newsday is not part of the selection process.)
Physicians selected for inclusion in this "Top Doctors" feature may also appear as Regional Top Doctors online at castleconnolly.com, or in one of Castle Connolly's Top Doctors guides, such as America's Top Doctors® or America's Top Doctors® for Cancer.
To see the whole list . . .
Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.