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Foot Problems and Care

By National Institute of Aging (NIA)

Helen has osteoporosis, but she didn’t know it before she fell. Osteoporosis is a disease that weakens bones to the point where they break easily—most often bones in the hip, backbone (spine), and wrist. Osteoporosis is called the “silent disease”—you may not notice any changes until a bone breaks. But, your bones have been losing strength for many years.

Bone is living tissue. To keep bones strong, your body is always breaking down old bone and replacing it with new bone tissue. As people enter their forties and fifties, more bone is broken down than is replaced. A close look at the inside of bone shows something like a honeycomb. When you have osteoporosis, the spaces in this honeycomb grow larger. And the bone that forms the honeycomb gets smaller. The outer shell of your bones also gets thinner. All of this loss makes your bones weaker.

Millions of Americans have osteoporosis. They are mostly women, but more than 2 million men also have this disease. White and Asian women are most likely to have osteoporosis. Other women at great risk include those who:

The risk of osteoporosis grows as you get older. At the time of menopause, women may lose bone quickly for several years. After that, the loss slows down but continues. In men, the loss of bone mass is slower. But, by age 65 or 70, men and women are losing bone at the same rate.

Millions more Americans have osteopenia. Whether your doctor calls it osteopenia or just says you have low bone mass, consider it a warning. Bone loss has started, but you can still take action to keep your bones strong and maybe prevent osteoporosis later in life. That way you will be less likely to break a wrist, hip, or vertebrae (bone in your spine) when you are older.

For some people the first sign of osteoporosis is to realize they are getting shorter or to break a bone easily, like Helen did. Don’t wait until that happens to see if you have osteoporosis. You can have a bone density test to find out how solid your bones are. Your doctor may suggest a type of bone density test called a DXA test (dual-energy x-ray absorptiometry) if you are age 65 or older or if he or she thinks you are at risk for osteoporosis.

The DXA test gives you important information to help you understand your risk for a fracture or broken bone. It could show that you have normal bone density. Or, it could show that you have low bone mass or even osteoporosis.

There are things you should do at any age to prevent weakened bones. Eating foods that are rich in calcium and vitamin D is important. So is including regular weight-bearing exercise in your lifestyle. These are the best ways to keep your bones strong and healthy.

Calcium. Getting enough calcium all through your life helps to build and keep strong bones. People over age 50 need 1200 mg of calcium every day. Foods that are high in calcium are the best source. For example, eat low-fat dairy foods, canned fish with soft bones such as salmon, and dark-green leafy vegetables. Check the labels on foods like orange juice, breads, and cereals to find those with calcium added.

If you think you aren’t getting enough calcium in your diet, check with your doctor first. He or she may tell you to try a calcium supplement. Calcium carbonate and calcium citrate are two common forms. You have to be careful though. Too much calcium can cause problems for some people. On most days, you should not get more than 2500 mg of total calcium. That includes calcium from all sources—foods, drinks, and supplements.

Vitamin D. Your body uses vitamin D to absorb calcium. Most people’s bodies are able to make enough vitamin D if they are out in the sun without sunscreen for 10 to 15 minutes at least twice a week. You can also get vitamin D from eggs, fatty fish, and cereal and milk fortified with vitamin D. If you think you are not getting enough vitamin D, check with your doctor. Each day you should have:

As with calcium, be careful. More than 2000 IU of vitamin D each day may cause side effects.

Exercise. Your bones and muscles will be stronger if you are physically active. Weight-bearing exercises, done three to four times a week, are best for preventing osteoporosis. Walking, jogging, playing tennis, and dancing are examples of weight-bearing exercises. Try some strengthening and balance exercises too. They may help you avoid falls, which could cause a broken bone.

Medicines. Some common medicines can make bones weaker. These include a type of steroid drug called glucocorticoids used for arthritis and asthma, some antiseizure drugs, certain sleeping pills, treatments for endometriosis, and some cancer drugs. An overactive thyroid gland or using too much thyroid hormone for an underactive thyroid can also be a problem. If you are taking these medicines, talk to your doctor about what you can do to help protect your bones.

Lifestyle. Smoking increases loss of bone mass. For this and many other health reasons, stop smoking. Limit how much alcohol you drink. Too much alcohol can put you at risk for falling and breaking a bone.