Question: I have been diagnosed with osteopenia. My doctor says it is important for me to take fosomax along with 600 mg calcium and 400 international units (IUs) of Vitamin D twice a day. He also recommends strength training.  All of this sounds like good advice because I read about it in health magazines. While I really do not want to take prescription drugs, I think that I should follow his advice. I have been with him for years and he has always helped me.  What do I need to consider?

Yes, you are right to take your doctor’s advice. He knows the degree to which you have osteopenia and you obviously have much confidence in him. Consider this though. Osteopenia can be a temporary pre-disease condition. Look at this diagnosis positively in that it can be the start of preventing you from getting osteoporosis. In 26 months you may reverse the osteopenia diagnosis if you are eating correctly, supplementing correctly, and performing the correct bone building exercises.  However, your doctor may not be sufficiently familiar with bone and strength building exercises to proscribe specifically so I’d suggest going to either a physical therapist or a personal trainer who is properly trained. If you are adverse to prescription drugs but will do the proper strength exercises consistently and will eat and supplement properly your diagnosis can be reversed.   Fosomax may be only a temporary jump start to building your bones strong again.  With the supplements, a good diet, and consistent strength training fosomax need not be a lifelong drug.

Question: I broke my hip 2 years ago.  I am 70 years old and I am too young to be sedentary after being active my entire life and eating correctly.  Now I am in poor condition. When I exercise I get very tired and winded. I feel weak and off-balance. What do I need to do?

Congratulations on recovering from your hip fracture and keeping your determination to become active again!  A debilitating fall like yours de-conditions not only the muscles and bones, but the cardiovascular system as well!   Many people have had bone fractures caused by osteopenia and osteoporosis even though, like you, they have been active their whole life and have eaten correctly.  It seems incredible to them that their bones have become weak. Unfortunately, all too often we think we are active or we think we eat correctly when we do not. Most of us go through periods of inactivity and poor eating habits that over the years manifest in ways that cause lifestyle diseases. Compounding this and related to bone health some of us who are consistently active may still not be involved in  activities that cause bones to maintain their strength.

Maintain a total conditioning plan that involves all the components of fitness: cardiovascular conditioning, muscular endurance, muscular strength, flexibility, and proper weight control. Additionally, since you have osteoporosis, a balanced training plan that emphasizes alignment and good form in executing daily skills should be adopted.  Unfortunately, once one has osteoporosis, the likelihood of reversing it is very rare. However, with a good solid training program your cardiovascular conditioning can be restored making you less tired and more likely to continue on with your active life once again. For more information see TWK dated November 4, 2008. 

Question: I am into preventative medicine. I am a firm believer in obtaining needed vitamins and minerals through the foods that I eat.  I’ve been reading information from various health magazines that indicate that most women and men do not get the recommended amounts daily calcium and vitamin D. I am over 50 and female. I should get 1,000 mg of calcium daily along with 400 -800 IUs of vitamin D daily. I don’t get these amounts from my diet but would like to. Would you suggest supplements or looking more closely at foods with high calcium and vitamin D?

Your intent to get your nutrients primarily through your foods is admirable. It is best to get these nutrients in the foods that you eat and the beverages that you drink. However, for those of us who cannot consistently get the correct dosages in our daily foods, it is wise to use supplements.  You may want to think of supplements this way. On days that you have adequate supplements from you foods and beverages, do not take any. On days that you do not get enough, then use a supplement. It seems we are never told to view supplementation in this manner, but it only makes sense and helps us to be more aware of our need to be accountable when it comes to our health.

The National Academy of Sciences has developed recommendations for how much calcium and vitamin D you need at every day:

Ø  Teenagers should get 1,300 mg of calcium daily

Ø  Adults up to age 50 should get 1,000 mg daily

Ø  Those over 50 should get 1,200 mg daily

To “unlock” the calcium, the American Academy of Sciences recommends between 400 and 800 IU’s of vitamin D per day. But some experts in the field of osteoporosis now say we should be getting 800-1,200 IUs of vitamin D per day. This is particularly important since the primary source of vitamin D is exposure to sunlight. Because many of us prudently slather on sunscreen to prevent cancer risks we need to make sure we get enough vitamin D.

Currently, many experts, including Dr Toni Stabile at the Osteoporosis Center at Columbia University Medical Center, believe that Vitamin D does more than “unlock” calcium. “Particularly in older individuals, vitamin D deficiency makes you more likely to fall down.” He also states

, “If you get enough vitamin D, you not only improve your calcium absorption, but you are less likely to fall and get a fracture.”

In answer to your question of supplements versus foods, here are some considerations:

     1.     It won’t hurt to try getting the recommended daily calcium and vitamin D intakes through diet. You can fill nutritional gaps on a daily basis as needed

     2.    Assess your weight periodically to see if the added nutrition causes weight gain. If so look at leaner sources of calcium such as eggplant, quava, leeks, okra, yogurt, swiss-chard, asparagus, snow-peas, raspberries, salmon and a host of other fruits, vegetables and lean protein foods.  You may also look at leaner sources of vitamin D such as, shrimp, spinach, kiwi fruit, salmon, eggs and lower fat milk products.

     3.     When traveling, supplementation may be a good alternative. The key here is to keep an open mind about how we do things. We can take pride in striving for a balanced diet mainly through food sources, but we need to acknowledge that alternatives should be considered if circumstances prove too difficult.