•  Arthritis Center •  Book Review: New York Times Book of Women's Health •  Osteoporosis: An Overview

Strong Women, Strong Bones
By Miriam E. Nelson, PhD with Sarah Wernick, PhD
G. P. Putnam's Sons
$23.95

Barbie had better look out as she careens downhill on her inline skates. One fall could be bone-shattering for the tall, thin doll who's now in her 40s.

She may not be in trouble yet. But as Barbie ages, her tall, slender build puts her at risk for getting osteoporosis. If yo-yo dieting has been part of retaining Barbie's slim build, that's one more factor that heightens her risk profile. This scenario comes from longtime nutrition researchers Miriam Nelson and Sarah Wernick, coauthors of Strong Women, Strong Bones.

The authors make it clear why one in three women will suffer from osteoporosis in her lifetime: Women's bone mass decreases by a half-percent to 1 percent every year after the mid-30s. After that, bone density declines even further. Bone mass is key to preventing a fracture if you have a critical fall or hazardous collision.

"Menopausal women typically lose 1 to 3 percent of their bone mass annually, and some lose as much as 5 percent," Nelson writes. With that kind of decline, women may have only two-thirds of their peak bone mass by the time they reach their 70s. To ward off that grim prospect, women are going to have to befriend bone-building calcium, enjoy a diet rich in vitamin D, and discover the pleasures of impact exercise.

Strong Women, Strong Bones sets the record straight on why osteoporosis isn't just about grandma. Nelson argues that by eating badly or failing to adopt bone-building habits, young and middle-aged women may be unintentionally weakening their bones now, paving the way for the condition to strike later.

The book opens with the story of a competitive runner who is diagnosed with osteoporosis at age 27. The danger for athletes? Women who train so hard that they cease menstruation show spinal bone density that's a shocking 20 to 30 percent lower than that of athletes who menstruate. With so many young women competing in sports these days, coaches, parents, and doctors need to know that even for the relatively young, osteoporosis is a concern.

Eating disorders are another risk factor for the disease. Women's bodies put the finishing touches on bone mass by age 25, Nelson and Wernick point out, so bad eating patterns among teenage girls and young women deserve attention. Reading the list of risk factors can make you want to shove a glass of milk at your niece and ship your mother a bottle of calcium tabs. The checklist will be a wake-up call for some, but it will also reassure others who show up in few or none of the risk categories.

The information caught my attention because, like Barbie, I'm a tall, slender woman (though my measurements aren't quite on a par with her scaled-down version of 32-inch hips). I already knew that the tall-plus-slender combination spelled risk -- three doctors had warned me -- but I had thought nothing of it. I'm safe, I thought: I run, because I know that impact sports build bone, and I've always been a milk drinker. But when I figured out my own risk profile from a checklist in Chapter 4 titled "Are you at risk?" the disturbing picture shook me out of my complacency.

Tall women are at risk because long bones break more easily. Slender women generally have less bone mass than their heftier counterparts, for whom the tug and pull of extra weight encourages the bones to grow stronger. It was a tempting invitation to up my calorie count. Instead, I upped my calcium intake.

Needless to say, body type is not the only risk factor. Those with a coffee habit that tops four cups a day double their risk of hip fracture. Do you take antacids? The ones with aluminum interfere with calcium absorption.

Encouragingly, the book's main theme is that osteoporosis is not a foregone conclusion as you age. It's a preventable condition, and one you can reverse if you have it. Her nutritional advice on getting calcium and including vitamin D, fruits, and vegetables in your diet reads like a recipe. Preventing osteoporosis can sometimes be literally as easily as eating candy. (Most experts believe you should get a dose of 1,000 to 1,200 milligrams of calcium a day. A single glass of milk, for example, contains 300 milligrams.)

The authors give the pros and cons of hormone replacement therapy as an antidote to losing bone mass, and discuss other bone-protecting drugs as well. Since the book was written, however, there has been new evidence linking long-term hormone replacement therapy to increased risk of heart disease, stroke, blood clots, and invasive breast cancer, so HRT is a less attractive option. Your doctor can talk to you about other bone-protecting drugs that may be a better choice for you.

Unfortunately, few women will read this book until their doctors suspect or diagnose the disease. For women who suddenly learn they have suffered bone loss, this book will be helpful in getting a grip on a rebuilding program. The contents include new statistics on therapeutic programs that are actually helping women increase their bone mass once the disease is already present.

Nelson and Wernick, who also coauthored the books Strong Women Stay Young and Strong Women Stay Slim, dish up an exercise program that includes small doses of impact and strength training for building strong bones. Nelson includes 53 illustrated pages of strength-training exercises -- good stuff for building bone strength and for staying healthy. Exercises are clearly illustrated and range from climbing stairs to lifting free weights in a program that can be done at home.

For women who haven't been diagnosed with the disease, but who would like to do more impact activity, Nelson offers this surprisingly easy exercise based on new research: Just jump up and down for two minutes a day, during TV commercials, perhaps, or on the job to work off some rage at the boss. The news is not so promising about walking, unfortunately. In research Nelson conducted in Boston, walking was shown to offer a slight benefit to the spine, but no benefit at all to hip density. Unfortunately, Barbie doesn't seem aware of these potentially shattering facts as she swoops about on those precarious inline skates.

Quick, someone pass her Nelson and Wernick's book.

-- Anne Chalfant is an award-winning writer and a book and features editor who has also taught journalism and mass communications at Santa Clara University and San Jose State University. She received two National Newspaper Association awards and four California Newspaper Publishers Association awards for feature and column writing. She lives in Pleasanton, California.

References

First published September 22, 2000
Last updated April 28, 2008
Copyright © 2000 Consumer Health Interactive

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