Thin Today, Thinning Bones Tomorrow: Many Young Women Set Themselves Up For Premature Osteoporosis

It used to be only professional models, actresses and dancers who starved themselves to look thin. Today, it's a way of life for many Generation X women. Not only are they eating less, many are exercising to excess, cutting out dairy products altogether and smoking more.

All of the above activities will indeed lead to a slimmer waistline. But at what price? Such bone damaging behavior can eventually lead to such unglamorous conditions as stress fractures in the hip, spine and wrist, as well as dowager's hump.

Osteoporosis has often been called a pediatric disease with a geriatric outcome. According to a policy statement recently released by the American Academy of Pediatrics, kids are not consuming enough calcium during puberty when the majority of bone growth occurs. Medical research shows that thinning bone (or osteopenia), a precursor to the disease, can strike at any age - even in the late teens and early 20s - a time when women should still be building bone, not losing it.

Melissa Mintz, a Manhattan dance student, was diagnosed with low bone mass the day before her 20th birthday. "In high school I was always dieting," she recalls. "Low-fat this, fat-free that, that's how I ate." Like many of her peers, she deprived her body of dairy products, carbohydrates and many vitamins and minerals she needed. Thanks in part to her past eating patterns, she's suffered two stress fractures in her hip.

Other women put their bones in even greater danger. Those suffering from anorexia or bulimia typically stop menstruating, which deprives their bones of much-needed estrogen. Amenorrhea, the absence of at least three consecutive menstrual cycles, if ignored, can lead to premature osteoporosis.

Many female competitive athletes and exercise-holics can also disrupt their menstrual cycles if they train too much to achieve low body weight. Referred to as the "female athlete triad," this syndrome of disordered eating, amenorrhea and premature osteoporosis can lead to a crippling future. It is estimated that at least 18 million Americans have low bone mass, and another 10 million are diagnosed with osteoporosis. Still, according to a 1994 study published in the Archives of Family Medicine, most young women do not believe osteoporosis is a problem that will ever affect them - even though fewer than 7 percent reported getting the recommended daily allowance of 1,200+ mg/day of calcium in their diets. Those surveyed feared developing breast cancer much more than bone problems. However, the National Osteoporosis Foundation points out that a woman's risk of developing a hip fracture is equal to her combined risk of developing breast, uterine and ovarian cancer.

Important Terms Every Young Woman Should Know

amenorrhea - the absence of at least 3 consecutive menstrual cycles in women who have begun menstruating. This condition indicates that something is wrong with a woman's hormone balance, or that she's pregnant. If ignored, this can lead to premature osteoporosis.

bone - living, growing tissue, made mostly of collagen - a protein that provides a soft framework, and calcium phosphate - a mineral that adds strength and hardens the frame. More than 99 percent of the body's calcium is contained in the bones and teeth.

bone density test - there are several ways to measure bone mass density - all are painless, noninvasive and safe. The tests measure bone density in your spine, hip and/or wrist, the most common sites of fractures due to low bone mass and osteoporosis.

bone mineral density -- the amount of calcium in a special region of the bone, which determines its strength.

calcium - an essential nutrient that helps build teeth and bones, as well as keeps the heart beating steadily, the blood working correctly and the body's nerves and muscles in good shape.

exercise physiologist - a specialist who studies human movement and how exercise affects the different parts of the body over the long term.

female athlete triad - a term used to describe the relationship between three health problems: disordered eating, amenorrhea and premature osteoporosis. This syndrome has been observed in some women athletes who become trapped in a cycle of dangerous food patterns and excessive training in an effort to achieve low body weight.

low bone mass - see osteopenia

menopause - the period of time marked by the natural and permanent end of menstruation. In America, the average age a woman goes through menopause is 52 years old.

osteopenia - bone thinning which, over a long period of time, develops into osteoporosis.

osteoporosis - literally means "porous bone." It is a "silent disease" characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine and wrist.

peak bone mass - when bones are at their strongest, somewhere between ages 20 and 30.

perimenopause - literally means "around menopause." It begins when hormone-related changes begin, as much as 10 years before menopause.

resorption - when the skeleton loses bone.

sports medicine - field of medicine that takes care of active people. Doctors and specialists, including orthopedists, physical therapists, exercise physiologists, nutritionists and others work together to provide healthcare to professional and amateur athletes.

strength training - another term for weight lifting. It can also include weight machines, barbells, calisthenics and other forms of muscle and bone-building exercises.

weight bearing exercises - exercises where you're supporting your body weight, such as walking, jogging, dancing, soccer, tennis and stair climbing.

Get More Calcium In Your Diet

National surveys have found young American women are not consuming enough calcium. In fact, many are getting less than half the daily recommended amount of 1,000-1,200 mg/day, according to the National Osteoporosis Foundation (NOF).

To boost your calcium intake, nutritionists recommend starting with calcium-rich foods and then taking a supplement. TUMS is the calcium supplement most recommended by doctors. Each TUMS E-X tablet contains 300 mg of elemental calcium in the form of calcium carbonate, which is easily absorbed into the body.

What's the best way to "bump up" the calcium in every meal you eat? The Women's Sports Medicine Center at the Hospital For Special Surgery in New York, offers the following delicious suggestions:

ADDITIONAL CALCIUM-RICH SNACK IDEAS:

• 8 oz hot chocolate made with steamed skim milk
• 8 oz warm skim milk with a few drops of almond or vanilla extract & cinnamon
• 1 oz low-fat cheese and crackers
• Crunchy cereal topped with creamy yogurt

CALCIUM-RICH RECIPE TRICKS:

• Stir 2 tbs. nonfat dry milk powder into your favorite beverage.
• Whip up a refreshing drink of low-fat milk, nonfat yogurt, fresh fruit, some sweetener and 3 ice cubes.
• Make hot cereal or soups with skim milk instead of water.
• Use plain yogurt as a substitute for sour cream or mayonnaise in recipes or on a baked potato.
• Use canned salmon with bones in place of tuna in sandwich spreads, fillings or on a bagel.
• Top pasta with tomato sauce and 1/2 cup ricotta cheese or some part-skim mozzarella.
• Chop tofu or tempeh into a green salad, grill it with herbs or add some to your favorite stir-fry dish.
• Use broccoli, kale, okra and turnip greens regularly.

ADEQUATE DAILY INTAKE OF CALCIUM FOR WOMEN
(National Academy of Sciences, Food and Nutrition Board, 1997)

(Note: Pregnant mothers age 19-50, should consume at least 1,000 mg/day because pregnancy and breast feeding put an added demand on their bodies. Women going through menopause should watch their calcium intake closely, because it's a life stage when bone loss accelerates. Post-menopausal women NOT on hormone replacement therapy may want to increase their calcium intake as well.)

CALCIUM EQUIVALENTS (each 300 mg of calcium)

Information Resources For Better Bones

HOTLINES:
Calcium Information Center (CIC)
Based at the New York Hospital-Cornell Medical Center and the Oregon Health Science University, the CIC provides current information on calcium research; offers free literature; and answers callers' questions. toll-free number: (800) 321-2681

WEBSITES:
CALCIUMinfo.com
A comprehensive online calcium information resource provided by SmithKline Beecham Consumer Healthcare. website: http://www.calciuminfo.com

National Osteoporosis Foundation (NOF)
The NOF is the nation's leading resource for up-to-date information on the causes, prevention, diagnosis and treatment of osteoporosis. website: http://www.nof.org

The Women's Sports Medicine Center at the Hospital For Special Surgery
The nation's first facility of its kind, catering to the healthcare needs of active and athletic women of all ages. website: http://www.hss.edu/womensport/index.htmBOOKS:
Bone Boosters : The Essential Guide to Building Strong Bones
Harris McIlwain, M.D., Debra Fulghum Bruce (Kensington Publishing Corp., 1998) Information on how to help keep bones strong, regardless of one's age. Available in paperback.

Our Bodies, Ourselves for the New Century
Boston Women's Health Book Collective (Touchstone Books, 1998)
Newly-revised edition of first book on healthcare for women by women. Available in hardcover and paperback.

Raising Our Athletic Daughters: How Sports Can Build Self-Esteem and Save Girls' Lives Jean Zimmerman, Gil Reavill (Main Street Books, 1999) A comprehensive look at the impact of sports in girls' lives. Available in paperback.

Bone Health Stats & Facts For Young Women

By about age 20, the average woman has acquired 98 percent of her skeletal mass. By age 30, she has reached her peak bone mass. (National Osteoporosis Foundation)

The body starts to form most of its bone mass before puberty, building 75 to 85 percent of the skeleton during adolescence. The body's 206 living bones continually undergo a buildup, breakdown process. (Food and Drug Administration)

Risk factors for osteoporosis include: having a calcium-deficient diet; being thin or small framed; having a family history of osteoporosis; experiencing an abnormal absence of menstrual periods (amenorrhea); suffering from Anorexia nervosa or bulimia; cigarette smoking; and excessive use of alcohol. (Food and Drug Administration)

The main mineral in bones is calcium. Healthy bones also need vitamin D, vitamin A, vitamin C, magnesium and zinc. (Food and Drug Administration)

The percentage of teenagers who don't drink milk dropped from three-fourths to little more than half, according to a survey comparing 1994 daily beverage intakes with those in the late 1970s. (U.S. Department of Agriculture)

1 in 4 American women will eventually develop osteoporosis. 77 percent of women with osteoporosis don't know they have it. (National Osteoporosis Foundation)

Osteoporosis is a major public health threat for 28 million Americans - 8 million women and 2 million men in the U.S. have osteoporosis; 18 million more people have low bone mass, placing them at increased risk for the disease. (National Osteoporosis Foundation)

Osteoporosis leads to 1.5 million fractures each year, including: more than 300,000 hip fractures, approximately 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other body sites. (National Osteoporosis Foundation)

A woman's risk of developing a hip fracture is equal to her combined risk of developing breast, uterine and ovarian cancer. (National Osteoporosis Foundation)