“Dr. Jack, I was told that I should be taking calcium supplements because of my age. What do you think?”
Nora, a 52 year old, small, thin, pale Caucasian stared intently at her doctor. “I was told that I had small bones and was probably osteoporotic. Should I be taking calcium and Vitamin D?”
Dr. Jack Reynolds folded his hands and leaned back in his chair. “Well, Nora, I never like to generalize with patients. It all depends on who you are and what you are, doesn’t it?” He smiled. “Yes, you are small-boned and small-boned women are prone to fractures but that doesn’t necessarily mean you are osteoporotic or that you should be taking supplements.
For example, when we say “thinning of the bones,” we don’t mean small bones like you have. Osteoporosis means your bones are losing their ability to maintain a strong, tight structure in the interior of the bone. This is brought on by your genetic make-up, your exposure to sunshine, your estrogen levels, your dietary intake of calcium, whether you smoke, whether you do weight-bearing exercise.”
“Does that mean walking?” Nora questioned.
“Yes.” Dr. Jack shook his head. “Sorry for the slip into medical-ese. It means doing any active exercise that requires you to be upright, supporting the weight of your body as you move.”
“But if my bone size is not an indication, how can I know?” Nora pressed.
“Let’s start by seeing if you an elevated risk for osteoporosis. I already know that you are not over 65, that you don’t smoke, and that you have never had a long bone fracture. Am I right?” Nora smiled and shook her head.
“Do you have osteoporosis in your family?” She shrugged. “Are you taking medicines that would lower your body’s ability to absorb calcium or to utilize calcium – like antacids, drugs that lower the acid in your stomach, steroids, or antidepressants?” Again she shook her head.
“Have you already started through menopause?” When she nodded, he said, “Okay, we can assume that your estrogen levels are falling. Now as to your Vitamin D levels, that’s something we can test for. Bone structure is a little harder to know.” He leaned forward. “But the easiest way to find out is a Dexa-scan – a low energy x-ray of your hip and spine to check your bone density. The test can be a little expensive – and is probably not necessary just yet at your age and with your low level of risk.”
Nora frowned. “But I really want to know what I should do.”
“Oh, that’s easy, Nora. Eat calcium rich foods, exercise outdoors at least twenty minutes each day, and decrease your salt intake – and don’t worry. Worry makes your bones thinner.” He grinned again.
“I’ll check your Vitamin D level and have the nurse give you some information about calcium in foods. Using that information, you try modifying your eating habits as best you can. When your test comes back in three weeks, let’s talk about what you’re eating and what levels of calcium your body needs. But let’s not assume you need supplements until we know that you’re doing the all the life-style activities you can. How does that sound?”
“That sounds fine, Doctor,” Nora said. “I’ll see you in three weeks.”