Dr. Stephen Honig, MD
Dr. Stephen Honig, MD is a Clinical Associate Professor of Medicine at the NYU School of Medicine and the Director of the NYU-HJD Osteoporosis Center. He is a member of the Rheumatology Division in the Department of Medicine at NYU School of Medicine. Currently, his main research interest is in studying the relationship of bone microarchitecture to bone strength. He is a graduate of Kenyon College and the University of Tennessee College of Medicine.
Q: I went through menopause over 20 years ago, but my doctor just told me I have postmenopausal osteoporosis. Is a late diagnosis like this normal?
Physicians consider menopause to begin one year after a woman’s last normal menstrual period. The decrease in estrogen levels that happens during menopause results in an increase in bone loss. This may be particularly significant in the first five to 10 years of menopause. After that period of time, it’s common for women to experience more gradual, sustained bone loss. Your doctor may diagnose osteoporosis based on findings on a bone density test or by a history of an osteoporotic fracture. It’s very common for women to receive a bone density diagnosis of osteoporosis 20 or more years after menopause. The diagnosis of postmenopausal osteoporosis made by your doctor would likely be correct as long as they’ve ruled out other causes of bone loss.
Q: What are some foods that I should focus on eating to help strengthen my bones?
An osteoporosis diet should include adequate supplies of dietary calcium and vitamin D. It’s often difficult to get enough vitamin D from dietary sources to achieve a normal blood level. So you may need vitamin D supplements. Your doctor can let you know how much vitamin D you should take by measuring the serum level of the vitamin through a simple blood test. The recommended calcium intake for postmenopausal women is 1,200 milligrams (mg) daily. At least half of this should come from dietary sources. Many people think that the daily recommendation refers to calcium tablets and other sources of supplemental calcium. They often forget about the calcium they get from their diet on a regular basis, and so may end up taking too much. If you have issues with dairy products, you’ll find there are plenty of alternative sources of dietary calcium.
Q: I’m a grandmother of three young, active grandkids. How can I keep up with them without worrying about getting a fracture or breaking a bone?
There’s no simple answer to this question. If you have osteoporosis or experienced a fragility fracture, you should avoid lifting grandchildren who weigh more than 10 pounds. Also, it’s important to remember to bend with your knees if you need to pick something up from the floor. Bending at your waist could be problematic if you’re at high risk for spinal fractures. In general, walking is good for both bone health and overall health.
Q: What are some simple exercises and stretches that are especially good for bone health?
Exercises are an important adjunct to good bone health. Weight-bearing exercises are recommended and can include walking on level ground or on a treadmill as well as climbing stairs. Muscle-strengthening exercises to improve core muscle strength are also helpful for bone health.
Q: I don’t know how to ask my family members for help. What do you suggest?
Osteoporosis is increasingly common as people age. Public awareness of this condition is much greater than it was even 10 years ago. Like any medical condition, osteoporosis may require some assistance from friends and family. This is particularly true when it comes to lifting and carrying heavier objects. I would suggest explaining your condition to your family so they understand why you need help. Then discuss what they can do to help you.
Q: Are there certain tests or exams that I should receive on a regular basis?
Bone density testing is recommended for women 65 and older as a screening test. It’s also recommended for postmenopausal woman younger than 65 who may have a risk factor including: a previous fracture, a family history of hip fractures, medical conditions associated with an increased tendency to fall, or other conditions that may increase fracture risk. Men 70 to 75 years of age should also have a bone density test. In general, if there is concern regarding the development of osteoporosis, bone density tests can be repeated every two years. They may be done less frequently if there is less concern about underlying bone health.
Q: I’m worried that having postmenopausal osteoporosis is going to put a halt in my life. Is there anything I can do to slow down the disease?
Osteoporosis is a condition that can be well-managed. The main concern with osteoporosis is an increase in fracture risk. Medications that are used to treat osteoporosis can reduce the incidence of fractures by at least 50 percent. In addition to drug treatment, you may benefit from balance-training activities and other approaches to decrease your chances of falling, the major cause of fractures in the osteoporosis population. It’s important to discuss with your healthcare professional a strategy for long-term bone health. This may include diet, exercise, adequate intake of calcium and vitamin D, as well as bone-strengthening prescription medications.
Q: Besides eating right and exercising, what can I do to keep my bones healthy and strong?
In addition to a good diet and regular exercise, adequate amounts of calcium and vitamin D are important for good bone health. Avoiding excess alcohol intake and not smoking are also important healthcare measures that you should take. Additionally, those at higher risk for fractures should discuss with their doctor their need for any bone-strengthening medication to reduce the incidence of fractures.
Q: Does having osteoporosis mean that I’ll eventually have to use a cane or a wheelchair?
Many with osteoporosis never experience a fracture. But those who do should be under the care of a healthcare professional and consider bone-strengthening medications to help reduce the risk of subsequent fractures. A multidisciplinary approach, which may include balance training and medications, can help prevent fractures. It may also reduce the likelihood of a fracture that impairs mobility and quality of life.
Q: How will I know if my osteoporosis treatment is working?
Your healthcare professional will monitor your response to osteoporosis treatment generally with bone density testing as well as laboratory tests that measure bone markers. The most critical measure of a treatment’s effectiveness is simply the prevention of fractures that are related to osteoporosis.