Health - June 30th, 2000

‘Them bones, them bones, them dry bones…’

Staying Healthy in Japan

by Elyse Rogers

There are trends (or fads) in medi­cine, just like in any other area of life, and osteoporosis (bone thinning) is definitely a front-and-center medical fad today. But unlike the fad of hula hoops or even the medical fad of new herbs such as Ginkgo Biloba to stave off Alzheimer’s, the “fad” of osteoporosis goes beyond that. Osteoporosis is a serious, widespread condition that has only recently got the attention it deserves. I’m afraid this fad will be around for a long time.

What is osteoporosis?

In the world of medical terms, where most are unknown words and more confusing than enlight­ening, osteoporosis is a relatively simple and explanatory one. Osteo (as most everyone today know) means “pertaining to bones” and “porosis” is from the word porous, and means “having cavi­ties or being less dense.” Which adds up to bones that are no longer the strong, rigid masses we de­pend upon for our body’s structure, but rather po­rous, less-dense structures that are easily broken or crushed.

Long considered a disease of the elderly, the focus is changing today. That’s for two reasons: 1) Our whole society is getting older, and many of us will be “elderly” for many, many years. Japan has a head start on that situation as it’s predicted that more than 25 percent of the population will be age 65 or over by the year 2020. 2) Bone loss, or decreased bone density begins much earlier than previously thought—as early as the late 30s or early 40s, particularly for women. And, believe it or not, even athletic youngsters as young as 15 can have signs of the disease.

If you’re into group statistics, it’s estimated that some 25 million American have fragile bones that are susceptible to fracture. That number includes roughly half of all women over 45. Men aren’t immune to the disease either (more about the growing interest in men with osteoporosis in a later column), and it’s estimated that 1 million have the same porous bones as the female population. Osteoporosis is estimated to cause 1.3 million bone fractures a year in people over age 45. What’s even more ominous is that close to 20 percent (one in five) of older people who frac­ture a hip actually die within a year after that frac­ture. Of those who survive the hip fracture, only a few return to the full level of activity they enjoyed before the fracture.

I don’t have any statistics about osteoporosis in the Japanese population as yet, but Dr. Koichi Fujii, of the Tokyo Medical Surgical Clinic, tells me it is common among Japanese women. (All Asian women are con­sidered “high risk” for this condition.)

Diagnosis of osteoporosis

Fortunately there are tools to diagnose those who actively have the disease, those who are at risk and to watch “normal people” through the osteoporosis-prone years. Bone density testing is the key. This simple, non-invasive, not-painful test can indicate the bone density level of the individual. Having a “baseline” bone density test done is important for all, as it allows not only identifying those with active disease, but also establishing a “norm” for those who might develop the disease in the future. (And, unfortunately, that latter category covers most of us, particularly those of us who plan to live a fairly typical lifespan.)

Bone density testing is fairly widespread both in the U.S. and Japan, with the DEXA (dual-energy x-ray absorptiometry) low-dose x-ray test as the most popu­lar. Ask your private doctor or hospital clinic physi­cian for information as to how you can obtain a bone density test. In Tokyo, DEXA testing is available at Tokai University Tokyo Hospital, Tokyo Women’s Medical College and Keio University Hospital.

Note—a bone scan and bone density test are differ­ent. I’ve described a bone density test above, but a bone scan is more invasive, requiring an injection of radioactive material. Unless there is some special rea­son, most people should opt for the bone density test as it is the quicker, easier and less expensive of the two.

Prevention and treatment of osteoporosis

Fortunately there is much we can do to prevent this disease—particularly (and parents of young girls should take special note) during the growing-up years. The general preventive measures are listed below:

  • Eat a balanced diet
  • Consume enough calcium
  • Exercise
  • Don’t smoke
  • Limit alcohol consumption
  • Watch the caffeine
  • Consider estrogen replacement therapy if you are a post-menopausal woman

For those who have been diagnosed with osteoporo­sis (and in some cases with osteopenia, which is a beginning stage of osteoporosis), there are some new medications that hold a great deal of promise. The four current “big guns” of osteoporosis prevention and treatment in the U.S. are listed below: (I’ve noted those that are available in Japan):

  • Estrogen (pill or patch)—women over 55, (or women who are past menopause) should carefully look at this type of replacement hormone therapy as it is, to date, the most effective prevention and treatment for osteoporosis in older women—reducing fracture risk by as much as 30-50 percent. (Available in Japan.)
  • Calcitonin (Miacalcin nasal spray). This is one of the oldest “treatments” (not approved for prevention) for osteoporosis, and is actually a synthetic product that mimics a salmon hormone. (Available in Japan.)
  • Alendronate (Fosamax tablets). A newer treatment that seems to be more effective than Calcitonin, but is difficult for people to take as it can irritate the esophagus, so special precautions are needed. Since this is non-hor­monal compound it’s suitable for both men and women. (In the final stages of government approval in Japan.)
  • Raloxifene (Evista tablets) A selective estrogen re­ceptor modulator (SERM) seems to prevent bone lose as well as does estrogen, but with a lower breast-cancer risk. (Not available in Japan, as yet.)

A good diet for osteopororsis prevention (and treatment)

Those living in Japan have a head start on good calcium-rich foods, and other foods that appear to promote bone density or to slow bone loss.

  • Soy products—soy appears to be a real “miracle food” for osteoporosis as it has bone-building isoflavones, and is a replacement for bone-depleting animal proteins.
  • Milk products—milk or dairy products are an unri­valed source of calcium in the diet. Tofu is good, too. Doctors recommend 1000 mg of calcium a day for an adult, and suggest that those over 50 take in 1200 to 1500 mg a day.
  • Green tea—there’s some thought that green tea is helpful in the battle against osteoporosis, but even if that eventually proves untrue, there is lots of other research that suggests that daily ocha is a healthy addi­tion to any diet. And it certainly is cheap, easy and ubiquitous in the Big Mikan.
  • Balanced diet—a good, overall balanced diet is the basis for a healthy lifestyle and therefore should be the cornerstone of any preventive-disease program.

Common sense rules

It won’t surprise any of you who know me, that I’d emphasize the same, common-sense lifestyle measures for the prevention of osteoporosis as for promoting general health. Regular exercise, a balanced diet, no smoking, mod­eration in alcohol consumption and a good attitude are the basic ingredients in a healthy lifestyle. Adhere to them in your own life, teach your children and spouse to follow them also, and “mem bones” should serve you well.