|Kona Pier During Tsunami|
For those of you who didn't see the photos from Kona making the rounds the day of the earthquake in Japan and subsequent tsunami, this is Kona Bay where the swim portion of the Ironman starts and finishes. The green tents to the right mark the location of the women's changing tent during the race. I'll bet your time for T1 would be a might slow here. (I believe credit for the photo goes to Bob Babbitt and Coffees of Hawaii.) For an absolutely insane video during the tsunami - taken by a candidate for the Darwin Award according to IMH Transition Coordinator Mike McCurdy, check out this video on Youtube
"Were lavish to the bone," Freddie Mercury, Queen
"What a dog I got. His favorite bone...is in my arm!" Rodney Dangerfield
For those of you who read last weeks blog, we discussed the definition of osteoporosis, risk factors, etc. and that it's not just a disease of elderly women. In fact, one fifth of all hip fractures occur in men. Although men start with a higher bone density and are not subject to menopause (even if it's hard to tell the way some guys act occasionally) both sexes are subject to this process.
First, the diagnosis of osteopenia (less bone) is made when there is a diminished amount of bone but not yet enough to be considered osteoporosis. Bone density cannot be measured, or even semi-accurately guessed at on regular X-rays. We normally use a test called a DXA (Dual-energy X-ray absorbtiometry) a type of X-ray. It uses two X-ray beams of different energy to allow subtraction of the soft tissue and subsequent determination of bone mineral density. It is NOT a bone scan which so many of you have had to rule in/out a stress fracture.
The World Health Organization recommends a DXA in :
1) All women over 65, men over 70.
2) Women under 65 who have additional risks:
- estrogen deficiency
- a history of maternal hip fracture
- low body mass (less than 127 lbs.)
- a history of amenorrhea (absent or diminished periods) more than a year before age 42
3) And, there are 12 other less common subclasses recommended
A standard exam in an adult is a scan of the lumbar spine and either or both hips. These results can be compared to a young adult reference population (Z scores) or to an age matched population (T scores) to calculate future fracture risk. In other words, the knowledge that one is osteopenic is crucial in slowing or halting the progression to osteoporosis.
In response to Osteoporosis Part One, a commenter noted, "I routinely ask my new running/coaching clients (mostly women) to get screened....and am on about an 80% 'Gotcha' rate for catching anemia, very low vitamin D levels or both. It's pretty stunning to me."
One condition that bears brief mention here is Transient Osteoporosis of the Hip, a process of unknown etiology noted by the acute onset of new hip pain with X-ray evidence of osteoporosis and an MRI indicative of inflammation of the bone itself. It resolves on it's own in 6 - 12 months with the short term goals of pain control and fracture prevention. These patients are often placed on a walker or crutches. Although uncommon, it's seen in pregnant women after the sixth month and in males aged 40 - 70.
In some sports, it's said that the best offense is a good defense. It's no truer than here. Once bone is lost, it's difficult to replace. If, while we're young, we're commited to a diet rich in calcium and vitamin D, maintain a dedication to exercise - a major portion of which is weight bearing - and pay attention to a healthy diet, we'll reduce the potential of developing osteoporosis.
Should we find ourselves facing the diagnosis of osteoporosis we may be required to take medication to strengthen the bone. Unfortuntely, as noted above, one is frequently symptomless until a fragility fracture brings the diagnosis to our attention.
So, for today: 1) Know the recommended daily amount of calcium and vitamin D for your age, sex, etc.
2) Understand that sunlight is a major contributor of our vitamin D and that we may have
different dietary needs in winter versus summer.
3) Maintain a life long commitment to exercise and a healthy diet.
The finish line in Kona after the tsunami. (same credit)