The effects often show up later in life, but it has its beginnings much earlier. Ned Amendola, MD, professor and head of UI Sports Medicine at University of Iowa Hospitals and Clinics, has these comments:

What causes osteoporosis?

Osteoporosis, a disease of bone loss or calcium loss, causes an overall decreased bone density in the bones of your body. It's a very common problem that happens naturally with aging in both men and women, usually after adulthood, past the age of 35 or 40. Both men and women begin to lose more calcium than they take in and so you get this generalized loss and decrease in bone density.

When that bone density reaches a certain threshold level, it creates weakness in your bone and so fragility fractures or osteoporotic-related fractures are common in the older population. This usually affects the spine, so you get vertebral osteoporotic fractures. It can also affects the hip, so you get hip fractures in the elderly. This is a very significant problem because fragility fractures are among the most common treatments that we give in orthopaedics.

How common is the disease?

The estimate is that there's probably about 10 million Americans that have the disease, and probably there's two or three times that number who are at risk of osteoporosis, but have not been diagnosed yet. That's something that we teach in our program and we have to be aware of is osteoporosis in the orthopaedic population. For example, if someone comes in with a fracture that may be a fragility fracture, we teach our residents and students that they should look at those patients a little closer and do a bone density test to see if they should have treatment for their osteoporotic fracture.

Who is at risk for this disorder?

The older population are at the greatest risk because both men and women lose bone density with age. Women are at a much higher risk after menopause because they don't have that normal stimulation that maintains the calcium levels and bone mass. The Caucasian and Asian population seems to be at higher risk of osteoporosis. In addition, African-American and Hispanic women are at risk. As you know, diet is an important component, so people who have a poor diet or poor nutrition, for example, anorexic patients, are at risk of osteoporosis. There are some habits that contribute to bone loss:

• Smoking
• Excessive alcohol use
• Inadequate exercise

What can be done to reduce a young woman's risk for osteoporosis?

This is an area that is somewhat controversial. It's clear that most women realize they're at risk of osteoporosis after menopause and most physicians understand that as well. It's common at that point to seek some advice on what to do. In that group, certainly, calcium supplements and vitamin D supplements may be necessary.

In the younger population we see in the UI Sports Clinic, it's a little bit more controversial. I like to think of it as a bone bank. In other words, if you start with a bank that's full of calcium before you reach that at-risk age of 35, 40, or 45, I think you have a better chance of keeping your bone mass. In this younger group, we advise a good, balanced diet to get your daily calcium and vitamin D dosage, and regular exercise. In addition, these younger females should have some calcium supplementation to keep their bone bank full.

For both men and women, what are the most important facts about osteoporosis you would like our listeners to keep in mind?

It's important that the adult population, in particular, avoid at-risk issues including smoking and excessive alcohol use. I think a good exercise program to load your bones and help maintain your bone mass is important. If you have suffered a fragility fracture or are seeing a physician who treats these types of fragility fractures, I think it's important to investigate those patients and see if they are osteoporotic and if they require any medication to try and prevent any further bone loss.

One of the ways that we judge a healthy weight is through something called the body mass index, which basically says if you're taller, you get to weigh more. You can look online through multiple Web sites for BMI calculators and be able to calculate your own body mass index.

The body mass index is a marker for the three types of toxicity that occur with obesity:

• The first is the mechanical way weight affects the body; it's hard on the joints, hard on the back.
• The second is another hormonal imbalance called insulin resistance that occurs when the body starts storing fat in muscle and then the liver, causing the development of insulin resistance.
• The third is over stimulation of the immune system which puts folks at risk for heart disease, for cancer, osteoarthritis, and multiple other problems.

In addition to that, what we know from looking at death rates across the country is that a normal BMI is 18-25 and being overweight is defined as 25-30, but both of those categories are not associated with any loss of life.

However, once you cross that threshold of the BMI of 30, you start to decrease life expectancy. And if you get your BMI between 30 and 35, you lose about one to two years; between 35 and 40, about five to eight years; and over 40, about 10 to 20 years.

This is a very important marker of the effect of obesity on your health. As far as the keys to achieving healthy weight, there are no currently medications approved in the United States to rebalance these hormones that cause these problems, so we are dependent upon lifestyle changes in order to be successful with this.

And what we know from making those lifestyle changes is the key is motivation.

When it comes to motivation, we know three important factors that are at the heart of that.

• The weakest has been shown to be fear, which is what physicians do best.
• Stronger than fear is desire, which I think a lot of folks have this time of year.
• The strongest motivating factor, which I think a lot of folks are still missing, is that belief in themselves. That they can actually be successful with these types of lifestyle changes.

So those three motivating factors are really the key in being able to achieve a healthy weight and achieve these lifestyle changes.

For the average person, what type of approach should he develop for weight management in terms of eating, exercise, etc.?

We believe in a comprehensive approach. Because obesity affects so many different systems and parts of the body, we believe that all of those things need to be addressed in order to achieve a healthy weight.

There are several things we focus on.

• The first and probably the most important, is calorie restriction. We calculate what your basic metabolic rate is, and there are calculators, again, that you can look at online to calculate that. We then subtract 500 calories from that to result in a deficit, and therefore, weight loss, and furthermore, we split those calories evenly across the day, so we mandate that folks have breakfast, lunch, and dinner every day and that's critically important to keeping the metabolic rate high.
• The next thing we do is ask people to try to get eight hours of sleep at night because we know that sleep is important
• We actively treat depression
• We actively treat pain
• We actively treat chronic stress and talk about stress management
• We promote physical activity.

All of those things are really at the focus behind developing a plan for weight management. And really, most of those do not really require physician visits to get going.

Speaking of physician visits, if people do need help managing their weight, what should they do?

They could definitely give us a call at the UI Weight Management service. We have openings.

The unfortunate thing, statewide, and actually national-wide, is that the insurance coverage for the management of obesity is not always covered. It's something that we think is a legislative issue that needs to be addressed. When you call us, we can check to see if you qualify for insurance coverage for this service.

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