On September 26, the National Osteoporosis Foundation launched Generations of Strength: A Mothers and Daughters Campaign, an initiative to encourage mothers and daughters to talk about how to protect their bones (I am the honorary chair). I only wish I had known enough about osteoporosis to help my mother prevent its worst consequences. In her late sixties, her sit bones became so powdery, it hurt her even to sit and read.

Given that most personal of warnings, I was vigilant during the menopausal passage, when for a span of five to seven years bone loss accelerates to 1.5% a year. In my sixties, however, I have slacked off. It certainly isn’t because my doctor lets me forget the necessity for monitoring this most stealthy of chronic illnesses. My gynecologist, Pat Allen, is more than proactive. She lovingly badgers her patients to follow up with diagnostic tests.

In the interest of full disclosure, I was a scofflaw. I thought I was home free after menopause. More than once Dr. Allen urged me to ask my internist to order an X-ray of the spine because a dark area had appeared on the bone densitometry evaluation of my spine. This could have meant a vertebral compression fracture.

I finally went for a current bone density test. This time, however, I knew enough to ask for an even more accurate test: a Vertebral Fracture Assessment (VFA), which requires an additional prescription. Richard Bockman, M.D., chief of the endocrine service at Hospital for Special Surgery (HSS) in New York, studied the printout and smiled. “Your hip has good bone density for your age,” he reported. “And look at the wrist!” He showed me on the colored graph that I am well above my age group in wrist strength.

The results confirmed the success of the three-pronged regimen I have chosen to follow for almost 20 years: Weight-bearing exercise for 30 minutes three times a week (I used to run; now I pedal on an elliptical machine with an incline, or walk briskly for 45 minutes in the park (or until my dog gets tired and flops). Once a week I grit my teeth through a full-body workout with a trainer who takes no prisoners, or I take an abs class from a brutal Navy Seal. Every day I swallow 1200 mg. of calcium with vitamin D and snack on yogurt. (A blood test can measure whether one needs additional Vitamin D.) I also use the lowest-dose estrogen patch recommended for bone loss, which has saved me from my mother’s painful osteoporosis. At this stage of my life, I have chosen to take the risks of prolonged hormone treatment to enjoy the benefits of mobility.

But what about my spine? “Your problem is not osteoporosis, it’s degenerative disc disease,” Dr. Bochman said. One of those gelatinous cushions between vertebrae has been wedged at one end and squished down to paper-thin. This can cause pain and sciatica. What to do about it?

Stretching exercises, pilates and yoga, and deep tissue massage, he recommended. The truth is, it’s after 65 that women must be the most vigilant. We continue to lose bone for the rest of our lives. So at 65, every woman — even those with no family history or other risk factors — should get a baseline bone density measurement. If a woman has experienced some months of aching back pain and had 1½ to 2 inches of height loss, she also needs a spine image to look for both osteoporosis and/or degenerative discs. Even better, get a Vertebral Fracture Assessment. But a woman has to know enough to ask for a VFA.

And that gets us back to the whole point:

Women need to talk to other women to share what we know and encourage one another to act. The Conversation is the key to prevention. Let’s talk.



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