After all, she lacked many of the classic risk factors for the life-threatening fractures and hunched posture that result from osteoporosis.
She always had pursued an active outdoors lifestyle that included hiking, skiing and heavy-duty gardening. Gates ate well, consumed plenty of calcium. She had a sturdy bone structure and didn't smoke, drink or use caffeine. There was no family history of bone loss.
Youthful and well-muscled at 60, Gates hardly fit the stereotype of the fine-boned senior woman who spends her days crocheting. But bone loss can affect anyone - male or female - and can show up as early as the 20s, said Patty Trela, a doctor of physical therapy at the University of Utah Orthopaedic Center.
In Gates' case, doctors figured a problem with low estrogen during her teens and 20s, while her bones were still forming, probably caused the too-steep decline in bone density she experienced over the past decade.
"We reach our peak bone density at age 30," Trela says. "The most critical time is the teenage years, when nutrition and eating habits are sometimes poor. If we don't develop our bones at a young age, they won't reach peak bone density. This disease is almost completely preventable. It's much easier to prevent than to treat."
Sedentary habits, poor nutrition and eating disorders such as anorexia nervosa play terrible havoc with bone development during teenage years, Trela says. But even bones that develop well can be leached of their strength later in life because of medical problems or lifeÂstyle choices.
Use of steroids - illicit, or through prescriptions to control conditions such as asthma - is a common cause of bone loss; medications to control seizures have similar effects. Chemotherapy, cigarette-smoking, alcoholism and excessive intake of soda pop and caffeine can weaken bones. But the biggest risk factor for bone loss, and the injuries and stooped posture it can cause, is inactivity.
"Our sedentary lifestyles are catching up to us," Trela says, pointing to computers, television and a decrease in regular outdoor play as major contributors.
Bone loss usually can be reversed by lifestyle changes, Trela says, and increasing activity is the place to start because it also improves overall fitness and quality of life.
"Everything that gets worse with age gets better with exercise," Trela says. "Exercising can increase 'healthspan,' not just lifespan. It makes people more energetic, alert and flexible. People who exercise have less incidence of injury and are able to enjoy leisure activities better."
Walking is the classic prescription for bone development because it is a weight-bearing exercise that strengthens skeletons without requiring special training or equipment. But some other forms of aerobic exercise, such as swimming and bicycling, don't do much for bone health.
"Research indicates that aerobic exercise alone does not support muscle strength and bone mass as we age," Trela says. "Progressive strength training is the key to improving walking, balance and bone density. Everybody needs a weight program."
Lifting weights gives spines, arms and legs the strength to resist fracturing as bodies age. But tailoring a program for individual needs, especially when such factors as arthritis or previous injuries must be considered, can be tricky.
Trela's solution is the Build-A-Bone program, which she directs through the Orthopaedic Center. Many of its participants are referred by doctors after fractures or diagnosis of low bone density, but anyone interested in treating or preventing bone loss can sign up for the classes.
Gates entered the Build-A-Bone program last fall after routine bone scans revealed her declining bone density. Although her lifestyle was already enviably healthful, Gates learned there were still changes she could make to reverse bone loss.
"I stopped drinking all the soda pop I used to drink," she said. "The phosphorus robs calcium from bone."
Gates says she makes certain she gets 1500 mg of calcium each day, along with vitamin D and magnesium. (Check with your doctor about your needs.) To help with calcium absorption, she tries to soak up 30 minutes of sunshine each day.
Medicare doesn't cover bone-density tests before age 65, but many doctors advise a baseline test at 50, then every five years thereafter.
Gates' college major was home economics with emphasis in nutrition, and she has always prepared healthy foods for her family. The Build-A-Bone classes validated her menu choices, which focus on chicken, fish, salads and whole grains.
When seated at her computer, Gates thinks harder about her posture now: "Ears over shoulders, shoulders over hips. Don't cross your legs at the knees, and take frequent breaks to squish your shoulder blades together." Such changes, though relatively small, can add up to great results, Trela says. She has seen patients with osteopenia improve their bone density to normal levels after implementing the Build-A-Bone program's suggestions.
"Not everyone is going change everything in their life to be perfect, but if they can improve on certain areas, it's just going to help them," she says. "We don't tell people to make huge changes, but if they can do little bits of change progressively, that will improve their general health."
For Gates, the biggest change is the new accessory she wears every day - the pedometer that came with enrollment in the class.
"We're supposed to get in 10,000 steps per day," she says. Determined not to let weakened bones curtail the activities she loves, Gates goes for 12,000 - running the stairs in her home twice instead of once for every errand, parking at the far end of parking lots and taking her dog for long daily walks.
The effectiveness of Gates' efforts won't be known for some time. Because bone changes happen slowly, she must wait two more years to find out whether her bone density has continued to decline. If so, she will be placed on medication. And she will have to think hard about the risk of fracture associated with her favorite sports, water- and snow-skiing.
Gates is doing everything she can to ensure that doesn't happen. She remains hopeful, even defiant:
"I'll go down fighting," Gates says. "I'm too young to give up my active lifestyle."
Risk factors for osteoporosis
* Current low bone mass
* Female
* Caucasian or Asian
* Thin or small frame
* Low calcium intake
* Vitamin D deficiency
* Over 65
* Family history of osteoporosis
* Personal history of fractures over age 50
* Estrogen deficiency from menopause, especially early or surgically induced
* Abnormal absence of menstrual periods (amenorrhea)
* Anorexia nervosa
* Use of certain medications (corticosteroids, chemotherapy, anticonvulsants, anti-seizure medications)
* Sedentary lifestyle
* Cigarette smoking, excessive caffeine intake, alcoholism
* Low testosterone
* Women with several risk factors can get osteoporosis at any age.
* Men with fractures and risk factors are also vulnerable.
Source: U. of U. Orthopaedic Center
Posture tips
Good posture protects against stooped shoulders and
spines. Some tips:
* KEEP YOUR WEIGHT down to lessen forward pull on back muscles and weakening of abdominal muscles.
* AVOID STAYING in one position for long periods of time.
* SLEEP ON a firm mattress; don't use oversize or several pillows.
* BEND KNEES when picking up or putting down objects; use two hands to carry a heavy load, and keep it close to your waist.
* WEAR COMFORTABLE, well-supported shoes. High-heeled or platform shoes distort the foot and throw the back's natural curves out of alignment.
* WALK WITH HEAD ERECT and chin parallel to the ground, allowing arms to swing naturally.
To learn more
* A COMPLETE exercise program for bone health, including videos, is available at www.citracal.com/best/ best.aspx.
About the Build-A-Bone program
* THE PROGRAM is a four-part series of two-hour classes on how to care for and strengthen your bones, designed for people with osteopenia, oseoporosis and general risk for bone density diseases.
* THE CURRENT SESSION begins this evening at the University Orthopaedic Center, at the corner of Foothill Boulevard and Wakara Way in Salt Lake City. Classes are Tuesdays from 5 to 7 p.m. and Saturdays from 9 to 11 p.m. Additional classes will be scheduled according to demand.
* COST is $90 for all four classes, and includes a pedometer.
* TO REGISTER, contact Patty Trela at Patty.Trela@hsc.utah.edu. More information about bone health and the Build-A-Bone program is available at www.uuhsc.utah.edu/ortho/services/bone.htm.
To begin, a few exercises
POSTURE EXERCISE
* Stand with your feet shoulder's-width apart, knees slightly bent. Place your hands behind your back at the level of your pelvis. Squeeze your shoulder blades together, hold three counts; relax. Repeat 10 times.
BALANCE EXERCISE, ONE-LEGGED STORK
This exercise is adapted from a classic yoga pose. It
improves posture, balance and hip flexibility.
* Holding a counter or wall for support, spread feet hip-width apart. Place the bottom of one foot against the opposite shin. Hold the position for 30 seconds, letting go of the support if you can. For more challenge, close eyes.
RESISTANCE EXERCISE TO BUILD BONE, BACK EXTENSION
Some resistance exercises don't require weights. This exercise
strengthens the muscles in your buttocks as well as the back
muscles that support your spine. Strengthening these muscles
stimulates the bones of your hip and spine.
* Lie face down with toes pointed, right arm to side, left arm straight out in front. Right palm faces up; left palm faces down.
* Raise right leg and left arm as high off the floor as comfortably can, allowing head and neck to rise, too.
* Pause for a breath, then slowly return to starting position.
* Try to do eight on each side. Rest for a minute or two, then do another set.
Source: U. of U. Orthopaedic Center
