Actress Sally Field always thought of herself as a strong woman -- an image often reflected in her award-winning movie roles. Dazzling us with Academy Award performances in films like Norma Rae and Places in the Heart, she became a signature actress for an emerging generation of equally strong women.
Indeed, even from her early days of TV stardom in comedies like Gidget and The Flying Nun, and later when tickling our funny bone in films like Steel Magnolia, she never failed to personify the baby boom generation at its best.
But recently, something happened that threatened to weaken Field's resolve, not to mention her hopes for what she calls "a great third act."
The 'Silent' Disease
Just shy of her 60th birthday, Field was diagnosed with osteoporosis -- a serious bone-thinning disorder that dramatically affects the risk of bone fractures. It is often referred to as the ‘silent disease’ because you can have no symptoms until you experience a fracture.
"I always knew I fit the risk profile. I was thin, small boned, Caucasian, and heading towards age 60. But I was amazed at how quickly a woman could go from being at risk to having full-fledged osteoporosis," says the still-petite brunette.
On the outside this vibrant actress remained an active sports enthusiast -- "hiking, biking, and doing extreme yoga on a regular basis," she says. But inside, a bone scan showed her hips and spine had started thinning.
"My bones appeared to be getting steadily thinner without any signs or symptoms I could see or feel," Field tells WebMD.
Osteoporosis: How It Happens
According to Steve Goldstein, MD, when we are young the process of bone building outpaces that of bone loss, which is why our skeleton remains healthy and strong. Bone mass peaks in early adulthood. As we age, however, he says the process begins to reverse.
"The older you get the more bone loss speeds up and bone building slows down," says Goldstein, a professor of obstetrics and gynecology at NYU Medical Center in New York City. So, the older we get, he says, the thinner our bones will be.
In women, however, the process of loss is accelerated further, thanks to the dramatic drop in estrogen that occurs at the time of menopause. What's the link?
"Estrogen is what is known as a 'resorptive.' It actually helps slow bone loss from occurring," says Goldstein.
Unfortunately, when levels plummet -- as they do during menopause -- bone loss speeds up, leaving many women at high risk for osteoporosis.
For awhile, hormone replacement therapy (HRT) came to the rescue. In fact, it worked so well that in addition to recommending it for hot flashes and mood swings, many doctors regularly prescribed estrogen for its bone-protecting qualities.
It has been a few years since it was learned that hormone replacement therapy might be doing more harm than good. That was when a major government trial, known as the Women's Health Initiative (WHI), linked the long-term use of combined estrogen and progestin as menopausal therapy to an increased risk of heart disease, as well as stroke and breast cancer.
Field says taking HRT helped her bones as well. It was when she stopped, however, that she says her bone problems really took hold.
"When I completely went off HRT, my bone density took a really big dive and my doctor noticed it," says Field.
Since tests showed she was also low on vitamin D -- necessary to utilize calcium -- her doctors also recommended vitamin D supplements. While Field was hopeful they would work, those hopes were soon dashed.
"Eight months later, we tested again -- and the bone mass went down even more significantly," Field tells WebMD.
It was then that her doctor told her she had developed osteoporosis.
"It was the full-fledged condition. No longer just a risk, it happened," says Field.
While some might take the news simply as a sign of getting older, Field had other ideas. Taking a decidedly proactive stance, she was determined to learn all she could about osteoporosis -- and to do whatever it took to stop it from affecting her life.
After talking with her doctor she chose to treat her osteoporosis with the new once-monthly medication Boniva -- a drug that works to slow bone loss, so the body's natural bone production can pull ahead.
Later, when approached by the makers of Boniva (Roche and GlaxoSmithKline) to spearhead an awareness campaign about osteoporosis, she jumped at the opportunity. Roche and GlaxoSmithKline are also WebMD sponsors.
"At first I was nervous. I thought, this is a big pill -- and I worried something bad would happen," says Field. Indeed, side effects to Boniva can include stomach upset, muscle pain, even ulcers.
Still, when she weighed her fears against what could happen if she didn't take charge, she says the medicine won.
People at Risk
Today Field says she's happy and relieved to be well on her way back to good bone health. But she also says this is not a journey she wants to take alone.
"Aging successfully isn't just about looking good, it's about having a good solid feeling about your health and yourself as a healthy person," says Field, who is asking women to take action by talking to their doctors and joining her in a commitment to better bone health.
According to the National Osteoporosis Foundation (NOF) Field's audience will be vast: Some 10 million women are already diagnosed with osteoporosis, with another 34 million at risk. Though men can develop this condition, they account for less than 20% of diagnosed cases.
In addition to gender, NOF says other risk factors include advancing age, heredity, having a small, thin, frame, low estrogen levels, and a lifetime of low calcium and vitamin D intake. Heavy use of alcohol and cigarettes, alone or in combination with an inactive lifestyle, also play a role.
While Boniva is the newest treatment for bone health, Goldstein says a variety of medications work equally well. These include Fosamax and Actonel, medications similar to Boniva, as well as Evista, a treatment that works like estrogen but does not affect the uterus or breast.
In addition, Goldstein says that a form of parathyroid hormone called Forteo that is given by injection and actually builds bone can also be helpful for some patients.
If pills are not your forte another option is Miacalcin, a nasal spray containing the ingredient calcitonin, which is also recommended as a treatment for postmenopausal osteoporosis.
"The point is that every woman is different, so talk to your doctor about which medications suit your life and your lifestyle, and which will work best to protect your bones," says Goldstein.
NOF also recommends a minimum of 1,000 milligrams of calcium daily from ages 19 through 50, increasing to 1,200 milligrams daily after age 50. This can be in the form of calcium supplements, or via natural sources such as low-fat dairy products including fortified skim milk, yogurt, and even ice cream.
To aid in calcium absorption NOF also suggests 400 to 800 international units of vitamin D daily. You can also try 15 minutes of sun exposure three times a week to help the body manufacture its own vitamin D.
And because experts say bone responds to stress by building more bone, NOF reminds us that exercise is also key to keeping bones strong. They recommend weight-bearing workouts such as walking, dancing or stair climbing, and resistance training, several times a week.
By Colette Bouchez, reviewed by Louise Chang, MD
SOURCES: Sally Field, actress; and Boniva spokeswoman. Steven Goldstein, MD, professor, obstetrics and gynecology, NYU Medical Center. National Osteoporosis Foundation, Prevention and Patient Information.