Good Bone Health

Years back, I had a client who advised me: “ As you get older, be deliberate with your movements.” As I type this with my sling on after a fall, I realize now that she meant “at all times (especially when hiking).” We have 2.8 million annual emergency room visits in America as a result of falls, according to the National Council on Aging.

Falls happen at all ages, but it is especially common with the elderly, and the recovery is usually more challenging. When a fall results in a fracture, good bone health can make all the difference with the healing process. Our body is continuously rebuilding and breaking down bone. Osteoporosis, which we think of as weak or brittle bones, occurs when more bone is lost than is replaced. The report by the U.S. Surgeon General states that, by the year 2020, half of the U.S. population will be at risk for, or have, osteoporosis. From the ages of 50 to 80, the percent of women affected with osteoporosis goes from 4% to 52%.  But osteoporosis, which is a skeletal disease characterized by low bone mass and deterioration of bone tissue, affects men as well. Although more is known about female osteoporosis, research is providing new information about male osteoporosis.
            The major complication of osteoporosis is a bone fracture, which then increases the risk for falls. This becomes a vicious cycle: with increased fractures, there is an increased risk for osteoporosis. Exercise is critical to bone health. According to the American College of Sports Medicine (ACSM), regular physical activity is the “only known intervention that can potentially strengthen bones and reduce the risk of falling in older people with osteoporosis.” The correct formula includes weight-bearing endurance activities 3-5 times per week, and resistance exercises 2-3 times per week, for 30-60 minutes of combined exercise a day (ACSM). Examples of weight-bearing endurance exercises include tennis, walking, jogging, stair climbing, or dancing.  If you are unable to do these exercises, swimming and cycling are good alternatives. Resistance exercises include free-weight lifting, use of weight/strengthening machines, devices such as TRX and exercises using stretch bands for resistance. In addition to strength-training exercises, yoga, tai chi and balance exercises (such as heel-toe walking, walking on tiptoes, and standing on one leg) can improve balance and help prevent falls.
            We can measure bone density. Bone Mineral Density (BMD) is usually recorded as a “T-score.” The level of the T-score determines the level of bone mass. The two types of tests are dual energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QTC). Although the DEXA is more commonly utilized, the QCT seems to be a better diagnostic tool for men. According to the National Osteoporosis Foundation, osteoporosis is identified at 75% or below the peak BMD. Because of new technology, the earlier stages of osteoporosis can be identified at 75-90% of peak BMD; this is called osteopenia.
            Bone density measures how thick or dense the bone is, but it does not measure the quality of the bone structure. Other tests are available, such as N-telopeptide (NTX), which provides markers for bone reabsorption status. A low NTX level means that not enough bone is being made, and a high NTX level mean too much bone is being lost. Therefore, it is important not only to measure your bone density, but it can also be valuable to measure the quality of your bone structure.
            The screenings for bone density and bone quality provide only part of the evaluation. There are other factors when determining your risk for osteoporosis: family history of osteoporotic fracture, thin or small bone structure, smoking, high alcohol consumption, rheumatoid arthritis or celiac disease, and the use of chemotherapy, anticoagulants or corticosteroid drugs.
              Another important component for developing good bone health is considering what we “feed” our bones. There are many minerals that contribute to good bone health, but calcium is the conventional mineral that comes to mind. Such foods as white beans, certain fish (salmon, trout), kale, spinach and dairy products are high in calcium, but often adults still require supplemental calcium. Overall, the standard for healthy adults is a minimum of 1000mg of calcium daily. According to the National Osteoporosis Foundation, women need 1200-1500mg of calcium per day, as well as all adults 71and over. Calcium does not absorb easily so it is best to divide the dose and take it twice daily instead of all at once. An important note about calcium: people’s heath conditions vary, so it is critical to discuss your intake of calcium with your physician, especially if you are on certain medications. The result could be more or less of the standard amount of daily calcium. Vitamin D, specifically vitamin D3, aids in calcium absorption. If you do not eat enough Vitamin D3 containing foods (fatty fish, egg yolks, cheese or foods fortified with D3) or do not expose yourself to about 10-15 minute intervals of sun several times a week, you might consider vitamin D3 supplementation, according to studies done by the National Institute of Health. Vitamin D3 levels can be measured in the blood, and this vitamin requirement can vary depending on your health status–just like we discussed with calcium. Again, it is best to review this subject with your physician based on your individual needs.
            A few facts about calcium: There are different types of calcium (carbonate and citrate, for example). Calcium citrate is typically better absorbed, but check with your doctor if you have any gastrointestinal problems. Sometimes antacids are used as calcium supplements, but antacids mixed with aluminum will weaken bones.  Do not take calcium from sources of dolomite, oyster shells, or bone meal; these forms of calcium can be contaminated with toxic heavy metals such as lead, mercury or cadmium. Additional minerals are vital to bone health, such as magnesium and silicon (trace elements), and studies are looking into the value of other vitamins and supplements, such as a form of vitamin K2 called menaquinone-4, which appears to also bolster bone.
            Finally, your physician might suggest the use of a class of drugs called bisphosphonates (oral Fosamax or Actonel/ injections of Boniva/ or infusions of Reclast), which increases osteoblasts (bone-builders) and decreases osteoclasts (bone-eaters). Treatment with these medications is no longer based solely on bone density test results; instead, a risk profile should be developed. A risk profile includes bone test results, analysis of a one’s activity level, medical history and risk factors. There are side effects to consider when taking these drugs, so it is critical that you understand this form of treatment and review any concerns with your doctor. Keep in mind: Drug therapy does not replace exercise; they should be done in conjunction.
            The status of our bone health impacts our lifestyle; we want to avoid bone loss. Solutions to prevention include staying physically active, practicing risk reduction for falls, and making changes with certain lifestyle habits such as alcohol and tobacco use. Being mindful of your nutritional status, including vitamin and mineral intake, is another component that bolsters bones. If necessary, drug therapy might be a consideration; this requires a discussion with your physician. Thus, it takes a combination of approaches to maintain strong bones, but building strong bones is well worth the effort.