Osteoporosis and improving bone health

Osteoporosis and improving bone health

Bone building reaches a peak during adolescence but then slows after age 25. In addition to this natural bone loss, we’re less likely to perform high-impact, bone-stimulating exercises (such as jumping) after age 50. This adds up to an increased risk of osteoporosis and bone breaks and fractures.

As you age, bone deterioration starts to surpass growth rate, causing a decrease in bone density. However, the good news is that you can build stronger bones at any age. Taking steps to increase your bone mass and density throughout your life decreases your chances of osteoporosis, bone breakage and fractures as you age.

What affects bone health?

A number of factors can affect bone health. For example:

• The amount of calcium in your diet
• Physical activity
• Tobacco and alcohol use
• Gender
• Size
• Age
• Race and family history
• Hormone levels
• Eating disorders and other conditions
• Certain medications

The basics of bone in health and disease

Both genes and the environment contribute to bone health. Some elements of bone health are determined largely by genes, and errors in signalling by these genes can result in birth defects. External factors, such as diet and physical activity, are critically important to bone health throughout life, and these factors can be modified.

Much of the cellular activity in a bone consists of removal and replacement at the same site, a process called remodeling. The remodeling process occurs throughout life and becomes dominant by the time that bone reaches its peak mass, typically by the early 20s. Remodeling continues throughout life so that most of the adult skeleton is replaced about every 10 years.

Remodeling consists of tearing down small parts of the bones, and then re-forming them. The breaking down portion is termed “resorption” and is performed by large cells within the bones called “osteoclasts”. However, remodeling does not seem to be a perfect give and take of bone mass. The osteoblasts are less efficient at making bone than the osteoclasts are at removing it. Any factor which causes a higher rate of bone remodeling will ultimately lead to a more rapid loss of bone mass and thus more fragile bones.

What is osteoporosis and how common is it?

Osteoporosis is by far the most common bone disease. Osteoporosis is ‘a skeletal disorder characterised by compromised bone strength, predisposing to an increased risk of fracture’.

It typically does not manifest until late in life, when bone loss begins due to bone breakdown and decreased levels of bone formation. Loss of bone mass leads to the development of structural abnormalities that make the skeleton more fragile.

How likely you are to develop osteoporosis depends on how much bone mass you attain by the time you reach age 30 and how rapidly you lose it after that. The higher your peak bone mass, the more bone you have and the less likely you are to develop osteoporosis as you age.

One in two women and one in four men over the age of 50 will have an osteoporosis-related fracture in their remaining lifetime. Yet the advanced effects of bone loss does not have to be in the future of people who eat wisely and exercise regularly.

Steps to prevent osteoporosis

To prevent porous, breakable bones as you age, you need to have sufficient calcium and vitamin D. The body uses calcium for a number of functions and will take it out of the bones faster than it can be laid down if your diet does not pump enough calcium into the pipeline. But calcium is not the only component, bones are also one-third collagen, which is a protein that gives bones their flexibility.

The biggest component of a bone-healthy diet is leafy greens, both cooked and raw, according to Annemarie Colbin, PhD, author of Food and Our Bones: The Natural Way to Prevent Osteoporosis. “Greens give you not only calcium, but vitamin K, potassium, and other minerals and nutrients you need to lay down bone. My first three recommendations are vegetables, vegetables, vegetables,” says Colbin.

Vitamin D is also important for strong bones, and a good source is the sun. Another building block of strong bones is protein and magnesium helps maintain strong bones.

In addition, external factors such as diet and physical activity are critically important to bone health throughout life and can be modified.

The skeleton needs certain nutritional elements to build tissue. Not only does the skeleton require the same nutritional elements as the rest of the body, but it also has a special requirement for large amounts of calcium and phosphorus. When calcium and/or phosphorus are in short supply, the regulating hormones take them out of the bone to serve vital functions in other systems of the body. Too many withdrawals can weaken the bone.

Stop smoking

You probably already know that smoking is extremely unhealthy. But did you know that smoking is associated with a higher risk of developing osteoporosis? Smoking interferes with your body’s ability to use minerals and nutrients. In fact, smoking is directly linked to lower bone density.

If you smoke, quitting quickly decreases your risk for many diseases. The longer you smoke, the higher your risk is of low bone density and fractures.

Smoking also reduces the production of estrogen in women, which can also lead to weaker bones.

Is exercise good for maintaining bone health?

Yes. Exercise is essential for everybody. When we exercise, our muscles pull on our bones, which in turn build bone. Hence exercise builds stronger, denser bones.

As a rule of thumb, 30 minutes of bone building exercise 4-6 times a week can help maintain better bone density. Exactly how much you need is dependent on the type of activity you do, how long you do it for and your age. Please note, it is important to talk to your doctor and make sure the workout you choose is safe for you.

Such exercises include:

• Weight-bearing exercises
  E.g. brisk walking, hiking, stair climbing, tennis, netball, jogging and aerobic dance
• Resistance training
  E.g. exercises can be machine-based (leg press, seated rowing) or done using free weights (dumbbells or ankle weights)
• High impact exercise
  E.g. skipping, jogging, jumping, netball and basketball
• Balance training
  E.g. standing on one leg with eyes closed, sitting on an exercise ball, tai-chi and yoga

Quick exercise tips to get you started

Here are some quick and easy exercise ideas to get you on your way. It’s a great starting point!

• Use the stairs instead of the lift
• A quick jump rope session will do wonders
• Take a brisk walk to the shops and back. This is walking to increase your heart rate, you should be able to talk but not sing
• Have a giggle with the kids and show them how to really dance
• Break up that leisurely stroll…Walk with purpose for 10 minutes, then stroll, then walk briskly again
• Did you know that 2 x 10 minute sessions jogging will give you a better bone score than 1 x 30-minute session?

Fast facts on bones health and strengthening

Here are some fast facts regarding sustaining mobility and independence into old age:

• Bone tissue loss generally begins at the age of 40 years, when we can no longer replace bone tissue as quickly as we lose it.
• Taking preventative measures including ensuring a healthy diet will slow the rate of bone thinning and reduce the risk of having osteoporosis-related fractures.
• Although bone healthy nutrition, exercise, and avoidance of negative lifestyle habits are important, drug therapies are critical for fracture protection in patients at high risk for fractures. A 30–50% reduction in fracture incidence can be achieved with 3 years of pharmacotherapy.
• Controlling osteoporosis risk factors and complying with treatment regimens, where prescribed, can ensure seniors live mobile, independent, fracture-free lives for longer.
• In men, bone loss tends to accelerate after the age of 70 years.
• Calcium levels may be lower in seniors due to decreased consumption i.e. poor appetite, illness, social and economic factors with malnutrition being common; decreased intestinal absorption of calcium (exacerbated by low vitamin D status) and decreased retention of calcium by the kidneys.
• Vitamin D levels may be lower because of less frequent exposure to sunlight for the housebound, decreased function of the skin to synthesize vitamin D and decreased renal capacity to convert vitamin D to its active form.
• To maintain physical function, older people need more dietary protein than the young.
• Supplementary protein or higher dietary intake of protein by older people who have been hospitalised with hip fracture has been shown to improve bone density, reduce the risk of complications and reduce rehabilitation time.

Read more on the importance of staying healthy over 60 in volume 2.
Volume two: Looking after your health and well-being after 60

Source:
– WebMD. Weight-Bearing Exercise: 8 Workouts for Strong Bones. 6 June 2008. By Rebecca Buffum Taylor, Reviewed by Brunilda Nazario, MD. Read article
– Weight bearing exercise builds bones. Healthy Bones Australia. Read article
– 7 Easy Ways to Build Strong Bones. 21 July 2016. By Linda Melone. Read article
– NCBI. Bone Health and Osteoporosis: A Report of the Surgeon General. Read article
– WikiHow. How to increase bone density. 29 January 2017. Laura Marusinec, M.D. Read article
– Nature Medicine. Vitamin E decreases bone mass by stimulating osteoclast fusion. 14 July 2011. Fujita, K; Iwasaki, M; Ochi, H. Read article
– Journal of bone and mineral research. Effects of vitamin E on bone turnover markers among US postmenopausal women. June 2012. Hamidi M, Corey P, Cheung A. Read article
– NHSUK. Osteoporosis – Prevention. 20 June 2016. Read article
– National Institute of Health. Smoking and Bone Health. May 2016. Read article
– WebMD. Building Stronger Bones. By Jean Lawrence. Read article
– Mayo Clinic. Bone health: Tips to keep your bones healthy. 15 January 2016. By Mayo Clinic Staff. Read article
– Osteoporosis Australia. Nutrition and bone health throughout life Fact Sheet. Read article

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