Wellness Wednesday – Bone Health

By: Ed Lippie

Each week, we discuss a variety of different health and wellness topics (last week’s topic was grip strength), some of which may be more applicable to you than others. Everyone needs to pay attention to this week’s topic of bone health, particularly women of every age.

Bone Basics

• A bone is a heavily vascularized organ constantly turning over by absorbing existing tissue and making new bone. Over a decade, your entire skeleton will be “re-made.”
• Bone is composed of 50-60% minerals, the predominant mineral being calcium.
• Calcium balance achieved through diet/supplementation is critical to maintaining bone health.
• Maintaining proper vitamin D3 levels is necessary for calcium absorption in the gut microbiome.
• Bone mineral density (BMD) is the primary metric to assess bone health.

Why Do We Lose BMD as We Age?

Humans have a narrow window to build the highest level of BMD genetically possible (genetics account for 50% of our bone health.) Between the ages of eight and 20, activity level, nutrition, and sleep quality can help us achieve the strongest bones possible. For men, BMD is stable from their early 20s to about 50 years old, when BMD starts to decline slowly.

For women, BMD is stable from their early 20s to the onset of menopause, after which the decline is quite steep relative to men. This is due to estrogen’s unique role in building and maintaining bone health. Both men and women build BMD similarly through the tensile forces exerted on our bones by ligaments and muscle tissue. Mechanoreceptors in our bones receive the signal to strengthen the bone we already have and make new bone through a hormonal carrier, estrogen. Men and women both produce estrogen, but because the estrogen ratio in women is far higher, the precipitous loss of estrogen during menopause disrupts this BMD signaling pathway, opening the door for far greater BMD degradation. Clinical BMD loss is measured on a spectrum that is initially diagnosed as Osteopenia, which is marked by an over 10% loss of BMD. If the loss of BMD surpasses the threshold of 25%, the diagnosis progresses to Osteoporosis.

What Potential Problems Does BMD Degradation Pose?

The loss of BMD makes us more susceptible to bone fractures, specifically hip, pelvis, and leg fractures, after a fall. As we get older, these fractures can be much more challenging to recover from, often leading to extended periods of inactivity and a significant decrease in health outcomes.

What to Do?

• Know your family history. Have closely related family members struggled with fractures and/or had bone scans? What were the results?
• Know your baseline – DEXA scans are a good and increasingly common way to learn about your current level of BMD. The franchise DEXAFit has made scheduling an appointment convenient. Find the nearest location to you here.
• Make resistance training a part of your weekly routine, ideally 3-4 sessions per week. Emphasize total body movements when possible. In cases of joint discomfort, exercises that feature isometric contractions work to apply the requisite amount of tensile force without inflaming achy joints like knees. Picking up and carrying relatively heavy things is a part of our ancient heritage and is very helpful in maintaining bone health.
• Standing sports with faster, more powerful movements are more effective than longer-duration endurance activities.
• Parents of children between the ages of 8 and 20 should maximize this critical window to build BMD through nutrition, activity, and sleep.
• Avoid smoking at any age, but especially before the age of 20.
• The use of corticosteroids is sometimes necessary, but know that one of the side effects is the loss of BMD when used for extended periods of time.
• Likewise, there are many cases in which Proton Pump Inhibitors are necessary, but know that some studies demonstrate calcium absorption disruption and a reduction in BMD.
• Make sure you are not Vitamin D3 deficient.
• Prioritize calcium-rich foods, and because calcium is fat-soluble, try to consume it with fat (2% yogurt, leafy greens with extra virgin olive oil, etc.).
• Calcium-rich foods include sardines, almonds, kale, spinach, dairy products, beans/lentils, tofu, and edamame.
• If appropriate, consider supplementing with 1000-1200mgs of calcium carbonate, carbon citrate, 800-1000 IU of Vitamin 3 and 300-500mgs of the following forms of magnesium: glycinate, carbonate, citrate.
• Women between the ages of 40-50 should make a point to discuss whether or not they are good candidates for hormone replacement therapy (HRT) with their doctors. In my experience, most GPs are not up to date on the latest research regarding HRT, so I would strongly encourage women to seek out an expert in treating perimenopausal and menopausal women.
• Because falls precipitate fractures in older adults, continuing to train your balance should be a key component of your exercise program, particularly for those over 50.

While 50% of your bone health was dealt to you through genetics, there is still another 50% you can heavily influence. I urge you to maximize the 50% within your control!