Our bones are the structural foundation of our bodies. They are living tissue that are constantly breaking down old cells and replacing them with new ones. Childhood is a time of rapid bone growth where we are depositing more net cells into our bones than we are taking out. This results in a net increase of bone strength and mass. We continue to grow bone until the age of about 30 at which point peak bone mass is obtained; of this about 85% had already been attained by the age of 18. There is minimal change in bone density or mass until menopause at which point there is accelerated bone loss.
Women will lose about 3% of their bone per year during the first years of menopause and bone loss slows down after about 10 years. Reaching a high peak bone mass is essential to minimize the impact of age related bone loss and experiencing fractures later in life. Osteoporosis is often viewed as an older women’s disease and an inevitable part of aging, however there are many things that can be done to maximize bone mass and quality. We need to start thinking about the health of our bones in childhood and adolescence.
One of the most important factors affecting our bones is our hormones. Estrogen and testosterone are protective to the bones and when hormone levels drop for any reason bone mass will be lost. Women who stop menstruation due to extremely low body weight or excessive exercise may lose significant bone mass that may not be recovered. Menopause, when hormone levels drop, is also a time of rapid bone loss.
Another essential component of bone health is nutrition. Many nutrients are essential to our bones and the most often thought of nutrient is Calcium. It is recommend that girls aged 9-18 have 1300mg of calcium daily and women aged 19-50 have 1000mg of calcium daily and over the age of 50 we need 1200mg of calcium daily. Calcium is best absorbed in amounts of no more than 500-600mg at a given time. It is best to spread calcium intake out over the course of a day. Ideally we should get calcium from the diet and to only supplement what the diet does not give. Certain groups of people may need to have more calcium intake and it is best to ask your health care provider.
Vitamin D is necessary for the absorption of the calcium we consume. Vitamin D deficiency will lead to softer bone quality and will increase the risk for fractures. It is recommended that most adults in Michigan take about 2000 units of Vitamin D daily. Vitamin D levels can be measured in blood tests and the exact dose should be based on individual needs. Other nutrients needed for good bone health include protein, magnesium, phosphorus, zinc, and vitamins C, K and B12. Diets rich with a variety of fruits and vegetables (including leafy greens) provide our bones with all the building blocks necessary for adequate mass and strength.
Weight bearing exercises, which include any activity where the body has to work against gravity, are also essential to our bones. Exercises like walking and weight training will help to obtain peak bone mass and will help prevent bone loss. Bone will be lost during long periods of inactivity. An exercise regime should include core exercises which train the muscles in the pelvis, lower back, hip and abdomen to work together. These exercises will provide a solid base of support and allow us to control our movements and stabilize our body weight as we move in different directions. This will lead to better balance and stability in all sports and in performing activities of daily living.
Smoking has been linked to low bone mass and an increased risk for fractures. Smoking is actually an independent risk factor for osteoporosis and inhibits the healing process of fractures and may lead to more complications. Alcohol in excess also results in lower bone density, interferes with calcium absorption and increases the risk for falls. It interferes with calcium absorption and also often replaces calcium rich foods. Excessive alcohol can also decrease estrogen production and increase cortisol (which will decrease bone formation and will increase bone breakdown). People who consume a lot of alcohol also tend to heal more slowly from fractures due to malnutrition.
Genetics play a role in determining peak bone mass and bone architecture and the rate in which bone is lost. If there is a family history of osteoporosis or fractures you really need to screen regularly and to take precautions to attain and maintain healthy bones.
Certain medications will also impact our bones. Corticosteroids over a long period of time will result in the loss of bone and will make the quality of the bones weaker. Other medications that are associated with poor bone quality include seizure medications, thyroid medications, loop diuretics, antidepressants, gastric reflux medications and cancer treatments.
Bone health is impacted by many factors. Ultimately low bone mass and poor bone quality increases our risk for fractures and impairs our ability to heal from fractures. We need to optimize bone mass and strength to reduce the risk for fractures and to improve long term quality of life. Bone health has been neglected as an area for health care concern.
Comprehensive orthopaedic bone health care is important and includes osteoporosis screening, diagnosis, treatment, therapy and education. It is vitally important to promote bone health, reduce fracture risk, accelerate healing and prevent re-fractures. Because every woman’s bone health is different, personalized treatment recommendations based on individual bone density and laboratory testing as well as comprehensive evaluations are important.
Tammy Beckett is an orthopedic nurse practitioner specializing in all areas of bone health care in Western Michigan. When she isn’t working at Orthopedic Associates of Michigan or mentoring college students she can be found in the community volunteering and mentoring children.