Standing Strong: The Six-Step Plan to Bulletproof Your Bones After 50
Bones are the ultimate taken-for-granted body part.
They support us for years without failure or complaint, so we forget . . . they can let us down – fall down.
They support us until . . . one day, they don’t.
You fall and break a spine or wrist, or you fracture a hip.
Furthermore, you can’t see how dense your bones are. They normally FEEL strong. But, over time, they grow weaker.
The older you are, the more at risk you are for osteoporosis (weakening of your bones so they become vulnerable to a fracture.)
Every year, around 319,000 older people suffer from a hip fracture. Within one year of surgery for these fractures, the mortality rate is 14% to 36%.
That’s scary. When older people are forced to remain inactive for long periods, their health deteriorates even when they receive the best of medical care. They’re still not at home taking care of themselves and living their lives as they wish.
Around the world, osteoporosis contributes to millions of fractures. It’s estimated osteoporosis affects 200 million people globally. According to the National Osteoporosis Foundation, osteoporosis affects around 54 million Americans.
Yet, 84% of older Americans who suffer a bone fracture are not tested or treated for osteoporosis.
The good news is, you CAN improve your bone health.
No matter what your age, you can greatly reduce your risk of suffering a bone fracture.
It takes just SIX steps – six healthy, no or low cost changes to your lifestyle.
But, first . . . what is osteoporosis?
Osteoporosis and Osteopenia
Osteopenia is the loss of bone mass.
So, what’s different about osteopenia?
Osteopenia and osteoporosis are closely related. Osteopenia is the loss of bone mass before it progresses to a diagnosis of osteoporosis.
In effect, osteopenia is the bone mass and mineral loss equivalent of pre-diabetes. Pre-diabetes means your blood sugar is too high, but not high enough (yet) to meet the definition of diabetes. It’s a warning to change your lifestyle so your blood sugar doesn’t get worse.
If you’re diagnosed with osteopenia, you’re losing bone mass and need to stop it before it progresses to osteoporosis.
For all practical purposes, I’ll generally refer to osteoporosis – loss of bone mass and bone mineral density.
Men Beware Too
Osteoporosis affects more women than men, so women are well-aware of the risk.
But too many men ignore the danger to their, so they don’t take action to reduce it.
Yet men suffer one-third of all hip fractures.
For 50-year-old white men, for instance, the lifetime risk for an osteoporotic fracture is 13%.
For white women that age, it’s 40%.
Clearly, women are at higher risk, but men are not safe. 13% may sound low, but that’s one out of every seven or eight older men.
That 50-year-old man is at greater lifetime risk of an osteoporotic hip fracture than prostate cancer.
Even though he’s probably more afraid of the cancer than the fracture.
But . . . bones are so hard. If we’re losing bone mass, how can we change that?
Your Bones are Dynamic, Ever-Changing, Living Tissue
Yes, hard – but tissue.
Just as much as your lungs and muscles.
We tend to think of our bones as solid, unchanging mineral – like a pipe, only full of calcium instead of iron.
You may be confused because you think your bones – the ones now in your own body – are just like the bones you’ve seen pictures of, or in real life. We’re most likely to have seen fossilized bones rather than actual bone remains.
Therefore, you may wonder how bones lose density. How and why do they lose calcium and other minerals?
Living bones are far from a calcium version of a pipe. They’re complicated organs. They have many functions besides holding our bodies up (though that’s most important.)
Also called osseous tissue, bones are glorified, specialized connective tissue. They’re organized as a matrix, like honeycomb – not just a rock of solid calcium.
This matrix of bone tissue contains two components:
1. Ossein – which is mainly collagen fibers that are flexible. That’s 90% to 95%.
2. Various mineral salts.
Mineralized bone tissue contains two types: cortical bone and cancellous bone.
Bones also contain bone marrow, blood vessels, nerves and cartilage.
Around 30% of your bone consists of the flexible matrix. The other 70% is the minerals bound to the matrix. This design enables your bones to be strong and hard, but still relatively lightweight.
The matrix of your bones consists of 90% to 95% collagen fibers – the ossein. The remainder is ground substance. Collagen is the connective tissue that comprises most of your skin and your tendons. Because it’s tough but not hard, it provides some cushioning to protect the bone from fractures caused by force.
An inorganic mineral salt, calcium phosphate, binds to the matrix. This forms bone mineral, a form of calcium apatite.
Besides calcium and phosphate, your bones contain the trace minerals magnesium, sodium and potassium.
Some of your bones contain bone marrow, which produces red and white blood cells. That alone tells you they’re a lot more than calciumated iron pipes.
Your bone marrow produces blood cells from hematopoietic stem cells. It also holds mesenchymal stem cells, which grow into bone and connective tissue.
Bone marrow needs oxygen and nutrients, so blood vessels run through your marrow.
Clearly, bones are more complicated than we realize.
But why do they weaken with time, and how is it possible to slow down – or maybe even reverse – that loss of bone mineral density?
Your bones are dynamic living tissue – that constantly change.
The Continual Osteoblast / Osteoclast Teeter-Totter – Mediated by Osteocytes
Your bones are not just hard but living tissue, they’re active living tissue.
We like to think of them as this permanent hard stuff that keeps us from being a puddle of blood and guts on the floor, but they are no more passive than other parts of your body.
That’s great. Our bones change constantly, giving us hope to slow down or reduce the reduction in bone density that comes with increasing age.
It works like this:
The three major bone cell types are:
1. Osteoblasts
2. Osteocytes
3. Osteoclasts
(It’s easy to confuse all the “osteo”s while reading or writing about bones, so I’ll use blasts, cytes and clasts instead.)
Blasts are the bone builders. They produce osteoid, a protein mixture (mostly Type 1 collagen) which becomes bone when mineralized.
Blasts produce collagen fibers around themselves. The collagen fibers act as a framework, like scaffolding. Blasts then deposit calcium phosphate, which hardens using hydroxide and bicarbonate ions.
Blasts can’t produce new bone for long, however, because they build it around themselves. Once it’s built, they remain trapped inside the new bone they just created – like medieval prisoners plastering their own brick walls to die behind.
Except, these blasts then turn into cytes.
Cytes are the most numerous kind of bone cells.
Cytes remain in communication both with the remaining blasts, with other cytes and with clasts.
Their job is to tell the other bone cells about the mechanical stresses the bone is under. This helps regulate the formation of new bones and the resorption of older bone tissue, to balance and maintain bone strength.
This is crucial when your bone tissue has suffered small microdamage. Cytes begin the process of repairing small problems in your bones before they become major.
Cytes also help regulate the metabolism of phosphate, and influence your kidneys and parathyroid glands.
Managing Your Stores of Calcium
Clasts break your bones down – a process called resorption.
That is, cytes break bone tissue down by secreting acids (such as hydrochloric) and enzymes (such as cathepsin K and other proteases) to dissolve both the minerals and organic bone components.
This releases calcium into your blood, to maintain the optimal balance of calcium in your body – calcium hormesis.
Bones are not the only parts of your body that require calcium. Your blood and other body fluids need a certain stable level of calcium to function.
Your muscles need calcium to contract. A deficiency can cause weakness and cramps.
Your nerves need calcium to transmit signals, so a deficiency affects neuron communications.
Your blood needs enough calcium to clot if necessary.
Also, by removing old and damaged bone tissue, cytes make room for blasts to build new, stronger bone tissue.
Therefore, when your blood level of calcium drops, parathyroid hormone is released, and this stimulates clasts to break down bone tissue to release more calcium.
Your blasts continually make new bone tissue.
After creating what bone they can, blasts turn into cytes – and help regulate the entire process.
Your clasts break bone tissue down.
Key Points
1. Blasts are continually repairing and rebuilding your bone tissue so it’s new.
2. Clasts are continually breaking down old and damaged bone tissue. This creates room for new bone tissue – and frees up calcium.
3. Your body treats your bones as a sort of checking account for calcium. It withdraws calcium from bone to supply your blood, nerves and muscles. It continually deposits both calcium freed up by resorption and calcium consumed in food.
Bone Remodeling
The back-and-forth processes of clasts breaking down bone tissue (resorption) and blasts creating new bone tissue (ossification) is called bone remodeling.
Like some people continually remodel their homes, the clasts and blasts work on your bones.
Your needs change over time, of course. In the first year of life, babies remodel almost all of their bones. This drastic remodeling continues through childhood. Obviously, a child’s skeleton has to adapt and grow along with their entire body.
Once we’re adults, about 10% of our bones turn over every year.
If you break a bone, obviously it will need a lot more blasts than clasts, to repair the damage.
Although we don’t see it or generally feel it, your bones also suffer microdamage just from living life. That too must be repaired.
Also, remember, the cytes respond to the mechanical forces operating on your bones – again, just from your physical movements and stresses.
Therefore, they help mediate the balance between bone breakdown or resorption and ossification, the formation of new bone tissue.
Of course, the process gets quite complicated. Other factors include the availability of an adequate supply of calcium, parathyroid hormone, Vitamin D, growth hormone, calcitonin and steroids.
It’s important to note: bone remodeling is a daily, continuous process. It’s not a fix some damage every week or so. It’s always happening.
Ideally, resorption and ossification remain in balance throughout your adult life. Clearly, you want old bone tissue replaced with the same amount of new bone tissue, plus whatever extra is needed to repair microdamage or actual fractures.
However, sometimes, especially as we age, the clasts break down more bone tissue than the blasts create.
Over time, this imbalance reduces bone mineral density, weakening your bones and making them more vulnerable to fractures.
That’s osteoporosis.
Pretend You Already Have Osteoporosis – You Probably Do, to Some Extent
You can’t see your bones get thinner, as you can see yourself losing muscle tissue as you age.
But that doesn’t mean your bones are at optimal strength.
Like so many of the chronic conditions of old age, osteoporosis comes on gradually. It gets worse for years until your hip finally snaps.
Osteoporosis Risk is Largely Lifestyle Based
Genetics can play a role, but it’s small. According to the Swedish Twin Registry (the largest in the world), less than 30% of osteoporosis is inherited.
Also, excessive bone loss and hip fracture rates vary enormously around the world. If osteoporosis affected everybody uniformly as we aged, the case numbers would not vary so much by geography.
The United States and Northern Europe have some of the highest rates of hip fractures in the world.
One study found hip fractures in 197 per 100,000 American men – and 553 per 100,000 American women.
Information for hip fracture rates in Africa is hard to find – because it’s such a rare condition. 43.7 per 100,000 men. 57.1 per 100,000 women.
That means African women suffer only 10% of the hip fractures American women do.
All Bone Fractures Pose a Longterm Health Risk
Osteoporosis not only causes bone fractures, it creates pain, making it harder for older people to perform their daily activities.
Very often, people with fractures must spend time in an institution. And institutionalization itself often damages health, reducing people’s ability to live by themselves. This often results in depression and a lower quality of life.
If a woman over age 60 suffers a hip fracture, her odds of dying within a year are 50-50. Small wonder women worry about how much calcium they consume.
Diagnosing Osteoporosis
Because of the nature of our bones, this is difficult unless someone is suffering from related pain and weakness.
Usually, there’re no symptoms until someone breaks a bone.
That’s why I say: assume you have it.
Not in a fear-based way. But to motivate yourself to establish healthy, bone-strong lifestyle habits that will help your skeleton remain strong and mighty until the end.
If your doctor believes you may be at risk of osteopenia or osteoporosis, they may review your lifestyle, medical factors, family history and risk factors.
Risk Factors for Osteoporosis
* Age (50 on up)
* Sex (more women get it than men, but men get it too)
* Small stature (underweight people are more at risk than overweight people)
* Caucasian or Asian race
* Family history
* Medical conditions, including rheumatoid arthritis and hormone imbalances
* Smoking (increases lifetime risk of bone fracture by 50% – and impairs the healing of broken bones)
* Drinking more than two adult beverages per day
* Women after menopause
* Men with lowered testosterone
* Oxidative stress – damage from free radicals
* Inflammation
Medical Conditions that Lower Bone Density or Increase Osteoporosis Risk
* Calcium deficiency
* Hyperthyroidism
* Malnutrition
* Diabetes
* Anorexia and other eating disorders
* Chronic kidney disease (CKD)
* Vitamin D deficiency
* Autoimmune diseases that can affect your bones, such as rheumatoid arthritis
* Such hormone imbalances as Cushing syndrome
Certain Medications Increase Osteoporosis Risk
* Anticoagulants
* Diuretics
* Seizure medications
* Some immunosuppressants
* Corticosteroids
* Proton pump inhibitors (they affect calcium absorption)
The PPIs are sold over the counter for heartburn – acid stomach. These include: Protonix, AcipHex, Prilosec, Nexium and Prevacid. They’re some of the most popular over the counters sold worldwide. Dozens of studies – with over 2 million participants – show they raise hip fracture risk.
* Hormonal cancer treatments
* Heparin (a blood thinner)
Clearly, the only way to escape all risk of osteoporosis is to live a healthy life until you turn 50, then die.
Not a desirable solution.
Sooner or later, we all hope, we’ll reach 50.
Thereafter, assume – in an emotionally nice way – you have osteoporosis.
The One Test for Osteoporosis
That’s (Dual-Energy X-ray Absorptiometry) – better known as DXA or DEXA scan.
They often get called bone density tests or bone density scans.
They use x-rays to measure the density of your bone mass.
You lie on a padded table for about fifteen to thirty minutes while they pass low-dose x-rays over your spine or hip. They may also scan other bones.
They then measure how much radiation your bones absorbed, which shows their density and their mineral content.
The U.S. Preventative Services Task Force (USPSTF) recommends osteoporosis screening for all women 65 and over. They also include younger women who are postmenopausal, have a family history of hip fractures, smoke, consume excessive adult beverages or have a low body weight.
People Who Most Need a DEXA Scan
* Women over 65
* Men over 70
* People with a parental or grandparental history of osteoporosis
* People who’ve lost 1.5+ inches off their tallest height
* People over 50 who have ever broken a bone
These are general guideliness. Your doctor may or may not wish to have you undergo a DEXA scan, depending on your particular factors.
DEXA Scan Dangers
No medical procedure comes risk-free.
1. DEXA scans employ low levels of ionizing radiation – x-rays.
X-rays can cause cancer. This risk, however, is minimal as long as you receive minimal x-rays over your lifetime.
Therefore, doctors and dentists order x-rays only when the benefit (such as seeing where you fractured your arm) outweighs the risk of harm.
Therefore, DEXA scans are “safe” only when a doctor believes the benefit of measuring your bone density outweighs the small cancer risk. That risk is small only because doctors these days realize the potential harm of radiation, and use x-rays only when required.
2. Allergic reactions
DEXA scans use a dye for contrast. A few people – especially those allergic to shellfish or iodine – are allergic to that dye.
3. Incorrect results
Such factors as muscle composition and body fat can throw off the results.
That’s why I’m saying, don’t wait for a DEXA scan. Assume you have osteoporosis or, at least, osteopenia, and follow the bone-healthy lifestyle plan.
Other Issues with DEXA Scans
Pregnant women should not have them, obviously so as not to expose the fetus to radiation.
If you have any doubts, discuss them with your doctor.
DEXA Scan Results
The medical profession measures your bone density as a T score.
T = 0 is defined as the average bone density of 30-year old white women.
Your T score compares your bone density to that ideal.
A positive T score means your bones are even denser than that average 30-year old white woman. Congratulations!
Most T scores are negative – below the ideal.
A T score of from -1 to 0 is still considered healthy.
A T score of from -1 and -2.5 means you have osteopenia. (Remember, that’s bone loss that hasn’t yet hit the danger level of osteporosis.)
A T score of over -2.5 means osteoporosis
Clearly, if you’re below -1, you need to improve your bone-related lifestyle before you suffer a dangerous fracture.
What About Osteoporosis Medications?
Such as Fosamax.
These are the go-to for treating osteoporosis. Their classification is biphosphonates (BP).
These BP medications reduce the activity of the clasts, reducing loss of bone mass.
They’re best at reducing one certain kind of vertebrae fracture in women. However, the absolute risk reduction is just 1.4%. In other words, to prevent one woman from having one of those fractures, the medication must be taken by 71 women. The other women are at the same risk of side effects, but receive no real benefit.
The big problem is, of course, that there’s no way of knowing in advance which one woman will benefit, and which 70 women will pay for nothing.
Therefore, to cover patients as best they can, doctors prescribe to all the patients who meet the guidelines.
Even more discouraging, these medications do not prevent the most dangerous type of bone break – hip fractures.
If you’ve never had a hip fracture, these medications don’t appear to help prevent them.
However, if you’ve already had a hip fracture, your normal risk of having another one doubles – and these pharmaceuticals do help prevent second ones, but only by a small amount. Try 91 people taking it for three years – to prevent one hip fracture.
Consequently, some experts suggest these medications do little to reduce overall mortality from osteoporosis.
How risky are these biphosphonates?
Some time back, the news broke they have two serious side effects: osteonecrosis (rotting) of the jaw and atypical femur (thigh) fractures.
The biggest bone in your body, the femur just breaks in half while you’re standing or walking or doing some other ordinary activity.
The rate of osteonecrosis is around one in 1,000 patients, so the benefit may outweigh the risk.
However, the rate of patients with femur fractures is around one in 300 patients taking the medication for three years.
The explanation for this ironical side-effect is that, in reducing activity of the clasts, the medication in effect “freezes” the entire resorption/ossification remodeling process – throughout your body.
This allows for microfractures to accumulate over time, leading to stress or fatigue fractures.
Yet – this must be said – these medications do prevent more hip fractures than they break thighs. However, the more years you’re on them, the more the ratio goes down.
What About Calcium Supplements?
Just a few decades ago, the medical community advised older women to take calcium supplements.
However, that has changed. The U.S. Preventive Services Task Force, and other groups advising on bone health, now tell women do NOT supplement with calcium.
What changed? Researchers carried out studies of women to find how that might affect their heart health. They fully expected to discover that women who supplemented with calcium had less risk of heart attack.
But scientific experiments don’t always turn out as expected.
Women who took calcium supplements had INCREASED risk of heart attack and stroke.
Whatever benefit the calcium may have given the women, it wasn’t worth the risk.
After all, as bad as hip fractures are, heart attacks and strokes are even worse.
When you take a calcium supplement – unlike simply eating calcium-rich foods – the mineral spikes in your blood, making your blood too thick. And that lasts up to eight hours. Thick blood results in more heart attacks and strokes.
Do calcium supplements – even if they cause heart attacks and strokes – at least prevent hip fractures?
For Preventing Hip Fracture Risk, All Calcium Intake – From Food and Supplements – is Overrated
Unless you’re literally starving, or eating so much junk food your dietary calcium intake is no more than about 500 milligrams, you get enough calcium from your diet.
That sounds counter-intuitive. Your bones are mostly calcium. When your blasts need to build new bone tissue, they need calcium.
If your bones are brick houses, calcium is the bricks.
When a construction contractor runs out of bricks, construction on a new house stops.
But, it turns out, most of us do eat enough calcium to keep our blasts on the job building and repairing our bones.
Our bodies understand how to balance, manage and regulate the calcium we eat in food. When your body needs more calcium – whether for bone health, nerve function or muscle movement – it absorbs more of what it digests, and excretes less. When we eat more calcium than we need, we simply excrete more.
Again, unless you really are malnourished, your body maintains calcium hormesis.
Besides, taking calcium supplements not only increases risk of heart attack and stroke, it doesn’t even prevent hip fractures. Even worse, studies have found taking calcium supplements may increase risk of a hip fracture by up to 64%.
They do see a 10% overall reduction in fractures. That’s desirable, but not worth a heart attack or stroke.
How did doctors get it so wrong?
The initial 1992 study that found calcium supplementation was effective was done on older women in such institutions as nursing homes. The women didn’t get outside, so they didn’t get sunlight. So they were all deficient in Vitamin D.
When the original researchers gave these women calcium supplements, they also included Vitamin D. That’s why their bone health improved over the placebo group who remained deficient in Vitamin D.
In another study, researchers gave nursing home residents either calcium supplements or exposure to sunlight. The group taking calcium supplements saw an increase in all-cause mortality.
So . . . What About Vitamin D?
We’ve known for hundreds of years that Vitamin D deficiency shrinks both bones and muscle.
As we age, our muscles lose Vitamin D receptors. This partially accounts for age-related muscle loss.
Loss of muscle tissue makes us weaker. Weakness makes us more vulnerable to falls.
And falls, of course, break bones. And bones suffering osteoporosis break more easily.
Therefore, levels of Vitamin D in the elderly are highly correlated with the risk of falling and suffering broken bones.
Vitamin D supplements improve general muscle strength, especially in your quadriceps, the large muscles in the front of your thighs. Vitamin D also seems to improve balance, which obviously is good for preventing falls.
Therefore, the U.S. Preventive Services Task Force and the American Geriatric Society recommend that people at high risk of falling take Vitamin D supplements.
But, how much Vitamin D?
First, avoid megadoses. Some doctors have provided patients with Vitamin D shots – huge amounts such as 500,000 IU injected at one time. Because Vitamin D is a fat soluble vitamin, it hangs around in your body, gradually going down over time. 500,000 IU is enough to last a year.
This is convenient, but hardly “natural.” And, in the first three months, fall and fracture risk actually increase by 30%. Not what we want.
Also, megadoses of Vitamin D may damage your muscle tissues.
Therefore, much smaller doses of Vitamin D taken on a daily or so basis work much better.
But, again, how much?
Studies have tested people taking daily amounts that were small (400 or 800 IU), medium (1,600, 2400 or 3,200 IU) or high (4,000 or 4,800 IU).
The women taking Vitamin D in the middle ranges were much less likely to fall than the ones who take either the small or high doses.
What About Milk?
It does contain calcium, and consuming dairy products can increase your bone density, but at a high cost.
Several large studies involving hundreds of thousands of people have found that high consumption of milk actually increases bone and hip and fracture risk – and all-cause mortality by 11%.
This helps explain why hip fracture rates in Northern European countries are significantly higher than in many countries where people don’t drink milk after childhood because they’re lactose intolerant. Their main source of calcium is green leafy vegetables, not dairy products.
Lifestyle Steps to Less Osteoporosis and Fewer Fractures
1. Diet
A. Eat to multiply the blasts and downsize the clasts.
We’ve known for years that acid-forming foods such as meat are highly correlated with osteoporosis and hip fracture risk.
We used to believe that’s because our kidneys pulled calcium from our bones to buffer the extra acid caused by such foods.
However, we’ve since learned that our kidneys first use calcium digested from food. However, if that’s not enough, they may turn to bone for the calcium they need to neutralize the acid.
Also, many acid-forming foods contain saturated fat. One common one, palmitic acid, kills bone-building blast cells in a petri dish. Plus, we’ve found that a high intake of saturated fat is significantly correlated with increases in risk of hip fractures.
With age, our kidneys lose some of their ability to excrete acid. That leads to our blood gradually becoming more acidic – having a lower pH.
That activates the bone-resorping clasts and inhibits the bone-building blasts – exactly the opposite of what we want.
However, scientists found we can reverse this.
When they removed anti-acid (alkaline) foods – fruits and vegetables – from the diets of the study participants, a marker of bone ossification (new bone) – dropped. That’s bone-specific alkaline phosphatase. At the same time, a marker of bone resorption – carboxyterminal cross-linking telopeptide – went up.
Again, that’s what we do NOT want.
We want bone ossification UP and bone resorption DOWN.
The researchers achieved this by giving study participants six cups of fruits and vegetables every day.
Remember – whole plant-based foods are alkaline-forming.
We’ve found that in people 65 and over, the higher the ratio of acid-forming foods to alkaline-forming foods, the greater the risk of hip fractures.
2. Eat six to nine servings daily of fruits and vegetables.
B. Eat to decrease inflammation and oxidative damage.
Postmenopausal women with osteoporosis usually have more damage from free radicals and fewer antioxidants in their bodies than women with healthy bones.
Inflammation and oxidative damage, therefore, are probably two more important reasons eating more fruits and vegetables decreases fracture risk.
Fruits and vegetables also come with Vitamin C. Consumption of Vitamin C-rich foods is also associated with lower risk of osteoporosis. For every 50 mg of Vitamin C you eat in a day (about one orange), you get a 5% lower risk of hip fracture.
Yes, in effect, this repeats #A above – but for different (though related) reasons.
3. Eat six to nine servings daily of fruits and vegetables.
C. Drink to lower osteoporosis risk.
Having one adult drink per day is considered mild by many, but those people have a 34% increased risk of osteoporosis compared to abstainers. Two drinks per day raises that risk to 63%. Part of the risk comes from the beverages themselves. Part of the risk no doubt comes from an increased risk of falls because of impaired balance and coordination.
Many sodas and other snack drinks deplete calcium loss via your urine.
Three or more cups of coffee doubles hip fracture risk.
However, regular consumption of tea lowers fracture risk.
4. Replace adult beverages, soda and coffee, with tea.
D. Eat and drink to make up for age-related loss of estrogen.
Notice that a lot of osteoporosis risk is for postmenopausal women. That is, women whose bodies are not making the estrogen they used to.
At one time, doctors gave postmenopausal women hormone replacement therapy (HRT) to increase their estrogen levels. And HRT did indeed improve their bone health.
Unfortunately, HRT also increased risk of blood clots and breast cancer.
Fortunately, however, there’s a way women can receive the benefits of higher estrogen without the blood clots and breast cancer.
Phytoestrogens.
Soy beans contain genistein, a compound that’s so structurally similar to estrogen, it occupies estrogen receptors in your body.
The result? Women who eat soy improve their bone mineral density with NO risk of blood clots or breast cancer.
In fact, soymilk reduces risk of breast cancer, lowers inflammation, improves gut health and cuts DNA damage.
(NOTE TO MEN: soymilk also reduces risk of prostate cancer, so you benefit too.)
In a 2020 meta-analysis of over 60 randomized controlled trials, postmenopausal women who consumed soy significantly increased their bone mineral density.
In one study that lasted two years, the group of women drinking two glasses of soymilk every day had MORE bone at the end of the two years than at the beginning.
A single daily serving of soy lowers fracture risk in women by 20% to 50%.
5. Eat more soy foods.
E. Get more Vitamin D.
Osteoporosis is usually not caused by a calcium deficiency – not under normal conditions.
However, your body needs adequate Vitamin D to manage that calcium. Therefore, low levels of Vitamin D are associated with osteoporosis.
Spend some time outside in the sunlight. (Just don’t get so much sun you get burned.)
Strong sunlight is not available every day to most of us, so supplements are more dependable.
There’s no one set dosage, but a mid-range of 1,000 to 3,500 IU as a daily average seems to work best to prevent osteoporosis.
6. Get sunlight and take Vitamin D supplements.
F. Exercise to encourage your bones to maintain strong density.
Remember cytes? Those are the blasts who’ve walled themselves up in your bones. They monitor the pressure on your bones, and direct blasts and clasts to build new bone or destroy old bone in response to that pressure.
That means the best thing you can do to maintain bone mineral density is to apply regular pressure on the cytes.
Your body’s own weight is one of those pressures. Underweight people are at higher risk of osteoporosis simply because their bones don’t have to support extra pounds. That’s why only 1% of obese people have osteoporosis. For their bones, every move they make is weight-bearing exercise.
That’s also why astronauts in a weightless environment lose 1% of their bone mass every month.
Therefore, the simplest and most direct way to increase your bone mineral density is to force your bones to respond to more pressure/weight/resistance.
That means physical activity.
That means weightbearing exercise – recommended by the National Osteoporosis Foundation, International Osteoporosis Foundation and others.
The basic idea is to stress your bones enough to get the attention of those cytes, so they speed up the bone-building of the blasts and slow down the bone dissolving of the clasts.
Therefore, they include both high impact activities such as running, jumping and aerobics.
Walking, bodyweight exercises and weight training also help, and they’re low impact.
Intensity counts. Most low intensity activity fails to stimulate your bones to grow. You need moderate to high intensity.
Therefore, unfortunately, regular walking – although healthy in many ways – does little to prevent or reverse osteoporosis.
What does work: making walking more intense. That could mean:
* Brisk walking – at least 75% effort.
* Wearing a weighted vest.
* Carrying out other forms of exercise during the walk, such as step climbing and jogging.
Activities with no impact, such as cycling and swimming, have little to no effect on bone mineral density.
Frequency also matters. In one study, participants hopped on one foot every day for six months. The other foot acted as the control group. The hip above the foot that took the impact gained strength, but not the control hip.
However, people who hopped on one foot less than seven days a week saw no improvement. Yet, when the subjects wore a 10-pound weighted vest, three times a week improved their bone mineral density.
My suggestion: hop on both feet every day. Simply perform the exercise Jack LaLanne invented: jumping jacks.
WARNING: High impact, weightbearing exercises may not be suitable for people who already have severe osteoporosis, a history of recent fractures or osteoarthritis.
Check with your doctor first.
7. Perform more weightbearing exercise: more often and more intensely.
G. Don’t fall.
The primary cause of bone fractures – with or without osteoporosis – is falling.
It is possible for someone with severe osteoporosis to break their hip just from walking or twisting or bending. However, that accounts for just 15% of hip fractures in women 65 and older.
The other 85% of fractures could have been prevented simply by not falling.
That helps to account for why older women suffer more fractures than older men. Women fall more often. Perhaps that’s due to less muscle strength in their legs, less muscle strength in their arms (to catch themselves from falling) and from having a worse sense of balance.
Over one-third of people over 65 years old fall every year.
Obviously, everyone should follow the general, commonsense advice to watch where you’re going, to keep their home free from junk on the floor, to have adequate night lighting, to place nonslip mats in your bathroom and grab bars in the tub, to get rid of throw rugs and so on.
Don’t step onto ladders either.
But fall risk is also related to muscle strength.
According to 81 separate randomized controlled trials, the participants who exercised reduced their falls by 23%.
Tai Chi reduces falls by 19%. Balance and functional exercises reduce them by 24%.
Adding strength training to balance and functional exercises reduces them by 34%.
The physical activity that helps you prevent falls is therefore a little more complicated than the weightbearing exercises. Your goal is not to influence the cytes to build more bone, but to improve your capacity to remain on your feet.
That requires strength in your legs for greater coordination while walking or encountering an obstacle. You also need greater arm strength to catch yourself when you feel yourself starting to fall. And it requires balance.
The Get Up and Go Test
How high is your risk for falls? Here’s an easy way to find out.
You start out sitting in a chair. Stand up, walk 10 feet, turn around, return to your chair and sit back down.
If that takes you longer than 10 seconds, you’re at high risk of falling.
8. Avoid falls
References:
https://nutritionfacts.org/video/are-calcium-supplements-safe/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3004072/
https://hms.harvard.edu/news/study-hip-fracture-burden-nearly-double-worldwide-2050
https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/bone-basics/are-you-at-risk/
https://www.ncoa.org/article/get-the-facts-on-osteoporosis-falls-and-broken-bones/
https://my.clevelandclinic.org/health/diseases/21855-osteopenia
https://my.clevelandclinic.org/health/diagnostics/10683-dexa-dxa-scan-bone-density-test
https://en.wikipedia.org/wiki/Bone
https://en.wikipedia.org/wiki/Bone_remodeling
https://nutritionfacts.org/hnta-video/how-well-do-medicines-like-fosamax-work-to-treat-osteoporosis/
https://nutritionfacts.org/hnta-video/side-effects-of-osteoporosis-medications-like-fosamax-boniva-and-reclast/
https://nutritionfacts.org/video/prunes-for-osteoporosis/
https://nutritionfacts.org/hnta-video/onions-and-tomatoes-put-to-the-test-for-osteoporosis/
https://nutritionfacts.org/video/almonds-for-osteoporosis/
https://nutritionfacts.org/video/is-soy-milk-the-most-nutritious-non-dairy-milk/
https://nutritionfacts.org/video/do-vegans-have-lower-bone-mineral-density-and-higher-risk-of-osteoporosis/
https://nutritionfacts.org/hnta-video/the-best-exercise-type-and-frequency-for-bone-density/