No Bones About It
My kids were measuring themselves the other day and I asked my husband to measure me too. I was so deflated when he told me I was 5’8 ¾”. For my whole life I have been 5’9”. I sighed, “Yet another sign midlife was upon me.” I dislike the thought of something happening to my bones which I can’t see. And the consequences of weak bones are terrifying…my mind immediately went to broken hips, instability, you get the picture.
Up to this point I haven’t given much thought to osteoporosis or bone density. I figured it was something to contend with when I was “old.” But the reality is we should be thinking about our bone health throughout our lives.
Why don’t we talk about this more in our 20s and 30s? Before we reach peak bone density. We should be doing everything we can to ensure our bones are as dense as possible, to protect ourselves in the future.
What is Osteoporosis & Osteopenia?
First, we must understand our bones. “Bone is living tissue that is constantly being broken down and replaced.” The inside of your bones is like a honeycomb and when bone density declines the spaces get larger, weakening the bones. Bone density, also called bone mass, is the amount of minerals in your bones.
Peak bone mass generally occurs in your 30s, after which time you don’t replace bone as fast as it is broken down. “Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.” It cannot be cured, but you can slow or stabilize the loss.
Although both men and women can get osteoporosis, women are 4x more likely to develop it than men! This is because women generally have lower peak bone mass and smaller bones than men. It is estimated “more than 53 million people in the United States either have osteoporosis or are at high risk of developing it.”
With osteoporosis bones become weak and fragile and can fracture or break with the slightest stress or impact. The most common bones affected are hips, wrists, and spine.
Osteopenia, another word you may have come across, is low bone density which puts you at later risk for developing osteoporosis. Having osteopenia does not necessarily mean you will get osteoporosis, but it does mean you should take steps to prevent your bones from becoming more brittle and developing osteoporosis.
Are There Symptoms?
Most people will not experience symptoms like you would for other diseases. According to Healthline some of the earliest indications are receding gums, weak & brittle nails, and weakened grip strength.
The Cleveland Clinic has a slightly longer list and if you notice any of these symptoms you should check in with your doctor.
Loss of height (getting shorter by an inch or more)
Change in posture (stooping or bending forward)
Shortness of breath (smaller lung capacity due to compressed disks)
Bone fractures
Pain in the lower back
Causes of Osteopenia & Osteoporosis
“For many women, the disease begins to develop a year or two before menopause.” Below is a list of other factors which can increase your risk for developing osteopenia and osteoporosis.
Genetics
Having a parent who has osteoporosis or has had a hip fracture.
Age
Everyone’s risk increases with age, especially women after menopause and men after age 70.
Body Size
Slender, thin-boned women and men.
Ethnicity
White and Asian women, particularly after menopause.
Role of Hormones
Low levels of estrogen in women and low levels of testosterone in men.
Diet
A diet, especially in childhood, low in calcium or vitamin D, as well as regular dieting and low protein intake.
Lifestyle
Not exercising, drinking too much, and smoking.
Medical conditions
Thyroid disease, gastrointestinal diseases, rheumatoid arthritis, certain types of cancer and anorexia to name a few.
Medications and Diseases
Certain medications can adversely affect your bones. They can change the relationship between the bone building cells and bone destroying cell, change how each act, or impact calcium absorption. This article by American Bone Health goes into more detail about the effects of different medications in the following categories:
High doses of corticosteroids and thyroid medications
Certain hormone blockers
Some diabetes, antidepressants, and mood stabilizers containing lithium
Some blood thinners, anticoagulants, and loop diuretics
Some anticonvulsants
Tramadol pain relievers
Some antiretroviral therapies for HIV
Certain stomach medicines
Preventing and Treating Osteoporosis & Osteopenia
The best action you can take is to try and prevent osteopenia and osteoporosis! The two main avenues of prevention are diet and exercise. However, if you already have been diagnosed with either, your doctor may prescribe medications to help slow or stop further bone loss.
Diet
You want a balanced diet which includes food rich in minerals like magnesium and calcium. Food high in calcium includes low fat dairy, leafy greens, canned salmon and sardines, and fortified juices & cereal. The RDA for women between 18-50 for calcium is 1000mg and for women over 50 it is 1200mg. The RDA for magnesium for women 19-51 is 310-320mg and for women over 51 320mg.
It is also important to get enough vitamin D and K2 as they help with calcium absorption. The RDA for vitamin D is 600 IU for women up to age 70 (I take 5000 IU and many of the functional medicine people I follow suggest taking higher doses than 600 IU). In addition, moderate alcohol intake and quit smoking.
Exercise
In terms of exercise, focus on strength training and weight bearing exercises like walking, running, jumping, and tennis. Throwing in some exercises which work on balance are also helpful in preventing falls.
Medications
If you have osteopenia or osteoporosis your doctor may prescribe medication in addition to lifestyle changes around diet and exercise.
Commonly prescribed medications to treat osteoporosis and improve bone mineral density fall into 2 categories, antiresorptive (to slow the breakdown of bone) and anabolic (to build bone). Well known medications include Fosamax, Boniva, and Actonel.
These, as with many drugs, are not without side effects. “Common side effects include upset stomach, difficulty swallowing, and heartburn. Rare side effects include bone, eye, joint, and muscle pain, cracks in the femur (thighbone), bone loss in the jaw, and heart rhythm problems.
To determine which of these may be beneficial to you your doctor will factor in your gender, age, medical history, and cost.
How To Check Bone Density Levels
“To check for osteoporosis, your doctor will review your medical history and do a physical exam. They may also run tests of your blood and urine to check for conditions that may cause bone loss.”
Depending on what they conclude, they may suggest a DEXA scan to check bone density levels. This test uses x-rays to measure bone density in your spine, wrists, and hips.
In terms of how often to get checked, the U.S. Preventive Services Task Force recommends:
§ Routine screening for women over age 65.
§ Routine screening begin at age 60 for women at increased risk for osteoporotic fracture.
The National Osteoporosis Foundation additionally recommends screening if:
§ You are a man age 70 or older.
§ You break a bone after age 50.
§ You are a woman of menopausal age with risk factors.
§ You are a postmenopausal woman under age 65 with risk factors.
§ You are a man age 50-69 with risk factors.
I recently had a DEXA scan as I wanted to establish a baseline. I plan to have it checked again in about 10 years assuming nothing significant changes. It is not recommended to redo the test more than every couple of years at most as bone changes do not typically happen that fast and changes may not show up given the margin of error in the DEXA screening.
Parting Thought
After doing research for this article, my personal game plan includes continuing to eat my green leafy vegetables, take a calcium supplement as I generally avoid dairy, and recommit to my strength training routine. While I can live with being 5’8 3/4”, I do not want to shrink anymore!
See you next week…
