Bone up and maintain healthy bones
You may not know this but according to the National Osteoporosis Foundation, osteoporosis is a very common disease. Over 10 million people of all genders in the United States have osteoporosis, and another 44 million have low bone density placing them at risk. Osteoporosis occurs more frequently in CIS gendered female and transfeminine individuals. During menopause, ½ of female-identified people will likely sustain a bone fracture. Yes, that is one-half. The risk of hip fracture, which is the most serious complication of osteoporosis since it can be fatal in 20% of the cases, is equal to the combined risk of getting breast, uterine, and ovarian cancer.
With statistics like this, you would think that everyone is talking about how to prevent osteoporosis. But often the diagnosis of osteoporosis creeps up on us and comes as a surprise. It is never too late to start taking good care of your bones, and the earlier you do, the better the outcome.
Osteoporosis is defined as low bone density caused by the lack of bone production or by increasing bone loss. This makes the bone weak and at risk of injury. In female-identified people, peak bone mass occurs in one’s 20’s and slowly drops after that. There are two major periods when bone loss is accelerated: in the first five years of menopause and more rapidly after the age of 65. During menopause, decreased estrogen is a big culprit of bone loss. Increased stress which causes degradation of bone mass and inflammation is also responsible for bone loss.
Risk factors for osteoporosis include female gender, thin body type, Caucasian and Asian race, family history of osteoporosis, tobacco and alcohol use, poor nutrition, certain medication use, and hormonal imbalances.
Ideally, promoting bone health is a lifelong endeavor. Most of us have learned that the easiest way to protect our bones in later life is to drink milk. Many of us remember having to sit at the dinner table until we emptied an entire glass of milk…..or maybe that was just me. In my family, my parents, who only had the best intentions, were led to believe that cow’s milk was the best source of calcium. When I was brought to the pediatrician multiple times for gastrointestinal issues it never occurred to anyone that milk could have been the offender.
According to Walter Willett, MD, DrPH, and David Ludwig, MD, Ph.D., the health benefits of dairy have not been established. Dairy can increase one’s risks for diabetes and cardiovascular disease as well as allergies and intolerances. Calcium is necessary for bone health, and often that is the take away we get from our health care providers. However, your bones need more than just calcium, they require a holistic approach to stay healthy.
Here are some things you can do to help you improve the strength and health of your bones.
1. Decrease stress
When stressed your body releases the hormone cortisol, which can block bone production and expose your body to more inflammation. Stress reduction is essential for bone health as well as your overall health. Easy to say, hard to embrace. Finding a few moments daily for mindfulness exercises, yoga, time alone, or whatever you need is not a luxury, but a priority.
2. Yes, you do need to get enough calcium in your diet
For women over 51, the recommended dose in the US is 1200 mg/day. I recommend that only half at the very most should come from calcium supplements. Food is your best medicine Non-dairy sources of calcium include chia seeds, canned salmon, tofu, almonds, and white beans to name a few.
3. Get your Vitamin D level checked and supplement if necessary
Adequate levels of vitamin D are necessary to ensure you are absorbing calcium as well as to help reduce the risk of cancer, heart disease, and diabetes. Sources include exposure to sunlight, oily fish, and orange juice, but many people benefit from supplementation due to lifestyles and climate. Too much Vitamin D can lead to complications so testing your levels first is highly recommended.
4. Include other dietary supplements in your arsenal
Magnesium and vitamin K are two more important dietary and nutritional supplements. Other minerals to consider include boron, vitamin C, and zinc. However, before you start indulging in supplements, consult your health care provider to individualize your needs. In addition, a healthy anti-inflammatory diet (the Mediterranean Diet) rich in green leafy vegetables and low in sugar and processed food will help lead to healthier bones.
5. Stop using substances that can weaken your bones
Many medications and other substances can lead to reduced intestinal absorption and metabolism of healthy nutrients causing a negative calcium balance. The growing use of proton pump inhibitors is one of the greatest offenders. Other prescription medications that can harm your bones include glucocorticoids that are often used for asthma as well as some cancer, seizure, and hormonal medications. Alcohol consumption and tobacco use can also impair how well your body promotes healthy bones.
6. Get moving
It is important to be physically active every day and include weight-bearing, resistance, and balance in your routines. Studies have demonstrated that weight-bearing exercise can lead to bone growth and strength. It is important to vary your routine and target different parts of your body, including your core and pelvis! It is best to exercise 45-60 minutes 3 times a week or more for optimal bone health.
7. Avoid falling and hurting yourself
Prevention is worth an ounce of cure. Do what you can to keep your environment free of clutter to decrease the risks of falling. Also, building strength from exercise will help improve your coordination to further increase prevention from falls.
8. Check your FRAX score
The US Preventative Task Force does not recommend bone scans until age 65. This often means that your health care provider may not discuss bone health with you until you are this age. Waiting this long can lead to missed opportunities to improve your health. The Fracture Risk Assessment Tool, or FRAX tool, was developed by the International Osteoporosis Foundation to evaluate fracture risk. You can do this tool yourself, or better yet, with your health care provider to evaluate your risk and to individualize your care.
9. Consider the use of hormones
Estrogen protects bone loss and can be an effective prevention of osteoporosis. Progesterone also promotes bone health. The production of these hormones is vastly decreased during perimenopause and menopause. For women who are younger than 60 or less than 10 years from menopause, hormone therapy with estrogen and progesterone is the most appropriate therapy to slow down bone loss or to treat osteoporosis. Testosterone, DHEA, and cortisol are also hormones that are involved in bone health and can help prevent osteoporosis.
10. Use osteoporosis medications as the absolute last resort
Medications are the conventional treatment of choice for severe osteoporosis. The most commonly used medications include Bisphosphonates and Estrogen Agonists/Antagonists (also called Selective Estrogen Receptor Modulators). Hormone therapy with estrogen and progesterone is another option as discussed above. There are other treatment options available, they all have risks and benefits and it is always best to individualize care and consider what is best for you
Your bones, just like every other part of your body demand love and care. Giving them the attention they deserve in every stage of life will lead to better health and quality of life. I would love to know what you do to keep your bones healthy. Let me know at Lifecycle Women’s Health.
In peace and health,
Susan
Susan Kamin is a certified nurse midwife and a certified sexuality counselor. After many years of helping people give birth and be born, she is now providing personalized integrative well body care at Lifecycle Women's Health in Readfield and Brunswick, Maine. She sees people across the lifespan with a focus on care during midlife/menopause and sexual health. She enjoys sharing her wisdom in the hopes of helping people find pleasure, knowledge, and empowerment in their bodies as they go through all of life's transitions.
