Strong, healthy bones are important for all of us as we age. Your skeletal system allows you to bear weight, balance, and generally stay active doing the things you love. Dr. Larry Gassner joins us again for this blog about bone health and what we each need to consider in maintaining bone density and by extension, maintaining the ability to move in all the ways you want to for as long as possible.
Throughout our lives, our bones are constantly recycling bone tissue through osteoclastic activity–osteoclasts dissolve old or damaged bone cells, and osteoblasts create new bone tissue. But as we get older, bone-building activity slows down. And in women, it takes a nosedive, (no) thanks to menopause.
That's why osteoporosis is a condition more commonly seen in women, although men can also develop it. Some folks are more predisposed to osteoporosis due to population genetics: if you're of Northern European or Asian descent, your risk of osteoporosis is greater than someone from Mediterranean or African ancestry. Other medical conditions, like hyperthyroidism in women, can also lead to more advanced osteoporosis.
Why does menopause cause such a drastic drop in osteoblastic activity in women in particular? A lot of bone growth is estrogen dependent, and as anyone who's gone through menopause knows, estrogen essentially goes off a cliff with menopause. Without new bone cells filling in for the damaged and old cells, bone density decreases.
While male menopause isn't a thing, men also experience a decrease in bone density with age, albeit more gradual than women, and it also depends on other medical conditions. For example, men who have undergone prostate cancer treatment often lose testosterone, which can lead to a more rapid onset of osteoporosis.
Osteopenia, Osteoporosis, & Measuring Bone Density
On the way to osteoporosis, you pass through osteopenia, which is reduced bone density that has not yet reached the level of osteoporosis. How do you know when you're losing bone density before you reach osteopenia or osteoporosis levels? Getting your bone density measured periodically over time can help you and your doctor keep an eye on your bone health as you age.
When should you start measuring your bone density? That can depend on several factors, such as family history of osteoporosis and sex. If you're female, menopausal, and your grandmother developed osteoporosis at a relatively early age, you'll probably want to get a baseline measurement sooner than later via a DEXA scan, which uses low dose X-rays to measure how dense your bones are and tell you your 10-year fracture risk.
Most women get a baseline reading around age 50, but if you go through menopause earlier, then you would want to do it then. There isn't really any benefit to checking your bone density while you still have periods, but once perimenopause symptoms begin, you should start thinking about scheduling a scan.
By tracking the rate of bone density loss over time, you can see if your risk of fractures is increasing at a rate that indicates you need more formal treatment. Before formal treatment is needed, calcium, Vitamin D, and exercise are the go-to's for supporting bone health.
Treating Bone Density Loss
Imagine your bone density is like a staircase. You begin at the top of the stairs with a normal bone density, and over time, you take steps down the staircase as bone density decreases. Treatments for bone density loss can't yet reverse the lost density, or in other words, they can't bring you back up to the top of the staircase. However, they can help keep you on the stair you're at when diagnosed, slowing down your descent.
There are a few interventions for bone density loss, but the main one is based on a drug called bisphosphonate, which is shown to strengthen bones and reduce the risk of fracture by slowing down bone remodeling. Another infusion drug is sometimes used for individuals with defined severe osteoporosis which can help speed bone building, but most folks will be recommended to do bisphosphonate treatment once a week or once a month for the rest of their lives.
Some people don't tolerate bisphosphonate as well, so there are other treatment options, such as infusion drugs that can be administered via a subcutaneous injection twice a year. Depending on the severity of bone loss or the number of fractures you've experienced, you may see a bone specialist, an endocrinologist, a rheumatologist, or an osteoporosis specialist to determine the correct course of treatment for your body.
What You Can Do to Support Your Bones
As previously mentioned, calcium, Vitamin D, and exercise are the mainstays for maintaining bone density. To boost your calcium intake, you can take a supplement of 1200 mg/day. For Vitamin D, 800 units/day can be enough, but many of us are deficient. A test can determine whether you need additional supplementation.
For exercise, anything weight-bearing strengthens muscle and bone by applying tension to the bones and stimulates bone tissue production. That can be bodyweight exercises, but adding even just some light weights to your upper extremities is a good idea, too.
What are weight-bearing exercises that support bone health? Walking, hiking, sit-ups, pushups, planks, yoga, tennis, climbing stairs, and running are all examples of weight-bearing exercises. What's not weight-bearing? Swimming and cycling. (Of course, swimming and cycling are still great exercises to do for other health reasons, they just don't help build bone density.)
Why It's Important
Weaker bones are prone to breaks, and osteoporotic fractures are a huge source of disability. They interfere with your ability to live independently and comfortably. The most common osteoporotic fractures are hip fractures or vertebral insufficiency fractures. Hip fractures are very painful and require surgical correction. And if you've seen someone with the so-called "dowager hump", then you've seen how vertebral fractures can make it impossible to stand up straight because the vertebrae have partially collapsed.
When osteoporosis goes undetected, it usually presents itself as a fracture. As we age, we tend to lose stability and are more likely to fall. So the ground really does get harder the older you get, with far greater risk of dramatic consequences from a fall than what you might have experienced in your youth. Kids bounce; when you're older, you go splat.
Osteoporosis can severely decrease your quality of life, and if you begin developing it in your 50s, that can end up being a very long time to be in pain–especially when the average woman lives beyond 85 years now. That's why it's so important for menopausal women especially to get their bone density checked early and consistently so they can take action to slow the development of osteoporosis before it becomes a major problem.
Like a lot of health topics we've discussed on the blog, osteoporosis is an easier condition to prevent than it is to treat. And prevention starts with building and sustaining healthy habits as early as possible to best support healthy aging. And just as it's never too early to live a preventive lifestyle, it's also never too late to change habits and prevent further development of a condition like osteoporosis. So keep an eye on your skeletal status and make conscious choices in support of your bone health each day.
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