If you can increase bone density, you might be not threatened by one of the sneakiest diseases lurking at our old age. The skeleton, along with the muscles and tendons that are attached to it, keep us upright and allows us to move. Unfortunately, bones may become brittle, which means they can break more easily. Osteoporosis develops slowly, with little or no symptoms at all, and a person may be unaware of having it, until a very surprising fracture or break in the (most commonly) hip, wrist or spine after what seems to be a harmless little fall, or a misstep. Sometimes even a cough or sneeze can cause a break in fragile bones in advanced stages. So, you’ll agree it can be useful to learn how to build bone density after 50.
It is much more common in women, though, than in men, because male skeletons are larger, they typically have piled up more bone mass than women, their bone loss starts much later and progresses in a slower pace. They also do not have a period of rapid hormonal change and bone loss, as women do after menopause.
There are two main types of osteoporosis: primary, where it is caused by age-related bone loss or the cause can’t be determined and secondary, where it is caused by certain unhealthy lifestyle behaviors, diseases, or medications.
Why is it happening, and why mostly at old age?
Our body rejuvenates completely every 7-15 years. Some parts faster, some slower. Cells in the skeletal system regenerate almost constantly, but the whole process of them being replaced completely takes about 10 years. There are bone cells (osteoclasts) that break down older or damaged bone into calcium and other minerals, which are released into the bloodstream, for further reuse in other body parts. Other cells (osteoblasts) lay down new bone tissue in place of the decomposed one, in the same quantity. How come then, that our bones become fragile?
The coordination between the two process is mostly good when you are young. As early as your early-30s however, this balance is disturbed, as your body starts to decompose slightly more bone tissue than it is capable of rebuilding. The holes inside the bone, which resemble a honeycomb, become larger and the density of the bone decreases. This disbalance intensifies in the coming decades and finally, the bones become more prone to breakage, even with the smallest effort.
The progress of the condition can be slowed down, but not completely reversed. According to International Osteoporosis Foundation, around the world, 1 in 3 women and 1 in 5 men aged fifty years or over are at risk of an osteoporotic fracture. Also, it is estimated that every 3 seconds somewhere, someone suffers such fracture.
The sad statistics further says one fifth of the patients with hip fracture, caused by fall with osteoporosis, will die within a year, half of them will be left with permanent disability and a quarter of them will need permanent nursing care.
So, preventing falls should be an equally important task as healthy diet and exercising. Most falls are predisposed by unsteady gait, visual impairment, hearing impairment, medications sometimes. Addressing these issues can significantly lower the risk of falling. Modification of our immediate surroundings should also be taken into consideration.
Who is in greater risk
-women with low estrogen levels, already after 55, or even earlier if their menopause started before they turned 45,
-male after 70, or earlier with a low testosterone level
-low body weight persons
-small-boned, petite persons, because there’s less bone to start with
-physically inactive persons
-someone who have poor nutrition and poor general health
-persons who excessively use alcohol
-someone with a family history of osteoporosis
-a Caucasian or Asian female, as research shows
-white men appear to be at somewhat higher risk than others
-cancer, stroke, chronic kidney or other hormone levels altering diseases suffering
-long term users of certain medications, which can initiate bone thinning
-some hormonal diseases, as hyperthyroidism and hyperparathyroidism
-chronic lack of calcium and/or vitamin D
How can you prevent bone loss
There is a painless and accurate test that can determine how healthy our bones actually are and before problems with osteoporosis begin. BMD, a bone mineral density test is in fact done by X-rays that use very small amounts of radiation to determine bone strength. It is recommended for women age 65 and older, women and men with numerous risk factors, menopausal women who have had fractures, men and women who suffered sudden loss of height or change in posture, a fracture, or sudden back pain.
After your 50s, you might already be in transition between healthy and osteoporotic bones. This condition is called osteopenia. At this stage, you still may help a great deal and increase the density of your bones by following a healthy diet, making sure you consume enough calcium and exercising regularly.
The management of osteoporosis should consist of improving bone health by healthy nutrition, increase bone density by adequate exercising, by calcium and vitamin D supplements, and reducing risks of fall.
You should take the following steps to preserve your bone health:
- If you are a woman aged 65 years or above or a men aged 70 years or above, schedule a BMD testing. Do this also, if you are at higher risk of osteoporosis than normal, even if you are not in that age yet.
- Check for secondary causes of osteoporosis. Pay attention and keep under control any underlying medical conditions that affects bone density.
- Discuss with your doctor the possible replacement of medications that are known to cause bone loss in the long run.
- Stop smoking, if you haven’t yet
- Reduce alcohol intake
- Try to increase the level of your physical activity during the day (take the steps instead of the elevator, park further from the entrance, go for a walk instead of driving to the local grocery store for some milk…)
- Your body needs calcium to maintain strong bones, and it needs vitamin D to absorb calcium. Make sure you have an adequate daily calcium intake, and a good exposure to sun.
- Exercise regularly. Include posture improving, strength improving, or weight bearing, flexibility- and balance improving exercises. Again, I can’t emphasize enough the importance of a doctor ‘s evaluation of the exercises for anyone already diagnosed with osteoporosis, or even osteopenia. There are many that are not helping, but rather increasing the risk of fracture.
Still, there are some exercises you may safely start doing,
like weight-bearing exercises in which bones and muscles have to work against gravity to keep you upright. Your brain sends signals and bones react to the weight on them by building new tissue and getting stronger. Think of low-impact ones, such as
- Walking (either outside or on a treadmill machine)
- Leg presses
- Push ups
- Low-impact aerobics
- Elliptical training machines
- Stair-step machines
- Resistance exercises, such as lifting weights and using resistance bands or resistance exercise machines, are also important and helpful.
If you’re only starting to exercise or haven’t worked out for a period, you should start slowly, and gradually increase your time until you are capable of doing 30 minutes of weight-bearing exercise per day on most days of the week. Exercising will also improve your balance and coordination, which can help you avoid falls.
You’ll want to be very careful with the high-impact ones, as inappropriate exercise may injure weakened bones, instead of improving them. It is always a good idea to discuss them with a health care practitioner first, even if you have been doing some of them before with great pleasure:
- Jumping rope
- Step aerobics
- Team sports, like basketball, football…
- Tennis or other racket sports
- Hard yard work (digging up the garden or pushing a lawnmower)
Margaret Martin, Physical Therapist, Physiotherapist and a Certified Strength and Conditioning Specialist from Ottawa, Ontario, has an “>excellent book on the subject, with very detailed explanation of all exercises, pros and contras.
How can osteoporosis be treated?
Once you have been diagnosed, your doctor will make a decision about whether you need a treatment, for how long and what exactly, depending on your current condition and your risk assessment. There is a wide range of medications available for this disease. They all aim to help strengthen your bones and reduce your risk of breaking a bone. Two types of drugs are in use:
- the ones that are slowing down the work of cells that break down bone, called antiresorptive drugs
- the other ones that are stimulating the work of cells that build new bone, called anabolic drugs
Sometimes, doctors will combine the two in treatment.
There is a possibility of hormone replacing therapy, which can effectively preserve bone and prevent fractures, but also bears potential health risks, so it is unlikely that the doctor would prescribe it only for osteoporosis. Also, the moment that the patient stops the therapy, the bone loss goes on from where it was.
Overall, the common therapies that have been medically approved has been reported to be safe and effective. As with any medication, side effects might occur, so it is important to know about their existence. Each type of medication is different and has different known side effects. If you are at high risk of fracture, you’ll together with your doctor decide whether the benefit of a treatment (decreasing the risk of fracture) outweighs the potential occurrence of the side effects, or it doesn’t.
Osteoporosis is a condition that can have serious consequences. It can lead to fractures, which can be painful, take a long time to heal, and lead to other complications and other illnesses.
The good news is, there’s a lot you can do both to prevent and to treat osteoporosis, from eating right, adequate calcium and vitamin D intake and exercising to taking appropriate medications.
If you think you’re at risk of osteoporosis, talk to your doctor, to schedule a BDM test. If you already have a treatment plan, stick to it and be realistic: expect that it will take effort and time to reverse your bone loss. Or at least to stop it’s progression. Keep in mind what brought you to osteoporosis at the first place, and that you can easily slip back to that path, should you lose your newly acquired healthy habits.
If you have experience with this condition, do share it with us in the comments, I’ll appreciate it and it might be useful to someone.
And, feel free to reach out should you have a question and I’ll be happy to answer it to the best of my knowledge.
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