ESSENTIALS 6: BONE HEALTH
#6.1 Bone health - are you looking after your bones?
As we age it becomes really important to look after our bones.
Podcast Episode available
We reach peak bone mass way before menopause but the decline of oestrogen can begin to have an effect on our bone density as oestrogen helps to maintain our bone health.
Oestrogen can also decline for other reasons, such as:
• Early hysterectomy
• Progesterone only contraceptive pill
• Being a competitive athlete
• Eating disorders
However, there are other factors that influence what happens to our bones which are important to be aware of, some we can control, some we cannot.
MODIFIABLE FACTORS (controllable)
• Diet
• Alcohol consumption
• Smoking
• Inactivity
• Low body weight
• Over and under exercising
NON-MODIFIABLE FACTORS (not controllable)
• Age
• Genetics
• Gender
• Hormones
• Early menopause / hysterectomy
• Long term use of steroids
• Eating / digestive disorders
• Chemotherapy treatment
MEDICATIONS THAT MAY AFFECT BONE HEALTH
• Steroids
• Some medications for epilepsy
• Anti-oestrogen treatment for breast cancer (Aromatase Inhibitors)
We have already hit peak bone mass in our late 20s so working towards maintaining bone mass is important even before menopause. It is good to consider how well you are looking after those precious bones!
IN THIS PART OF THE PROGRAM, WE ARE GOING TO TAKE A LOOK AT:
1. Bones and what happens to them as we age2. Risk factors for Osteoporosis
3. Exercise for bone health
4. Nutrition for bone health
WHAT HAPPENS TO OUR BONES?
When we think of osteoporosis, we tend to relate it to little old ladies, hunched over, probably in their 80s. What we need to be aware of is that bone health isn’t just about little old ladies!
Peak bone mass or bone health is around age 20 for women – our bones are at their best at this point.
It’s a balancing act! - We have bone building cells (osteoblasts) and cells called osteoclasts which break down bone tissue and it’s the balancing act between these cells that affect bone mass. We need both types of cells but the balance changes once we have reached peak bone mass and as we age further.
Osteoporosis or osteopenia – what is it?
Osteoporosis is a loss of bone density or bone mass leading to potential fractures. The main problem areas are the wrist, head of the femur, neck of the femur and the thoracic spine.
Unfortunately, women are more prone to osteoporosis than men.
Osteopenia is the precursor for osteoporosis. Therefore it is the initial stage of losing bone density and will lead to osteoporosis. Osteopenia, however, can be reversed in some cases.
THE WARNING SIGNS:
• Loss in height
• Postural changes to upper spine
• Sudden back pain over 45 with no obvious cause
• Bone fractures from a minor incident
The statistics
• Osteoporosis affects 200 million women worldwide• 70% of women over 75 will have osteoporosis
• 1 in 3 women will suffer osteopenic fractures in their life and a fracture may be the first sign of osteoporosis
• 75% of hip fractures are in women
• Risk increases with age
• In women over 45, osteoporosis accounts for more days spent in hospital than many other diseases including diabetes, heart attacks and breast cancer
• In older women risks associated with mortality due to falls, breathing difficulties due to increased kyphosis and social isolation due to their increasing disability or difficulties with walking etc.
• 1 in 3 women won’t be diagnosed until after 3 or more bones have been broken
We don’t hear enough about the fact that there is a clear need for us to address bone health!
Like many other things that are vital to women’s wellness; we are given limited information. Similar to many other facets of everyday life, a preventative approach is far better than a reactive approach.
FACTORS AFFECTING BONE MASS
A variety of genetic and environmental factors influence peak bone mass;
• Genetics are understood to be a big factor. Take a look at your Mum and your Grandma and how they aged.
• Gender – Peak bone mass tends to be higher in men than in women. Before puberty, boys and girls acquire bone mass at similar rates. After puberty, however, men tend to acquire greater bone mass than women.
• Age – not something we can change!
• Race – Caucasian and Asian women are more at risk of bone health decline
• Menopause / Hormonal factors. The hormone oestrogen has an effect on peak bone mass.
• Bone health is affected when oestrogen has dropped in post menopause.
• Women who had their first menstrual cycle at an early age and those who used oral contraceptives (which contain oestrogen) often have high bone mineral density. In contrast, young women whose menstrual periods stop because of extremely low body weight or because of excessive exercise, may lose significant amounts of bone density. This may not be recovered even after their periods return.
Other factors – Low body weight / over exercising / inactivity / eating disorders / lack of periods / chemotherapy & other medications / smoking / alcohol
Nutrition & lifestyle behaviours
We will be looking specifically at exercise and diet in this program
DIET
In some parts of the world statistics have shown lower incidents of bone density issues. For example women who embrace a traditional Japanese lifestyle have a lower incidence of menopausal symptoms, breast cancer and Osteoporosis. However, if they move to the UK or the US and adopt our typical diet their statistics level with ours.
Their diet contains less dairy, more fish, raw fish, sea vegetables, rice, spices that have anti-inflammatory properties such as Miso and Tamarind etc. Food for thought?
Dairy in the diet - although we always think of drinking milk to help bones because of the calcium in dairy. However – dairy is not necessarily essential for bone health!
SEE MORE IN FOLLOWING INFORMATION
EXERCISE FOR BONE HEALTH
Bones are a living tissue and are responsive to loading. Exercise and movement that pulls on the muscles and tendons and stress the bone will lead to bone building. Improvements in bone density may be seen when regularly practicing strength training.
SEE MORE IN FOLLOWING INFORMATION
PHYSICAL ACTIVITY IN OUR CHILDREN
Children and young adults who exercise regularly generally achieve greater peak bone mass than those who do not. Women and men age 30 and older can help prevent bone density loss with regular exercise.
IF YOU NEED TO SEEK MEDICAL OR SPECIALIST HELP
If you are concerned about your bone density, have a family history of osteoporosis or any other indicators it is always best to consult your health provider. A Dexter Scan will reveal your “T” score which reveals your level of bone density. Your health provider will guide you to what steps they consider will help.
EXERCISE PRESCRIPTION
If you do have any bone health issues, it is important that you are not only advised of the exercises that you should be avoiding (as fractures can occur when you least expect it!) but also the exercises you should be doing to help you build more bone density. Osteopenia can be reversed in some cases.
OUR DIET
It is important to look at our diet - a nutritionist can help you with this.
The FRAX (Fracture Risk Assessment Tool) on the WHO (World Health Organisation) website allows you to input data such as your age; weight; height; gender; whether you smoke; your alcohol intake and any history of family hip fractures. This can then help to determine your risk factors.
OTHER CONSIDERATIONS
Gut health influences Bone HealthSleep influences bone health – deprivation may influence bone mineral density
Soda and fizzy drink intake (particularly cola) may affect bone health