With so many vital organs and systems to worry about, most people don’t think much about their bones, let alone, the health of their bones. But bones are an essential component of our overall health. Not only do they protect our vital organs, but they also provide an internal framework for our muscles and tendons. Bones are also home to close to 99% of our body’s calcium, a critical nutrient involved in a multitude of bodily functions. At the simplest level, taking care of your bones is similar to the plan you should be following to take care of your overall health. The two most important things you can do for bone health are to exercise on most days, especially weight-bearing exercise, and to eat a whole foods diet, including plenty of vegetables and fruits, calcium and vitamin D.
Poor bone health can lead to osteoporosis (porous bone) and/or a major fracture, which can lead to pain and disability. Some people—thin, small-boned women with a family history of osteoporosis or hip fracture—are at a greater risk than others. Everyone should have some idea of the health of their bones. In general, a bone mineral density test is a good idea sometime in the first decade after menopause for women and at around age 70 for men.
But let’s step back and delve into this topic a bit more deeply.
Bone is a living tissue that is continually growing and changing. Bone is repeatedly broken down (bone resorption) and built back up (bone formation). This process is called bone remodeling and it is what keeps our bones healthy, flexible and strong. When we are younger, new bone is added to the skeleton faster than it is broken down, resulting in bone growth in both size and strength. Bones continue to grow until one’s mid- to late-20s when they reach what we call the “peak bone mass.” You want to maximize this. Later in life, the strength and health of your bones depend on both the peak bone mass achieved earlier in your life and the rate of subsequent age-related bone loss.
As we age, and especially after menopause for women, the breakdown of bone occurs at a faster rate than the laying down of new bone. Hence, our bones become thinner and more fragile over time. When this thinning reaches a certain point, it is called osteopenia, which can then progress to a more consequential disease called osteoporosis.
The good news: Once thought to be an unavoidable aspect of aging, experts now understand that osteoporosis is largely preventable. Healthy lifestyle factors can allow one to maximize peak bone mass and minimize bone loss, which can help prevent or slow progression of osteoporosis.
How is osteoporosis defined? Osteoporosis means “porous bone” and is characterized by thinning of the bones, or a decrease in bone mass and density. Healthy bones look much like a honeycomb. When osteoporosis occurs, the spaces between bone become larger, which makes the bones less dense and more susceptible to fracture.
Clinically, osteoporosis is defined in one of two ways:
The presence of a fragility fracture at the spine, hip, wrist, humerus (upper arm), rib or pelvis. A fragility fracture is one that occurs from a fall from standing height or less, without major trauma such as a motor vehicle accident, or
A bone mineral density (BMD) T-score that is 2.5 standard deviations or more below the young-adult mean BMD.
Bone Mineral Density Test and Scores --A bone mineral density test (BMD) measures the density of your bones and provides an idea of the health of your bones. Your results are compared to an established norm (usually the ideal bone mineral density of a healthy 30-year-old adult), and you are given a T-score. Differences between your BMD and that of the healthy young adult norm are measured in units called standard deviations (SDs).
--A score of 0 means your BMD is equal to the norm for a healthy young adult. The more standard deviations below 0, indicated as negative numbers, the lower your BMD and the higher your risk of fracture. Scores between +1 and −1 are considered normal or healthy. Scores between −1 and −2.5 SDs indicates that you have low bone mass, although not low enough to be diagnosed with osteoporosis. A T-score of −2.5 SDs or lower indicates osteoporosis. The greater the negative number, the more severe the osteoporosis.
Osteoporosis is often considered a silent disease because it usually progresses without signs or symptoms until a fracture occurs, or a vertebra in the spine collapses. Fractures, which are the ultimate consequence of osteoporosis, can lead to severe pain and disability, which, in turn, lead to further poor health outcomes. In extreme cases, fractures can occur from everyday activities such as bending, lifting or coughing, or from minor bumps or falls.
Hip fractures are the most serious consequence of osteoporosis. Twenty percent of older people who fracture their hip die within the first year, either from complications from the fracture or from the surgery to repair it.
FRAX (Fracture Risk Assessment Tool) The FRAX is an online tool that can be used to estimate your risk of hip fracture, whether or not you have had your bone mineral density tested. Go to Sheffield.ac.uk/FRAX to access the tool. Note that you will need to indicate your country of origin and race using the drop-down menu on the Calculation Tool tab. If you know your femoral neck BMD (hip BMD), then you can enter it. Otherwise, leave that field blank and your score will still be calculated.
Are you at risk for osteoporosis? You are at greater risk for developing osteoporosis and subsequent fracture if you have any of the following risk factors:
Are female
Are thin and of slight build
Have a family history of hip fracture or osteoporosis
Have a previous fragility fracture
Have certain diseases, including celiac disease, diabetes, eating disorders and rheumatoid arthritis
Use certain medications such as glucocorticoids and steroids
About half of all postmenopausal women and one-quarter of men will develop a fracture due to osteoporosis. Approximately 20% of Asian American women have osteoporosis. Though not as common, African Americans can also suffer from osteoporosis.
We will pursue the various ways to help preserve bone health as we age in the next post. For now, be sure to exercise regularly and to eat a diet of whole foods high in calcium, vitamin D and vitamin K from sources such as fruits, vegetables, nuts, and seeds.
Resources
Demontiero, O, Vidal, C, and Duque, G. “Aging and bone loss: new insights for the clinician.” Ther Adv Musculoskelet Dis. 2012; 4(2):61-76.
Gourlay, ML et al. “Bone-density testing interval and transition to osteoporosis in older women.” N Engl J Med. 2012; 366:225-233.
Kleerekoper, M, MD. Screening for osteoporosis. www.uptodate.com/contents/screening-for-osteoporosis?source=search_result&search=Screening+for+osteoporosis&selectedTitle=1~150
Lewiecki, EM, MD. Osteoporotic fracture risk assessment. www.uptodate.com/contents/osteoporotic-fracture-risk-assessment?source=search_result&search=Osteoporotic+fracture+risk+assessment&selectedTitle=1~150
Fracture Risk Assessment Tool. www.sheffield.ac.uk/FRAX/tool.jsp
National Osteoporosis Foundation. “What Is Osteoporosis and What Causes It? www.nof.org/patients/what-is-osteoporosis/
The Nutrition Source. Harvard School of Public Health. Calcium: What’s Best for Your Bones and Health? www.hsph.harvard.edu/nutritionsource/calcium-full-story/
Dana Hayse, PhD
Dana is passionate about empowering people to lead healthy lives through good nutrition and physical activity. She is a former Associate Professor of Epidemiology at UCSF with a background in osteoporosis, heart disease, successful aging and obesity research. She currently works as a nutrition educator in the community and as a researcher in the Stanford Cancer Center Health library. Dana has a degree in Human Biology from Stanford University, a Masters in Epidemiology from the University of Massachusetts, Amherst, and a PhD in Epidemiology from the University of California, Berkeley. You can contact Dana at dana_hayse@me.com with any questions about osteoporosis or overall general health and wellness.
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