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What Lies Beneath…

Happy Hallowe’en!  Could there by anything more appropriate today than a discussion of our skeletal integrity?  Granted, this is very likely not the first thing the day evokes, but it does make sense to think about bone health, particularly for women.   So let’s use the calendar as an excuse.  And, thank goodness, despite all the dire warnings and dark predictions, we can indeed do a great deal, pretty easily, to protect our bone health. Diet, physical activity and a few lifestyle adjustments go a long way to keeping us upright.

Our bones obviously play many important roles.  They provide us with structure – hooray for cheekbones! – give our muscles something to hang on to, keep our organs lined up and out of harm’s way and they store vital calcium, too.  They are always changing.  They are best built in childhood and adolescence, but we can protect our bones as adults.  When we are younger, new bone is made by the body faster than old bone breaks down.  About age 30, peak bone mass is attained.  Thereafter, the process of remodeling carries on, but we start to lose a bit more bone than we gain.

Now comes the scary word: osteoporosis.  This is the condition that makes our bones brittle and weak.  How likely we are to suffer its ravages depends on how much bone mass we have achieved by age 30 and how quickly we lose it as we age.  The higher the peak bone mass, the lower the risk of developing the o-word.

So what actually affects bone health?  Consider the following:

  • Physical activity level.  Couch potatoes and those who are essentially inactive have a far high risk of osteoporosis than those who stay physically active.
  • Calcium-poor diet.  A diet low in calcium means poor bone density, early bone loss and vulnerability to fractures.
  • Being a woman.  Women have less bone tissue to start with.
  • Aging.  Bones become thinner and less strong as we age.
  • Tobacco use.  Much research indicates that tobacco use contributes to bone weakening.
  • Excessive drinking.  Regularly consuming more than two alcoholic beverages per day has been shown to increase the osteoporosis risk.  It is thought that alcohol interferes with calcium absorption.
  • Hormone levels.  For women, bone loss increases rather precipitously after menopause as estrogen levels drop.  For men, low testosterone levels can contribute to bone mass loss.  The absence of menstruation (before menopause) also increases the risk of osteoporosis.  And too much thyroid hormone can cause bone loss.
  • Eating disorders, certain conditions and procedures.  Anorexia and bulimia suffers risk bone loss.  Some stomach surgeries (gastrectomy), weight loss procedures and diseases such as Crohn’s, celiac disease and Cushing’s disease interfere with the body’s ability to absorb calcium.
  • Some medications.  According to the Mayo Clinic, long-term use of corticosteroid medications (prednisone, cortisone, prednisolone and dexamethasone and so on) damages bone health.  And other drugs are associated with greater osteoporosis risk: long-term use of aromatase inhibitors to treat breast cancer, certain antidepressants called selective serotonin reuptake inhibitors, the cancer drug methotrexate, some anti-seizure medications, some acid-blocking drugs called proton pump inhibitors and, of all things, aluminum-containing antacids.
  • Family history, race and frame size.  If you’re  white or of Asian descent, you’re at greatest risk of osteoporosis.  The same applies to those who have very small frames or are extremely thin (you have less bone mass, literally, for your body to draw on as you age).  Having a parent or sibling with osteoporosis also ups the risk, especially if a family history of fractures is also present.
How to help keep bones healthy?
  • Stay active.  Be sure physical activity is part of your daily routine.  And include weight-bearing exercises – walking, jogging, climbing stairs, tennis, dancing (it can be fun and beneficial both!).  These activities help build strong bones and slow down bone loss.
  • Get your vitamin D.  Check with your health care provider for the right daily amount for your age and health.  And sunlight is a source of vitamin D (though it may not be appropriate for everyone).  Other sources are oily fish, such as sardines and tuna, egg yolks, fortified milk and supplements. 
  • Keep calcium-rich foods in your diet.  Dietary sources include dairy products, almonds, kale, broccoli, soy products (tofu), canned salmon with bones and sardines.  Check with your health care provider for supplements if you are not getting enough from your diet.
  • Take care not to abuse alcohol or tobacco.  Avoid smoking and tobacco in all its forms; stick to two or fewer alcoholic drinks per day.
  • Talk to your health care provider about bone-boosting medications.  There are a number of such medications on the market.  If you are presently taking a medication that affects your bone health, talk to your doctor.  He or she will monitor your bone density regularly and could suggest other drugs to prevent bone loss.
  • Estrogen therapy for women.  This approach is not without its own risks but it may help you maintain bone density after menopause.  Only you and your doctor can decide what’s best.

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