Boning Up on Bone Health for Healthy Aging

Why Bone Health is Important for Healthy Aging

What do we need to ensure we all age well and do so in a healthy vibrant way?
How can we be the architects of our future, not the victims. Aging and wellness are popular topics in magazine and talk shows, but we need to be clear about what is evidence based as opposed to trendy, what has true merit, rather than anecdotal stories.

The number one event that is common to both men and women over the age of 50 is the risk and the likelihood of fracture. Slipping and falling is very, very common, but not everyone fractures. Some people will bounce and NOT break. What is the secret? How can we have strong robust bones?

Essential Vitamins

Well, bone health starts for us all when we are young. We need calcium and Vitamin D. No, I don’t work for the Milk Marketing Board of Canada, but in truth, they ae quite right. Calcium is essential and is absorbed by the body from milk, cheese and yogurt, much more efficiently than from tablets. For people over the age of 50, Osteoporosis Canada, out guideline body says we need 1200 mg per day. That is 3-4 servings of dairy. Yes, we can get some calcium from broccoli and from almonds and salmon, etc., but dairy products pack the biggest punch. Vitamin D is from the sun. See any of that lately? Even in the summer, when we do see sun, the sunblock we use to prevent skin cancer, blocks out the vitamin D absorption, so we need 1000-2000iu (international units) as adults over 50.

Our children should be having milk and calcium containing products and vitamin D. And you know our grandmothers and great-grandmothers fed us cod liver oil! They were right.

What does this mean. Our bones will be stronger and more able to stand the expected slow loss of bone with age.

What Bone Density Tests Tell You

By age 65 everyone, men and women need a bone density test. This tells us how much bone we have, the quantity of bone. It does not tell us, the quality of that bone. Bone quality is not as easily measured but we do know any fracture past age 40 should be evaluated to determine if it was a fragility fracture or a traumatic fracture. If you are hit by a truck, any fracture is traumatic. If you step of the curb, a fall from your standing height or 1-3 steps higher, that is generally a fragility fracture. And a fragility fracture is a predictor of weak bones, risk of hip fractures. A fracture is the event that warns us that our bone quality is not ideal.

Evaluate Your Risk

It is reasonable to evaluate your risk, whether you have fractured since age 40, whether your parent had a hip fracture, what drugs you may be on that can have an effect on bone, what underlying diseases, such as rheumatoid arthritis that may impact bone health. By focusing on bone health, you may be doing great, or you may need some intervention, but the goal remains the same for you and your doctor:  maintain your activity, independence and ability to age in a healthy way for years to come.


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No Bones about it: Protect Yourself From Osteoporosis

Fitness Assessment (2)

Part # 1

A ninety-four year old woman has had two major falls in the past twenty years. Upon falling down a flight of stairs, she fractured her arm. More recently, when this tiny woman was picked up by a gust of wind and then dropped on the parking lot pavement one icy winter day, she fractured her elbow.  In both situations she could have also easily broken her hip or spine yet she didn’t. She recovered fully, continues to drive, live independently and most importantly enjoys a healthy and active life.

At ninety-four she most certainly has lost bone mass which peaks at the age of 16-20 for girls and 20-25 in men.  As women approach menopause they lose bone mass at the rate of 2-3% a year. Yet it would seem that a healthy diet, regular weight-bearing exercise and preventative medication are able to decrease the risk of fractures and the advance of osteoporosis.  And in a healthy, fit, active person, even when there is a fracture, there is better healing and recovery.

What is osteoporosis? 

Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue. This leads to increased bone fragility and risk of fracture (broken bones), particularly of the hip, spine, wrist and shoulder. Osteoporosis is often known as “the silent thief” because bone loss occurs without symptoms. Osteoporosis is sometimes confused with osteoarthritis, because the names are similar. Osteoporosis is a bone disorder, with loss of the normal strength and quality of the bone, as well as a decrease in the amount of bone. Osteoarthritis is a disease of the joints and surrounding tissue, often described as wear and tear of a previously normal, smooth joint.  *

Consider this:

Osteoporosis can strike at any age and affects both men and women.

The most common sites of fractures are the hips, wrist, spine and  shoulder.

At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime.

Twenty-eight per cent of women and 37% of men who suffer a hip fracture will die within the following year.

Over 80% of all fractures in people 50+ are caused by osteoporosis.

How can you protect yourself?

Fortunately, there are a variety of ways an individual can protect or improve their bone health.

Have your physician conduct a fracture risk assessment! This may include a bone mineral density test, (BMD) which determines the amount of healthy bone you maintain.  Risk assessment is also evaluating your personal risk, your family history, your age and other complicating factors.  The average age for a BMD is 65 according to Osteoporosis Canada, but a risk assessment begins at age 50!

The two main issues I try to look at with every patient over the age of 50 is significant height loss, yes that’s why we measure your height, and if you have had a fracture since I last saw you–that way I quickly have an idea if there is an increased risk of osteoporosis in that patient.

Eat a healthy diet of calcium rich foods such as leafy greens and dairy products or soy-based products if you are averse to dairy.

Take Calcium & Vitamin D. If you are eating well, you may be getting enough calcium in your diet and supplements are not needed.  Generally speaking, we all need Vitamin D supplements as we get little direct sunlight in North America and that is the common source of Vitamin D.

For those over 50, Canada’s Food Guide recommends 3 servings of milk and alternatives – yogurt, cheese, calcium-fortified beverages, puddings, custards, etc.

This essentially means that, if you are over 50, you need the equivalent of one good serving of dairy at each meal or 1200 units a day of calcium supplements.

I have yogurt each day and at least one latte, so I often decide at night if I have had that 3rd serving of dairy that day.  If not, I take 500mg of Calcium.  If I have had 3 servings, then the third calcium is not needed and NOT advised. More is not better. So you can decide day by day, depending on your diet as it is normal for this to vary a bit every day.

Vitamin D a day –400-1000 IU’s for adults under 50 and 800-2000 IU for adults over 50.  That is a must!

Exercise.  Use weight-bearing exercises that uses your body weight such as walking, running, weight lifting to help to strengthen both bones and muscles, as well as improving your balance.

Consider taking medications that build bone density and prevent bone loss if your risk assessment is significant and you are at risk for fracture. We know that low risk individuals have less than a 10% risk of fracture in the next year and can do well with diet and exercise.  High-risk folks have a greater than 20% risk and should be on medications. And for those of us between 10 and 20%, the moderate risk patients, the decision is individualized, as there are more issues to consider this is the art of medicine and warrants a discussion with your physician.
*Osteoporosis Canada