Why silent? Well, usually there aren’t any outward symptoms that your bones are slowly getting weaker until one day, SNAP! You break a bone. I’m not normally one for statistics but the following facts did cause me to sit up and take notice:
• Should someone with osteoporosis break a hip there’s a 30-40% chance of them dying within a year.
• If you’re a woman, there’s a 50% chance that you’ll break a bone because of osteoporosis. If you’re a man, you have a 20% risk for an osteoporosis fracture.
• Even if you’re one of the lucky ones to survive, there’s a 20% chance that you’ll require long term care.
Let’s face it, no one wants to be like Humpty Dumpty who could not be put together again.
The good news is that proper nutritional help and targeted movement exercise can keep you all in one piece with healthy bone density and strong bones.
Can bone density tests predict fractures?
Bones are made up of two components:
• Minerals such as calcium and magnesium which give bone its hardness, and
• Collagen which gives bone its ultimate strength and provides the scaffolding that binds minerals.
Bone density tests measure only the amount of minerals in the bone. While this is the way osteoporosis and pre-osteoporosis (osteopenia) are diagnosed and monitored, in reality a bone density test offers only a poor prediction of who will break a bone. Fracture risks depend largely on factors other than bone density, e.g. balance, bone strength, medications, smoking, consumption of alcohol or fizzy drinks.
Why bisphosphonates are not the answer
Creating and maintaining both minerals and collagen is the job of two cells: osteoclasts and osteoblasts. Osteoclasts break down old bone and osteoblasts create new bone. The purpose of bisphosphonates is to increase bone mass and they do this by preventing the osteoclasts from breaking down old bone. Meanwhile the osteoblasts continue building new bone which explains why results on bone density testing appear dramatic in the first year on a bisphosphonate. Sadly although bone may appear to be denser initially it doesn’t mean the bone is actually stronger. Women who have been taking a bisphosphonate-type drug for a few years may be faced with more brittle bones and fractures. This would explain the frequent occurrence of the unusual femur fractures.
Are your medications causing bone loss?
The package inserts in your medications should warn you of this since it is no secret that many pharmaceutical drugs cause bone loss:
• Acid blocking medications such as PPIs, Nexium etc, were never approved by the FDA for long term use, yet people often take them for years to treat symptoms of reflux or heartburn. These medications can increase osteoporosis and fracture risk by 22% after just one year and 59% after 4 years of taking them.
• In a study of adults over the age of 50, use of antidepressants (SSRIs) not only lowered bone mineral density but also increased the odds of falling and doubled the risk of osteoporosis fractures.
• Steroid medications such as cortisone and prednisone are the most powerful bone destroyers and as such they are the most common cause of drug-induced osteoporosis and fractures.
The list goes on, so if you’re taking any medications do your own research, especially into finding a natural alternative as a substitute.
So what do bones need?
If you give bones what they need they will stay strong and healthy and can even regrow where you may have already lost bone.
Making sure you have enough vitamin D is crucial. Without it your body cannot effectively absorb calcium, which is essential to good bone health.
Did you know that death rates from osteoporosis in the Middle East are two to three times higher than in Western countries? In Egypt alone, more than 80% of women have osteoporosis or osteopenia. This is due to the common practice in this region of covering most of the body year-round, which blocks vitamin D production.
Are you getting enough vitamin D? The only way to really know is to take a blood test. To reduce the risks for falls and fractures, a person’s Vitamin D blood concentration should be 30-44 nanograms per millilitre (ng/ mL). Depending on your starting level this can be achieved by taking between 2000-4000IU vitamin D3 daily. However for added benefits I usually recommend aiming to get your levels above 60ng/ml, and to get there one would need to take higher doses, 4000-8000IU daily.
What about calcium?
It is well recognised that bones need calcium in order to be strong, however if you’re getting calcium in your diet and supplementing you could be getting too much. More is not better when it comes to calcium. Rather strive to get enough from your diet and supplement with vitamin D and K to ensure it is absorbed and utilized properly. Click here to download a calcium-rich foods chart to help you calculate how much calcium you are getting in daily. If you feel you need more and wish to supplement then look first at green food powders. If you want to go for inorganic supplements avoid the cheap and nasties that contain calcium carbonate only – you might as well go and lick the lines on a rugby field.
How necessary is vitamin K?
Normally all the vitamin K you need can be obtained from a good diet and is also made by your gut bacteria, however, if you are taking very high doses of vitamin D daily you might consider adding about 45-100mcg of Vitamin K2. This is to prevent possible calcium accumulation in the arteries since vitamin K2 helps activate proteins that incorporate calcium into the bones. Together, vitamin D3 and K2 regulate the absorption of calcium and phosphorus, which improves bone health.
The glue that holds everything together
Then there’s collagen which not only makes bone slightly flexible and more able to withstand the impact of a fall without breaking, but it’s also the framework to which calcium and other minerals bind.
Type I collagen makes up 90% of the non-mineral part of bones with Type III making up the rest. So it makes sense to add bovine collagen to your supplement regime. Research indicates that hydrolyzed collagen is safe, highly absorbable and supports healthy bone metabolism and bone strength.
Eating for bone health
One dietary pattern that has consistently been shown to increase bone density and lower osteoporosis and fracture risk is the Mediterranean Diet. It emphasizes fruits, vegetables, grains, legumes, nuts and healthy oils such as olive oil. Following a Mediterranean Diet means eating lean proteins such as chicken and fish a few times a week, and eating red meat only a couple of times a month.
What about alcohol?
Alcohol is an interesting one: Research shows that drinking too much alcohol, as in 2 or more drinks per day, increases your risk of hip fracture by 39%, while drinking alcohol in moderation ie. half to one alcoholic beverage per day, can reduce people’s risk by 20%. This was confirmed by a study done on more than 100,000 postmenopausal women which also concluded that the reduced fracture risk was seen in women who drank wine and not hard alcohol.
Of course the other downside of drinking too much alcohol, it affects your balance and hence increases your chance of fracture due to falling.
Get active!
To evaluate the effect of exercise on fracture risk, researchers followed 9704 women, aged 65 and older, for an average of 7.6 years. They found that when compared to no activity, vigorous or moderate physical activity reduced the risk of hip fracture by 42% and spinal fracture by 33%. Most experts recommend a combination of balance and strength training to reduce the risk of falls and fragility fractures.
I suggest mixing things up so you’re not doing the same thing two days in a row. Variety is the spice of life! And that goes for exercise too. But whatever you decide, just do it!
Make non-negotiable appointments on your calendar for exercise.
A caveat for those with osteoporosis: Lifting weights or doing sit-ups may be dangerous for people with severe osteoporosis. Furthermore some yoga or Pilates exercises may be fantastic for improving balance and strength in someone with osteoporosis, yet without an instructor trained as an osteoporosis exercise specialist, even gentle yoga or Pilates may cause fractures in people with osteoporosis where the bones are already quite fragile.