Dr. Mom blog explores the importance of building strong bones and osteoporosis prevention.

Before I started medicine, I didn’t put too much thought into my bone health, but after treating older patients I realize how important it is to build strong bones. As we age, our bone density naturally changes, putting us more at risk for osteoporosis, making bones more brittle, weak, and increased risk for fractures and breaks.  Building strong bones is especially important for women because it affects women almost 5x more than men!  Osteoporosis increases as women age because of the female biology after menopause affects bones significantly. 

What I didn’t know before I went to medical school is that our body is constantly breaking down bone and building up new bone.  Peak bone mass in is achieved at age 16-20 in women and 20-25 in men, so building strong bones when you’re young is the best prevention for fractures and breaks when you are older!  

Osteoporosis is somewhat of a silent disease often no physical manifestations until you suffer from a fracture.  Before medicine, I often thought that having a bone fracture/break was “no real biggie” other than it being painful and very inconvenient.  But working as a hospitalist in a busy medical centre has taught me that fractures can be fatal, especially if you are older.    

Osteoporosis often develops as part of the aging process, but it also can develop if we do not have adequate nutrition including adequate Calcium or Vitamin D. 

Without adequate nutrition and stable health, our bones do not have the building blocks to be strong.  So the important take home point is here is that building strong bones is incredibly important and starting young is key!  Here are some strategies to help you build strong bones:

  • Maintain a balanced diet: Throughout your life, it is important to have a balanced diet that includes getting enough protein and calories, and is rich in calcium and vitamin D.  
  • Get enough calcium: Premenopausal women and men should get at least 1000 mg of calcium per day – this can come from food, supplements, or vitamins.  Postmenopausal women should aim to get at least 1200 mg of calcium per day.
  • Foods that are rich in calcium include Dark leafy green vegetables, almonds, milk, yogurt, orange juice with calcium, Cheese, and beans. 
  • Foods that are rich in vitamin D include cod liver oil, salmon, mushrooms, tuna fish, and mackerel.  Some milks and orange juices are fortified with vitamin D. 
  • Avoiding drinking more than 2 alcoholic beverages per day.  Studies have shown excessive alcohol intake can increase the risk of fracture.  
  • Exercise regularly as this can decrease the risk of fracture.  Every time you exercise you improve your bone mass and density.  Exercise is important lifelong for many reasons, but is especially important after menopause.  The benefits of exercise are lost quickly once the exercise stops – so it is important to engage in a lifelong exercise routine (at least 3 times a week) if you can.  Weight-bearing exercise is best to build up bone health, but cardiovascular exercise has other benefits too.  Find an exercise routine that has a mix of these two, and do it as much as you can.  Exercise can also improve your muscles and balance which may prevent falls which lead to fractures. 
  • Avoid smoking all-together or cut down if you can.  Quitting smoking can be hard, and we have all heard about the ways smoking impacts health.  Smoking cigarettes speeds up bone loss, so it can worsen osteoporosis.    

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References

1.    Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006; 17:1726.

2.    Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012; 23:2239.

3.    Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 2017; 28:1531.

4.    Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 2014; 29:2520.

5.    Johansson H, Oden A, Johnell O, et al. Optimization of BMD measurements to identify high risk groups for treatment–a test analysis. J Bone Miner Res 2004; 19:906.

6.    Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995; 332:767.

7.    Johnell O, Kanis JA, Black DM, et al. Associations between baseline risk factors and vertebral fracture risk in the Multiple Outcomes of Raloxifene Evaluation (MORE) Study. J Bone Miner Res 2004; 19:764.

8.    https://osteoporosis.ca

9.    Potts JT, Juppner H. Parathyroid hormone: Molecular biology and regulation. In: Principles of Bone Biology, Bilezikian JP, Raisz LG, Rodan GA (Eds), Academic Press, San Diego 1996. p.325.

10. Brown EM. Four-parameter model of the sigmoidal relationship between parathyroid hormone release and extracellular calcium concentration in normal and abnormal parathyroid tissue. J Clin Endocrinol Metab 1983; 56:572.

11. Diaz R, El-Hajj Fuleihan G, Brown EM. Regulation of parathyroid function. In: Handbook of Physiology, Section 7: The Endocrine System, Fray GGS (Ed), Oxford University Press, New York 1999.

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