No Bones About It

Keeping bones strong as you age is essential to your overall health.

Skeletons at Halloween can be creepy, but if you love your skeleton, it just might love you back. The human body’s 206 bones serve many purposes, allowing us to move in certain ways, providing structure to our body and protecting our internal organs. Healthy bone also regenerates regularly, shedding old cells and making new ones. “Bone is alive,” says Roderick J. Bruno, M.D., an orthopaedic surgeon at Access Sports Medicine and Orthopaedics. And like most living things, bone responds to proper care and feeding – but also, unfortunately, the passage of time, which can cause bones to lose density and hence their strength.

Although thinning bones was once considered largely a women’s issue, men who think they’re off the hook with this one should think again: everyone loses bone density with age. Bone density in men typically decreases at a slower pace than it does in women, who experience a surge in their rate of bone loss following menopause and are at greater risk of developing dangerously weak bones than men. But one in three bone density-related fractures occurs in a man, and fragility fractures present a higher risk of death in a man than in a woman, according to the National Institutes of Health.

But even though we’re all expected to have diminished bone strength as we grow older, normal aging does not include shrinking height or bone fractures caused by weak bones, Bruno says. Those are signs of osteoporosis, a disease that does not usually offer early warning signs and is characterized by fragile bones. “Osteoporosis is kind of like hypertension, where you really don’t notice you have a problem until something happens,” Bruno says. “A ‘dowager’s hump’ and getting smaller with age are classic signs of osteoporosis, but people don’t complain about that – they just think they’re getting shorter.”

Osteoporosis weakens bones to the point where minor trauma, such as tripping on a hallway rug or falling from a seated position, can cause a bone fracture, says Kame G. McAuliffe, PA-C, a physician assistant at New Hampshire NeuroSpine Institute. In extreme cases, something as innocuous as coughing or sneezing can cause a stress fracture in the back of a person with osteoporosis, she says.

Hip fractures commonly occur in osteoporotic patients, along with wrist and spinal fractures. A hip fracture might not sound like the most threatening medical diagnosis around, but in the elderly, it can lead to death – especially in men, who have a 50/50 chance of surviving a hip fracture, McAuliffe says. The risk does not stem so much from the fracture itself exactly, but from resulting hospitalization and surgery, which can lead to complications such as pneumonia and blood clots, she says. Fallout from a broken hip can be greatly life-altering for patients. “They lose independence, they lose mobility, a lot of patients just sort of lose that luster for life,” McAuliffe says. “They end up being nursing home-bound, [caught in] a slow downward spiral where a combination of factors, from medical issues to psychological issues, just really compounds things.”

If a patient is suspected of having bone density problems, they typically undergo a “DEXA” scan, which is a low-radiation x-ray that measures bone density and helps doctors determine treatment. “The DEXA scan has really become the gold standard for testing,” Bruno says. “There’s not much radiation, so it’s a very safe test, and you can use it to monitor patients over time.”

If a DEXA scan confirms low bone density in a patient, prescribed treatment might include calcium and vitamin D supplementation along with lifestyle changes, such as regular exercise and smoking cessation, and possibly medications to help maintain density and slow down further loss, Bruno says.

Invest in your bone bankThe foundation for strong bones is set while we are still very young, so embracing bone-friendly habits – such as getting adequate calcium and vitamin D and being active early in life – has a long-term payoff. Diet and lifestyle in your younger years greatly affect how much your “bone bank,” as some experts call it, will hold in reserve for you later. “You stop building bone in your late teens/early 20s, so pretty much what you’ve been able to build in those adolescent years is what you have to live off of the rest of your life,” says McAuliffe.

Those of us over the age of 25 can still bolster our bone strength, however. Diet is “one of the best ways to prevent deterioration in bone as we age,” McAuliffe says. To feed your bones, you must consume calcium, either through your diet or through supplements. Getting calcium via food is preferable to taking supplements because “your body will be able to absorb it better and you utilize more of it,” McAuliffe says. (If you are unable to get enough calcium through your diet, then by all means, go for supplements, she says.) And don’t forget the vitamin D to help the body absorb calcium – especially important for those of us living in the Granite State, where vitamin D-generating sunshine is in short supply.

Another primary way to maintain bone health is exercise. To get the most bone benefit from your workouts, be sure to include actions that work against gravity in your exercise routine. “The bone is a dynamic structure,” Bruno says. “The more it’s stressed, the more it responds and grows.” Activities like walking, running and dancing help to beef up bones because they load the bones with body weight, stimulating them to get stronger. Weight-bearing movements prompt the bones’ internal support structure to thicken, Bruno says. “Exercise is critical to maintaining bone density,” he says, “and the key really is weight-bearing exercise – that’s what makes a big difference.”

No turning backUnfortunately, all the calcium, vitamin D and exercise in the world cannot fully restore bones to their peak capacity. “Once you lose bone density, you can’t get it back,” Bruno says.

And a good diet and gym visits can’t always compensate for uncontrollable risk factors, such as genetics, aging and gender. They can slow down the progression of density loss, though, minimizing it or preventing some of it from occurring in the first place, so they are an excellent two-pronged preventive strategy, McAuliffe says. “It’s something everyone should try,” she says. NH

Some of the risk factors, according to the International Osteoporosis Foundation, that make you more likely to develop osteoporosis:Age

Gender

Insufficient calcium and/or vitamin D

Smoking

Excessive alcohol use

Eating disorders

Sedentary lifestyle

Estrogen deficiency (if you’re a woman)

Low body weight

Family history of osteoporosis

Other medical conditions, such as rheumatoid arthritis and hyperparathyroidism.

Did you know?Eighty-five percent of adult bone mass is acquired by age 18 in girls and age 20 in boys, according to the National Osteoporosis Foundation.