We often think of our bones as if they were Legos that hold us in place, but they are much more than that. A bone is a living, active organ that is affected by our hormones and by the nutrients, vitamins and minerals we consume. Peak bone mass occurs at the time of puberty and into our 20s and early 30s. However, even as we age, our body constantly creates new bone.
We can be proactive to support good bone health at any age, which means getting enough vitamins and minerals. The best way to ensure this is with a well-balanced diet that includes all food groups.
Osteoporosis: A Silent Disease
Osteoporosis, which refers to a loss of bone mass, is a silent condition. That’s why many people may not know they’re at risk or think about prevention until they have a fracture in an unexpected way. Osteoporosis causes our bones to become weak and more prone to a fracture as we get older. The hip, spine (compression fracture) and wrist are most susceptible, but a fracture may occur in any bone.
It’s normal for women to start experiencing a decrease in bone density when they enter menopause. This happens due to hormonal changes and is generally a slow process. Breaking a bone after falling while in a standing position could be a sign of osteoporosis. Any fracture should prompt a discussion of bone health with one’s doctor.
Osteoporosis is diagnosed with a bone density test, a quick and painless type of x-ray that provides information about bone strength and the risk of a future fracture. Many people are surprised to learn they have osteoporosis because they have no symptoms.
Osteoporosis can have devastating consequences. Falling may lead to a life-altering fracture and permanent disability. When severe, even opening a window could cause a fragile wrist to break, or a compression fracture in the spine, which means that the back bones compress like pancakes and can lead to kyphosis.
Recommended screenings and appropriate treatment are important. Healthy women are advised to have an initial bone density screening at age 65. For men, it’s age 70.
Earlier screening is recommended for women with certain risk factors for bone loss, such as a family history of fractures or the use of certain medications such as steroids. Those who consumed very little calcium in younger years, had an eating disorder, smoke or consume excessive amounts of alcohol may also be vulnerable to accelerated bone loss. Women who are underweight are at increased risk, as well.
Weight-bearing exercises such as walking or dancing are excellent for bone health. Muscle strength training is also important for bone health and balance. However, exercising in excess is not good for people who are underweight. They likely are not getting enough fuel for their body and the energy they are expending. Energy balance in the body is key to preserving bone health, and an adequate consumption of nutrient-rich foods is imperative.
Low Bone Mass for Age
A loss of bone density can occur in younger women, as well, and it frequently goes undiagnosed. In this age group, it is referred to as “low bone mass for age.” Very active, athletic individuals may develop a condition known as the “female athlete triad.” Signs include an irregular menstrual cycle or a stress fracture, which should warrant a visit to the doctor for a metabolic bone evaluation that will include blood work and a bone density exam.
A fracture can be devastating at any age, and in athletic individuals it can affect their ability to participate in a sport they love. A balanced food regimen that provides sufficient fuel for one’s activity level is important to ensure healthy bones and support athletic performance. Most people are not thinking about their bones in their teenage years, 20s, and 30s. Developing peak bone mass during these crucial years is essential for long-term bone health.
Treatments for Osteoporosis
Every patient is different and there’s no cookie-cutter approach to treating osteoporosis or a loss of bone density. Medications used to treat and prevent osteoporosis should be tailored for each individual patient. These drugs are generally well-tolerated.
Most people think of calcium and Vitamin D when it comes to bone. There are so many more nutrients that are essential for bone, including Vitamin B12, phosphorus, magnesium, and Vitamin K, to name a few. Protein is very important for bones as well. Eating foods that contain these vitamins, maintaining a healthy weight, sticking to a nutrient-rich diet, and engaging in weight-bearing and resistance exercises are measures that can help preserve bone mass, even as we age.
It is preferable to get one’s calcium from food sources. However, if supplements are taken, two forms are available. Calcium carbonate is absorbed most efficiently when taken with food. Calcium citrate is absorbed equally well with or without food. We recommend that patients divide their dose for optimal absorption, taking no more 500 mg at one time. A calcium supplement can interact with various prescription medications, so you should talk to your doctor about the best way to take it.
Dr. Dorothy Fink is an endocrinologist with particular interests in women’s reproductive health and bone health. She is an Assistant Attending Physician at HSS and board certified in endocrinology, internal medicine and pediatrics.