September 14, 2020
Osteoporosis Is Silent, Until It Isn't
I know, I know. I hate to be a downer, but seeing how November is osteoporosis month, I thought it was time to bring this important discussion to the forefront. People often (and falsely) think that our concern about osteoporosis should be reserved for the older generation. While it is true that women are at a greater risk following menopause and men in general, after 65, knowing your family history, if possible, is very important. If you have a family member who has osteoporosis, you are at a greater risk of also developing it. Ask questions and learn about your family’s health history. And even if you are unable to learn about your family’s history, this is still very important information to consider.
Thankfully, there is a lot you can do with your lifestyle choices to prepare for the future. Even so, it is wise to prepare as though you are at risk, because unfortunately, even if you don’t have a family history it doesn’t mean that you didn’t get handed a risk factor in your genetic make-up that could cause it in the future.
Osteoporosis is silent, until it isn’t.
Osteoporosis is not like any other physical affliction where if you have a skin rash, you’ll see it. If you are having issues with your kidneys or thyroid, you will likely feel the symptoms. Bone loss and the deterioration of bone tissue are the number one characteristics of osteoporosis. It occurs over time without showing any symptoms, because if you can think about it this way… the bone is porous. A little bit like the Crunchie toffee chocolate bar. When you break it open, or bite in depending on your chocolate bar eating preferences, you’ll see this porous structure. As osteoporosis develops, the pores get larger and the support system in the bone becomes more fragile. As you place load on the bones by moving around, your bones become less able to handle stress.
So, all of this means that you or your family members are not likely to know it’s happening, unless you know of an increased risk and are being monitored with bone mineral density tests or sadly there is a fracture. And let’s face it, a fracture can be a traumatic experience, not only to heal from, but it can deeply affect your quality of life. I remember when I got the call that my grandfather broke his hip out in the barn on his farm. At the time, there were no cell phones, ok maybe there were cell phones, but only the big shots carried around those bricks, so being the tough guy that he was, he heroically dragged himself back home. I repeat that. He dragged himself back home. It was winter. He was in the military for a long time, but I assume his life’s work trained him for this particular moment. Experiencing a hip fracture can be catastrophic and can greatly affect your quality of life. I am going to get real here, because basic things like going to grab yourself a glass of water or use the washroom are going to be HARD. Then if you are responsible for the care of other people, guess what?! You are now the one being cared for. The worst thing is that 28% of women and 37% of men can die within the first year of hip fracture.
The other thing you need to know is that osteoporotic fractures are more common than the total of heart attacks, breast cancer and strokes. Two million people are affected by osteoporosis in Canada. That is 5.3%. According to Osteoporosis Canada, one in three women and one in five men will break a bone from osteoporosis in their lifetime. I don’t know about you, but that feels like a lot.
The good thing is that more can be done to prevent this from happening.
Bone density and exercise
The areas of the body mostly likely to experience a fracture from osteoporosis are the hip, spine (lumbar or low back), wrist and shoulder. Bone mineral density scans will show reduced bone density in these areas. This means that the mineral density in the bone has decreased, making the bone weaker and more susceptible to fracture. One great way to counter bone mineral loss is exercise.
After 50, it gets harder to regain bone loss, BUT you can slow the decline of bone mass with load or weight bearing exercise. So, making sure that your bones are as strong as possible by investing in your bone health BEFORE you reach a vulnerable stage in your life, is important.
What do THEY really mean by weight bearing exercises?
Let’s talk about Wolff’s Law. This law says that bone will adapt to the stress it is exposed to by laying down more bone. The opposite is also true, if there is no stress, the bone will adapt by making the bones less dense. So, what is the stress that will help lay down more bone? Exercise! Unfortunately, not all exercise is created equal AND working out your legs will have zero impact on your shoulder, which is why doing full body workouts is so important.
Think of exercises that will place a load on the bone like: jumping, running, walking, squatting, weight-bearing exercises (supporting your own weight), lifting weights. Swimming and cycling unfortunately don’t do enough loading to make enough of a difference. Another thing to take into consideration are the joints themselves. Being a Pilates instructor, my aim is to make sure that I am helping you load your joints in a variety of directions. To make it simple, if you consider the hip joint, I would recommend loading your hip joint, front and back and side to side and you guessed it, in as many directions your hip will go. Building strength, agility and mobility around a joint will help support you in your day to day life.
Exercising your bones and exercising your muscles and why it’s different. How much do you actually need?
You can exercise your muscles without a lot of impact on the bone. Think about exercises to increase mobility and balance. Both are hugely important and highly recommended to improve quality of life – they help prevent falls and subsequent fractures, but they have little impact on bone density.
Most studies to date have shown that moderate-impact exercises haven’t been reliable in showing increases in bone mass in older women. So one group of researchers prescribed professionally supervised high-intensity resistance and high-impact exercise to women over 58 years with osteoporosis or osteopenia 2 days a week for 8 months.
Guess what?! They saw a difference in strength, height and bone mass compared to a group of women only working on the mobility and balance portion of the program. I think one of the fears with older people and exercise is that they can’t handle as much and that they are more prone to injury. The researchers showed that high impact exercise in the right conditions can be safe and effective for older women.
How can we support our bones with diet?
Now that we’ve covered my favourite part, exercise isn’t the only thing you can do to help prevent osteoporosis. Calcium is a mineral that is required for maintaining bone mass and eating a calcium rich diet is key to healthy bones. Getting it in our diet is so important and it comes in the form of milk products, like milk, yogurt and cheese, it comes in cruciferous vegetables like broccoli and kale, spinach, kelp, sardines, and white beans. I encourage you to research Calcium rich foods online, there is ample information out there.
Then there is Vitamin D, although it feels so good to get it directly from the sun, being Canadian, you know that that isn’t always possible, so make sure to supplement. Vitamin D plays a role in the absorption of Calcium. So you can see how, if you are lacking in Vitamin D, this will impact your Calcium absorption and bone mineral density. Osteoporosis Canada has some great guidelines on what amounts of both Calcium and Vitamin D are needed at different ages.
My kids like to tell me I am no fun and I feel like this blog post proves this point 10 fold. LOL My next recommendation is to keep drinking alcohol to a minimum and the reasons why this is important is two-fold. One is that it interferes with the absorption of Calcium and Vitamin D in the pancreas and two, it interferes with the liver’s ability to activate Vitamin D. Bones start to deteriorate because too little Calcium is getting to the bone, and then on top of that, when there is a deficit of Calcium needed for other functions in the body, it will start pulling Calcium from the bone to accommodate that need.
So to summarize, care about your bones. Early. Ask your family members about the family history, if you can. Exercise at least twice a week with high resistance and high intensity, preferably with the guidance of a fitness expert. If that isn’t possible and it’s not possible for everyone, there are great apps out there and many self-directed programs you can do. Eat a diet rich in Calcium and Vitamin D and avoid drinking a lot of alcohol. I care about your bones and even if you are past 50, there is still a lot you can still do. Osteoporosis Canada is a wonderfully thorough resource where you can find everything from exercise recommendations, recipes, and treatment options of those affected by osteoporosis.