My friend, and former student, Cindy underwent a hysterectomy at forty-five because of suspicious irregularities in her uterus. Up to that point she had been a very active women who spent hours a week at the gym running on a treadmill. I knew, because I often joined her there.
Eight weeks after the surgery Cindy returned to the gym. She complained to me that it still felt as though a brick was lodged in her belly. Could I show her some ab work? Of course! And we returned to the mat together.
Cindy had done Pilates with me before her surgery and knew all about the ‘corseting’ effect of a strong core on the body. Instead, her belly felt domed and bloated and never thought she’d feel right again. You will, I insisted. We worked on abs, and pelvic floor, and finding the deepest level of abdominals, but nothing on stimulating bone growth.
At the time I was a novice teacher trained more in core strength than bone health. We both knew that the “routine” procedure that removed Cindy’s ovaries, would put her body into early menopause – or “surgical menopause”, as her doctor called it. But the results of her first bone density test were a shocker: osteoporosis in her left hip!
What she or I didn’t fully understand was how the hysterectomy would impact on her bones. During menopause, the bone remodelling process is interrupted. Bone remodelling is the lifetime process whereby the osteoblasts lay down new bone and osteoclasts digest old bone. Before menopause, the body’s estrogen stimulates the bone-building force of the osteoblasts and suppresses the bone resorption of the osteoclasts. However, the loss of estrogen during menopause changes this process so that osteoclasts work more than osteoblasts.
Cindy was put on Estrogel, (taken off it after five years because of possible side effects including blood clots and/or breast cancer.) Fosamax was recommended, but after doing her own research on it, Cindy stopped it four months later. Instead, she made an appointment with a Toronto research scientist, Dr. Who, who studied the effects of vitamins on the body. Dr. Who put her on a regime that included Super Enzymes, Vitamin A, C, D, E, magnesium, zinc, fish oils and ground flax seed. In addition to this, Cindy beefed up her weight bearing exercise and committed to a better eating plan to support bone health and overall wellness.
For a handful of years her bone density remained the same, though thankfully without any signs of deterioration. Because of changes in her blood sugar, she went to see a nutritionist who designed a bone-healthy eating plan that eliminated almost all sugary snacks and alcohol from her diet. In addition to this, Cindy continued on with the hefty vitamin regime from Dr. Who. She loved the routine and social life at the gym and went often, continued to work on her core but began to increase the poundage of the free style weights she used.
Then about ten years from her first bone density test, and about nine months from her previous one, the picture changed for Cindy. She described to me in detail meeting a new endocrinologist at St. Michael’s osteoporosis clinic in Toronto. The specialist was so astonished by the T-scores she was holding in her hands that she asked Cindy to repeat her full name, and age, twice. What she was seeing in the report was a significant shift from moderate osteoporosis to osteopenia! The difference in the T-scores was so stunning that the doctor asked permission to invite in two interns so that the three of them could interview Cindy on ‘everything she had done’ during the last year or so. They wanted to know exactly what she had eaten, what vitamins she took, how much, and what brand names were used, what exercise she did. After spending an hour with her, the endocrinologist said: ‘We don’t need to see you again any time soon. Off you go.’
Managing Osteoporosis and Osteopenia
There is much we can do to prevent and manage osteoporosis and its precursor condition osteopenia. As discussed in last week’s blog, weight-bearing exercise can actually hinder the actions of the bone-degrading osteoclasts. When bone reacts to muscle contractions or the impact with the ground the “stress” goes through the bones and creates a sort of electric zap in the bones. This effect, in turn, attracts bone-building osteoblasts to work better to promote bone repair. This is why physical activity is so important in osteo management. So are diet, vitamins and minerals, and, where appropriate medication.
The key thing to remember is if you want to stimulate bone growth, you need to push yourself harder than you’re used to working. Here are some pointers to remember:
Bones need good stress: running, jogging, jumping for osteopenia; fast walking, stepping, stair climbing, gentle hopping or Heel Bumps for osteoporosis. (Heel Bumps is the exercise where while standing tall you lift up your heels and lower them down with the emphasis on “bumping” the heel down on the floor. Avoid with heel pain). Moderate to high intensity is needed to stimulate bone growth but it doesn’t need to be long in duration. Research mentioned in Strong Women, Strong Bones shows that two minutes a day of vertical jumping can produce significant improvement in bone. If you have osteoporosis and shouldn’t do jumping, ask your health care provider if Heel Bumps are appropriate for you. Be consistent with workouts. Once a week is not enough!
Bones need upper and lower body strengthening: Strong muscles exert forces on the bones and reduce the stress on joints. Upper body weight exercises strengthen not only the arms but the scapulae and spine. Weight bearing for the lower body builds strong hips, knees, and ankles. Work in good alignment, to the point of muscle fatigue.
Bones need stimulation: Try tapping feet or hands on the ground; and clapping or rubbing hands together. Explore low-intensity, whole body vibrating machines currently on the market. About the size of a stationary bike, they have a large vibrating plate that you stand on as you do your weights, squats, lunges and stretches. These machines are designed for home use and many are also now found in specialized gyms.
Bones need balance training and footwork: Stand on one leg as you do your weights or try tandem feet (one foot directly in front of another). Try doing moves with your eyes closed and/or turning the head to challenge and enhance your balancing skills, in order to prevent falls and stumbles. Do lots of squats (some with heel lifts) and knee bends – any exercises that develop strong ankles and work to increase flexibility in the front crease of the ankle and the arches on the bottom of the feet.
Bones need stress management: A study mentioned in Strong Women, Strong Bones found that women who were depressed had lower bone density. Speaking of stress, walking and swimming are great for stress management, but unfortunately these are not weight bearing activities, which are the best things you can do for your bones. Try a light jog (35 to 55 seconds) mixed in with your walk. Repeat and build up.
Bones need good nutrition and lifestyle: Avoid smoking, and cut back on alcohol and sugary beverages. Build proper nutrition, vitamins and minerals into your diet.
Bones need consistent monitoring: In Strong Women, Strong Bones, Dr. Nelson writes that our bones change with the seasons and usually peak after the sun-filled summer months. She advises to schedule regular bone density test at the same time of year.
Next week’s blog tells the extraordinary story of Liuda, who at 60 suffered a hip fracture with complications and had to fight hard to get her life back.