At least 1 in 3 women and 1 in 5 men will break a bone due to osteoporosis in their lifetime! (osteoporosis.ca)
Osteoporosis is a serious condition where bones deteriorate so much that the bone tissue becomes porous. It is an invisible and painless disease, and without a bone density test we have no way of knowing if we have it.
I myself was diagnosed at 60 with osteopenia (the precursor condition, where bone is characterized as thin but not yet porous). Hearing the results of my first bone density test was a shocker until I found out how common this diagnosis is in postmenopausal women. Osteopenia does not automatically lead to osteoporosis, but it should be a wake-up call. For the last five years, I have been trying everything in my power to get my levels back to normal (or as close as possible). As soon as the pandemic allows, I will book another bone density test to see how I’m doing.
Osteoporosis is a much more severe condition than osteopenia as it means the bones are porous, very weak, and with a dangerously high risk of fractures. Without an active intervention, osteopenia can become osteoporosis.
Numbers Don’t Lie
The best way to know about your bone-mineral density (BMD) is to take a safe, quick, and painless test that measures the amount of mineral in a specific area of your bones (hip and spine measurements are the ones usually done). The test gives you a T-score that compares your bone density with that of the average healthy young woman. As Dr. Miriam Nelson explains in Strong Women, Strong Bones, your T-score is calculated to describe the density of your bones and your risk of fracture in each category (below normal is always indicated with a minus (-) sign). If your T-score is between -1 and -2.5 this is a diagnosis of osteopenia, which means your fracture risk is approximately twice as high as average. If your T-score is less than -2.5, the diagnosis is osteoporosis. This means your bone mass is very low, lower than the average young adult woman by more than 2.5 standard deviations, and your risk for fractures is approximately three times higher than average (link to Strong Women, Strong Bones by Miriam Nelson).
Nelson recommends that women get a bone density test as early as perimenopause: ‘As you approach menopause, bone loss accelerates. A baseline test will help you decide about hormone replacement and other protective measures during these critical years.’
In addition to getting a bone density test, it’s also important to know the risk factors for osteopenia and osteoporosis, and consider which may apply to you. The first risk factor is being a woman and being postmenopausal, especially if you experienced early menopause (before age 45). Other risk factors are genetic: if your parents have had a hip fracture, or if you yourself have fractured a wrist or other bone. Asian and fair-skinned Caucasian women are most at risk. Menstrual history should be taken into account, (women who started menstruating at age 15 or older are at higher risk) and body type (tall and slender or underweight).
What Happens to our Bones
Throughout our lifetime our bones continuously refashion themselves through a process called bone remodelling. After menopause, however, most women lose bone fast as calcium absorption and estrogen levels decline. This creates an imbalance between bone reabsorption and bone formation. The bone cells that break down are called osteoclasts. They dissolve bone—clear it away. Cells called osteoblasts build the bone back up in a process that takes three to six months. As Nelson writes: ‘Without estrogen to contain them; the bone-dissolving osteoclasts increase their activity by about 20 percent; the osteoblasts don’t increase to match’.
One of the risk areas for fractures are the spinal vertebrae, especially in the low back area and mid-to-upper spine where compression fractures can occur. With this sort of fracture, the front of the vertebra compresses or squishes down on top of another vertebra, eventually creating a humped or bent-over posture in the spine. Another high-risk area is the hip, where fractures can occur at the neck of thighbone (most common) or across the top of the thighbone. Hip fractures are extremely serious, as they can lead to loss of independence, the need to move into supportive care, and earlier death. But remember that if you have a diagnosis of either osteopenia or osteoporosis, there’s a lot you can do to manage and even reverse these conditions.
How to Take Charge—Bones Need Stress and Stimulation
Exercise is highly recommended in both cases; so is balance, strength and core training. Resistance training, using weights and bands, protects joints and improves the quality of bone by delaying the action of the osteoclasts that break down the bone. In one of Dr. Nelson’s studies, she incrementally and progressively increased the amount of resistance. She divided a group of healthy but sedentary postmenopausal women into two groups. Half the women maintained their usual lifestyle, while the other half came to her lab twice a week and lifted weights. After strength training twice a week for a year, bone loss was prevented or reversed in the second group and flexibility and balance improved. In addition to weight training, Nelson also advocates the benefits of hopping and jumping for women who have joints strong enough to withstand the impact. Bones need stress and stimulation, always keeping proper alignment in place. Avoid jumping and other high-impact moves if you have osteoporosis, knee or hip replacements, or ankle and feet problems.
Other actions that are not recommended for those with osteoporosis are bending forwards or sideways, as well as rotation and twisting. When doing planks and exercises on the hands and knees, avoid taking weight on the wrists, go down on your forearms instead. Also you must learn how to get up from the mat, or out of a bed, without twisting or bending.
Nutrition is another important component to bone health. As is the intake of calcium and Vitamin D. Avoid smoking, and limit alcohol and carbonated beverages. I would highly recommend that if you have a diagnosis of osteoporosis, you meet with a nutritionist who specializes in diet and medication for your condition to advise you on how you can build up your bones.
Start Early with Prevention
Osteoporosis is a preventable disease. In youth, our bodies are programmed to accumulate bone. This is why good diet and exercise are so essential for preteens and teens, and why resistance training benefits youth as much as older people. You might remind your grandchildren and the young people around you that their present diet and exercise habits will affect them much later in life. Encourage them to take up bone-stressing play, such as skipping and hopscotch, or activities such as dance or track and field.