Michael Hunter, MD on Medika Life

Are You Destroying Your Bones?

How being sedentary can put your bone integrity at risk.

DO YOU KNOW HOW MUCH YOU NEED TO EXERCISE to get real benefits in bone density? Regular exercise can help prevent the bone density loss that occurs with aging. Be sedentary at your peril.

Today we explore how you can promote your bone health. I recently wrote about how vitamin D supplementation may not be associated with a lower risk of bone fractures:Vitamin D: What? It Doesn’t Prevent Bone Fractures?VITAMIN D SUPPLEMENTS DO NOT REDUCE FRACTURE RISK, at least among adults in midlife and older adults. That is the…medium.com.

But what can you do to optimize your bone strength? Let’s examine exercise — types and duration — that can help you dodge bone issues. First, a look at poor bone health.

Poor bone health

Bone is living tissue, one that constantly breaks down and replaces itself. Osteoporosis happens when the new bone formation does not keep up with the bone loss.

Osteoporosis results in bones becoming brittle and weak — even mild stresses such as coughing may result in a fracture. Fractures secondary to osteoporosis commonly occur in the spine, wrist, or hip.

Multiple osteoporotic-related wedge fractures as seen on a spine X-ray. https://en.wikipedia.org/wiki/Osteoporosis

Osteoporosis strikes men and women and can affect individuals of any race. The highest risk is among older women who are past menopause.

Your osteoporosis risk hinges, at least partly, on how much bone mass you attained in your youth. Our peak bone mass has an inherited genetic component, and mass varies by ethnicity. The higher your peak bone mass, the lower the odds you’ll get osteoporosis.

Bone density peaks at about 30 years of age. Women lose bone mass more rapidly than men. https://en.wikipedia.org/wiki/Osteoporosis

I approach osteoporosis risk-reduction with a two-pronged approach: 1) maximizing peak bone mass; and 2) minimizing bone loss.

Osteoporosis risk-reduction — Peak bone mass

To optimize your peak bone mass, have a healthy lifestyle during the bone-forming years, especially adolescence. Here are the components:

  • Nutrition. Adequate calcium and vitamin D intake are important. Children ages 9 to 18 should consume about 1300 milligrams of calcium daily, preferably from calcium-rich or calcium-fortified foods. A meta-analysis of 19 randomized trials showed a small increase in total body mineral content in children receiving calcium supplementation (300 to 1200 milligrams daily) compared with those taking a placebo.
  • Physical activity. Exercise promotes bone health. On the other hand, excessive physical activity can harm bone health.
  • Avoid smoking. While cigarettes damage bones, quitting can improve bone density (within one year of cessation).
  • Avoid alcohol. Chronic heavy alcohol use, especially during adolescence and young adult years, can dramatically hurt bone health, increasing the future risk of osteoporosis.
  • Avoid eating disorders. For example, anorexia nervosa, an increasingly common eating disorder in female adolescents, is linked with drops in bone mineral density and increased fracture risk.

Nutritional disorders in adolescence (such as inflammatory bowel disease, cystic fibrosis, and celiac disease) can interfere with bone formation. In addition, congenital disorders such as cystic fibrosis appear associated with low bone mass.

Osteoporosis risk-reduction — Minimizing bone loss

Alas, I am beyond peak bone mass time. My goal is to stabilize my bone mineral density (BMD) or reduce my rate of bone loss.

The United States Surgeon General’s Report on Bone Health and Osteoporosis suggests adopting a pyramid approach to preventing osteoporosis. Doing this means that we focus on physical activity, nutrition, and fall prevention. The second tier of risk reduction includes addressing diseases and drugs associated with bone loss. The third tier involves the use of bone-building drugs.

Let’s start with tier one:

  • Physical activity and bone health. Do you do weight-bearing physical activity? Doing so can improve bone mineral density modestly for pre-and postmenopausal women and men. The Surgeon General suggests we aim for 30 minutes on most days of the week. An added benefit? You may improve your muscle tone and reduce your chances of falling.

Weight-Bearing Exercise: 8 Workouts for Strong BonesHere are the latest weight-bearing workout trends. What are the best ways to exercise and improve your bone health when…www.webmd.com

  • Nutrition and bone health. The optimal intake (diet plus any supplements) of vitamin D and calcium is not established for men or premenopausal women, with many advocates suggesting about 1000 milligrams of calcium. The World Health Organization recommends 500 mg of calcium daily, and the United Kingdom sets the goal at 700 mg.

Interestingly, in 1997, an Institute of Medicine (USA) panel lifted the recommended level for calcium intake from 800 to 1200 milligrams daily for women over 50. The panel based this recommendation based on calcium balance studies lasting only weeks.

We don’t have evidence that consuming that amount of calcium reduces the risk of breaking a bone. The recommendation remains, however. The optimal amount for men or premenopausal women is not known.

Photo by Leohoho on Unsplash

What about vitamin D? The 2018 US Preventive Services Task Force (USPSTF) concluded that “there was insufficient evidence to assess the benefits and harms of calcium and vitamin D supplementation for the primary prevention of fracture in men and premenopausal women.”

The panel recommended against supplementation with 400 international units of vitamin D (and 1000 milligrams or less of calcium) for the primary prevention of fractures in postmenopausal women. It concluded that there is no good evidence to assess the benefits and harms of higher doses.

Individuals at higher risk of being low in vitamin D (such as older individuals confined indoors) may benefit from higher doses. If you take vitamin D supplements, you may wish to consider adding vitamin K:Top 6 Sources of Vitamin KVITAMIN K IS AN ESSENTIAL NUTRIENT central to bone and heart health and blood clotting. You have heard about the roles…medium.com

One potential downside of calcium supplementation? You may raise your risk of kidney stones. Those in the landmark Women’s Health Initiative study who took calcium and vitamin D had a higher risk of kidney stones compared with those taking a placebo. Getting that calcium through food may be best, as high dietary levels may protect against kidney stones.Healthy Foods High in CalciumYour body holds an abundance of calcium. Around 99% of this mineral is stored in your bones and teeth.www.webmd.com

Of course, you shouldn’t smoke (for numerous reasons). Cigarette use is linked with reduced bone mineral density and a higher fracture probability.

Excessive alcohol consumption (more than two United States drinks or three United Kingdom units) harms bone health for many reasons.

Finally, I won’t review pharmaceutical agents (such as hormonal replacement therapy for menopausal women) that help to fight bone loss.

Oh, one more thing: Resistance training may also help you dodge premature death:

Weight-lifting and LongevityRUN, SWIM, JOG, OR WALK. So many cry out for all of us to get more physical activity. But are we being remiss in not…medium.com

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Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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