Why Bone Health Should be a Priority

...and how to protect your bones before the damage is done

Osteoporosis is shockingly common and profoundly life-altering. Weak bones can lead to pain, loss of independence, bone fractures, and more. This disease can turn your world upside down - I know, because I’ve seen it in my family.

In my opinion, osteoporosis doesn’t get nearly as much attention as it deserves. Today, I’m sharing a bit about my family’s story, and some practical advice steps that you can take to reduce your risk of osteoporosis.

I can vividly picture my gentle, soft-spoken grandmother. Thought she never complained about her condition, it was clearly debilitating. She quietly spent her days in bed, surrounded by a slew of mysterious medications, which I now realize included many painkillers. When she did leave her bed, she walked slowly, with a cane or walker, stooped over to an extent that was hard to fathom.

Osteoporosis rocked my mom’s world three years ago, shortly after her 70th birthday, just as she retired from an intense academic career. She had been visibly shrinking for several years but she felt good, and led a very active life, including brisk hilly walks and bootcamps where she kept up with fit youngsters. This disease has transformed her life. She is dramatically shorter, needs a walker to take even a few steps, pops several different painkillers daily, and periodically suffers such intense back pain that she is bedridden for days. Her posture and slow pace are now eerily similar to that of her mother.

Naturally, I’m terrified of suffering the same fate. To get a sense of why you, too, should be fired up about osteoporosis, and what you can do about it, read on.

Osteoporosis statistics

• Bone fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined. Here’s a snapshot of diagnosed osteoporosis (an underestimate) among Canadians age 40 years and up (from Canada.ca):

  

• The US Surgeon General’s report predicted that for adults who are now age 50, roughly half of women and a quarter of men will experience an osteoporosis-related bone fracture in their lifetime (this figure is rising as we live longer).

• Hip fractures are a common and devastating outcome of osteoporosis. Roughly 22% of women and 33% of men who suffer a hip fracture will die within the following year.

Fortunately, there is a lot we can do to reduce our risk of developing osteoporosis. Lifestyle choices can make a big difference, especially if we invest early and consistently. Before we dive into preventative strategies, let’s talk definitions and diagnosis.

How is osteoporosis diagnosed?

Osteoporosis is often diagnosed through a dual-energy x-ray absorptiometry (DXA) scan that shows bone density. The official cutoff for osteoporosis is a bone density that is 2.5 standard deviations below that of an average healthy young adult (in other words, lower than 98% of young healthy adults). Osteoporosis can also be identified through a fragility fracture - breaking a bone under circumstances that wouldn't normally break a strong bone. Read more about T-scores and testing here.

Scary Fact: Bone density peaks around age 30, then slowly declines. In women, it drops steeply for 5-10 years after menopause due to declining estrogen levels.

How can I reduce my risk of osteoporosis?

Don’t smoke. Smoking is directly linked to a greater risk of osteoporosis. The less you smoke, the better for your bones.

Limit alcohol. High levels of alcohol are associated with a greater risk of osteoporosis. The effect of moderate levels (<5 drinks per week) is unclear.

Eat well to fuel your bones. The star nutrients for bone health are calcium and vitamin D. It’s worth taking stock of your calcium needs and intake, and investigating your potential needs for a Vitamin D supplement. Other important nutrients include potassium, magnesium, and vitamin K. In all of these cases, bear in mind that more is not necessarily better - the goal is to meet your needs. To cover your bases, experts recommend loading up on fruits and veggies, including leafy greens, along with ample calcium-rich foods (see UK National Health Services).

Exercise to load your bones: Resistance and weight-bearing workouts are your bones’ best friends - ideally paired with balance. Note that you don’t have to pump heavy iron to load your bones; even body weight exercises, like walking can help. A recent meta-analysis looked across studies in post-menopausal women found a positive effect for a wide variety of exercises - though results vary considerably from study to study. That said, if you are inclined to pump iron, go for it - there are so many benefits to strength work. Studies have shown that older adults can safely pick up resistance training, with proper coaching to avoid injuries.

Body weight: A moderate weight is your best bet from an osteoporosis perspective. There is a fairly strong link between body mass index (a highly imperfect measure of obesity) and bone density. Thinner, lower body weight people are at considerably greater risk, and people with obesity are at lower risk, a phenomenon dubbed “the obesity paradox”.

At the same time, there are many major risk factors that we can’t control. People like my mom can succumb to osteoporosis despite doing everything in their power to avoid it. She checks just about every risk box: caucasian, female, slim, family history, and a long history of use of glucocorticoids (steroid hormones) that she needs to manage a separate medical condition. These hormones damage bone density in a big way; yet, for her, these drugs are not optional.

Should I get my bone density screened?

We can’t feel the strength or weakness of our bones, so we often don’t realize that we have weak bones until we get a fracture. This is where bone density screening comes in. It can help flag low bone density and provide an extra nudge to pursue lifestyle strategies and/or medications as needed.

Any type of screening comes with a balance of risks and benefits, which is why guidelines often differ slightly across expert bodies, and decisions need to be tailored to each person. For women, most organizations advise starting bone density screening at age 65 (or younger in people with major risk factors). Guidelines are aligned across Osteoporosis Canada, the US Bone Health and Osteoporosis Foundation, and the US Preventative Services Task Force. For men, things are murkier. Osteoporosis Canada recommends screening after age 65 whereas Bone Health and Osteoporosis Foundation advises age 70 (and younger if other risk factors present). However, the US Preventative Services Task Force concluded in 2018 that “the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.”

Personally, given my anxiety, the high stakes and the opportunity to intervene before things get ugly, I wanted data ASAP. I pushed to get my first official DXA scan done last year (at age 46) due to my high-risk profile: white, family history, and early menopause. I also paid for a few lower-resolution body scans out of pocket a few years earlier, as part of a personal self-experiment to track the results of my personal fitness project. Thankfully, my bones are looking good, and I plan to keep it that way as long as possible!

If you want to know your 10-year risk of a bone fracture, your bone density is a big part of the picture, but it’s not the only piece of the puzzle. The gold standard for fracture risk is called FRAX. The key risk factors overlap a lot with the osteoporosis risk factors we touched on above and include: age, sex, height & weight, previous fracture, family history (hip fracture), smoking status, glucocorticoid use, rheumatoid arthritis, presence of secondary osteoporosis, alcohol use, and bone density.

Closing thoughts

I hope this article helped raise your awareness of the urgent need to invest in bone health from an early age, and empowered you to take concrete actions for yourself and your loved ones. Stay tuned for more information on osteoporosis treatments, which can be a powerful addition to your toolkit.

Last but not least, please check out my podcast and other resources below for more information and talk to your doctor. The information in this article only scratches the surface of this complex topic, and is not a substitute for personalized medical advice.

Best,

Chana Davis @FueledbyScience

Related podcast episodes

Bone Health Part 1: Osteoporosis Prevention with Dr. Joy Wu. Dr. Wu is an endocrinologist and researcher at Stanford University’s Department of Medicine who specializes in osteoporosis and other bone mineral diseases. She brings remarkable knowledge, compassion, and optimism to the table. 

Tune into Get Real Health with Dr. Chana Davis, Ep.54 on my website, Apple Podcast, or Spotify.

Resources

• Risk Factors (International Osteoporosis Foundation)
  https://www.osteoporosis.foundation/patients/about-osteoporosis/risk-factors

• Fracture Prevention (Bone Health and Osteoporosis Foundation)
  https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/

• Osteoporosis Canada (Osteoporosis Canada)
  https://osteoporosis.ca