How to Protect Your Bones from Osteoporosis
"One in three women and one in five men over age 50 are thought to have osteoporosis."
It’s almost Halloween… so let’s talk about our skeletons! Today, Dr. Keller Wortham, MD, is talking about bone health. Our bones are the scaffolding on which our entire body hangs. They protect our inner organs, and our bone marrow is where we create our red and white blood cells. Although they’re a popular theme for Halloween parties, there’s nothing inherently scary about bones themselves. There are, however, some scary things that can happen to them. Tune in to learn more about a particularly scary bone condition, and how to prevent it and keep our bones healthy and strong.
- 01:39: What is Osteoporosis?
- 03:17: What Causes Osteoporosis
- 04:24: Osteoporosis Risk Factors
- 11:08: Diagnosing Osteoporosis
- 12:47: Preventing Osteoporosis
- 15:35: Treating Osteoporosis
- 18:02: Wrap-Up
If you've ever broken a bone, you know that can be very painful and debilitating. But what we’re talking about today is an even scarier condition that happens within your bones as you age, that puts you at greater risk for fractures, and might happen silently without noticeable symptoms. This condition is called osteoporosis, and what’s even scarier than the condition itself is the number of people who have osteoporosis around the world.
What is Osteoporosis?
The term osteoporosis means porous bones. It's basically a condition in which your bones lose minerality — they lose the calcium within them and develop holes, like a sponge. And the scariest part, as we already mentioned, is that this can happen silently. The first symptom that you might notice could be a broken bone.
Unfortunately, osteoporosis is very common and risk increases as you age. One in three women and one in five men over age 50 are thought to have osteoporosis, and it's estimated that osteoporotic fracture happens every three seconds in the world. That is a very scary thought. So, this is certainly a topic that's affecting a lot of people. The fractures that people get are most common in the wrists, hips, and spine, although they can happen anywhere in the body.
What Causes Osteoporosis
Many people think of bones as being solid — we rely on them, and believe they're stable — but the bone is actually a living tissue. It's not just concrete in our body, it is a living tissue that is constantly changing and remodeling, which means that every day, part of our bone is being resorbed and part of our new bone is being created. And this system of resorbing and laying down new bone is hopefully happening in balance, which means we neither lose nor gain bone, but it's just there as a healthy, flexible, resilient tissue.
However, as we age some things can happen which throw off that balance, meaning we are resorbing bone at a faster rate than we’re laying down new bone. When that gets out of balance, you can end up with bone that is demineralized which weakens the bone, causing it to become porous, hence the term osteoporosis. Don't worry, though — there are some good things that you can do to counteract the effects of osteoporosis and aging. Before we get into those, let’s talk about some risk factors that can put you in a higher risk category for developing osteoporosis.
Osteoporosis Risk Factors
As you get older, especially once you reach the age of 50, your risk for osteoporosis goes up.
Women are at a higher risk for osteoporosis than men for multiple reasons. Womens’ bones tend to be thinner and less dense to begin with, and after menopause when estrogen levels fall, the risk of osteoporosis goes up substantially.
If you've got family members who've had osteoporosis then it’s more likely to happen to you as well.
If you have a thinner body, and smaller wrists or ankles then those thinner bones can lose minerality faster and that puts you at risk for osteoporosis.
There are also some other risk factors having to do with hormone diseases or conditions. We talked about menopause, which is not a disease, but when estrogen falls during menopause, women have a tendency to lose bone faster and can get osteoporosis more easily. The same thing happens in men with testosterone. As you get older testosterone levels can dip, and men can lose bone more quickly, putting them at risk for osteoporosis.
There are also other issues that can mess up your hormones. That can include treatments for breast cancer, some of which involve estrogen blockers, which can make osteoporosis worse. Treatments for prostate cancer in men block the hormonal effects on the prostate but also block the benefits of testosterone for the bone. Additionally, hyperthyroidism tends to cause bones to weaken faster. Even more commonly, people who have low thyroid (hypothyroidism) but are on a thyroid medication, can see an increase in the speed of the bone metabolism, leading to osteoporosis, if their thyroid medication dose is too high. So, if you're on a thyroid medication, it is really good to have your thyroid levels checked and make sure that your prescription is right in the sweet spot for controlling your thyroid levels. Also, there can be conditions of the parathyroid glands which are little glands within the thyroid area — if they're hyperactive, they can lead to issues with bone minerality.
Not Enough Calcium in the Diet
There are some other things that you have a little more control over, including what you eat. Calcium is very important for bone health, as you probably know. We have all heard it since we were kids — we were told to drink our milk because calcium is the main mineral in bones and we need to get a lot of that from our diet. Dairy products are one of the main sources of calcium. It can be found in yogurt products, cheeses, or products like kefir. If you're not a dairy person, you can get calcium from leafy greens like kale, spinach, and broccoli.
In addition to the need for calcium, dietary habits contribute to osteoporosis risk in other ways. For example, if you're not eating enough calories and become malnourished, that can put you at a higher risk of osteoporosis because you’re not getting all of the other minerals you need for your bones and the proteins you need for proper metabolic function.
For people who are taking steroids like prednisone on a long-term basis, for an inflammatory condition or an autoimmune disorder, that can really decrease the minerality of our bones. So, if you are taking this type of medication, it’s important for you to be screened for osteoporosis. Other medications, such as medications for acid reflux or stomach ulcers, can alter the acidity of your stomach and that can make it harder for you to absorb calcium from your food sources. If you're taking long-term antacids like Prilosec, or Zantac, you can reduce the amount of calcium that you're absorbing from your diet.
Medical conditions that can increase your risk of osteoporosis include gut diseases like inflammatory bowel disease, and celiac. Again, this is due to the absorption capabilities of your gut. Kidney disease and liver disease can also be a factor, since a lot of the vitamins that we need for our bones, including vitamin D, are made and activated within the kidneys and the liver. Diseases that affect these organs can change the way that our bones mineralize and put you at greater risk.
People who have a sedentary lifestyle have a higher risk. So, if you drive a car or a truck for a living, or you have an office job and you don't get a lot of exercise, that puts you at a higher risk. Exercise is really good for generating bone minerality. Our bones love to feel the impact of jumping and running and dancing, and as our muscles get stronger, especially with things like anaerobic exercise that strengthen muscles, the muscles put tension along the length of the bones. That muscular tension also stimulates the bones to get stronger. So, exercise is very important.
Smoking and Excess Alcohol
Smoking tobacco is terrible for your bones, and may increase your risk. Excess alcohol is also terrible for your bones. So, if those are things you're doing cut back on both to help protect your bone health.
How do you know if you have osteoporosis? We’ve already discussed that it is a disease that can happen silently, and often the first indication is a broken bone. You don't want to wait until you break a bone to discover you have osteoporosis. So, if you have some of the risk factors we just talked about:
- You're over 50
- You're a postmenopausal woman
- You've got a family history of osteoporosis
- You have thin frame bones
- You have some of the medical conditions we mentioned
- You’ve been on prednisone or acid blockers for a long time
Talk to your doctor about screening. Your doctor can do a test called a DEXA scan, which looks at the density of your bones using X-ray technology. They can look specifically at the density of the bones of the hip and spine, the different vertebrae, and determine what your risk is for having an osteoporotic fracture based on how your bone density levels compare to those of people in your age group, as well as people of an ideal age position (such as someone in their early 20s). This information can produce a calculation to determine the risk of your breaking a bone within the next 5 to 10 years. If that risk is high then you need to start some kind of treatment.
Prevention is always key, so it’s best to start with preventative measures. If your bone density is low, they could be in a category called osteopenia which is just before osteoporosis. In that range, your bone is thinner but not quite at the level that we would call osteoporosis. If you're in that risk category, there are some things you really need to start working on to make sure that you're getting your bones stronger.
- Exercise — Just start exercising, putting stress on those bones, they are going to love it. Obviously be careful; you don't want to fall and break something, but that muscular stress is going to be very helpful for your bones.
- Healthy Diet — Eat a diet that includes things like kale and other leafy greens, dairy products, and other foods that will help you get enough calcium to fortify your bones.
- Maintain an Ideal Body Weight — Keeping your weight in a healthy range can help you avoid other conditions like diabetes, which can reduce your bone density.
- Supplement with Calcium — If you think you're not getting enough calcium from your diet, you can take a supplement. About 1,000 mg of calcium is a great dietary target or 1,200 mg of calcium if you're over age 50 and at risk for osteoporosis. A note on calcium: it's a crucial mineral but you don't want to take too much because there are indications that it could promote kidney stones or coronary artery disease. So you want to make sure you’re taking enough, but not too much — less than 2,000 mg of calcium per day.
- Supplement with Vitamin D — Vitamin D is really important for your bones because it helps get the calcium into the bones. Calcium doesn't get there on its own; you need vitamin D to help absorb it. Typically, if you've got normal vitamin D levels in your body, somewhere around 600 to 800 International Units, that’s sufficient, but a lot of people are vitamin D deficient. They don't get enough in their diet, and they don't get it activated in their skin by sunlight because they're indoors or wear sunscreen. In that case, you need to take a higher amount — 4,000 to 5,000 IU per day. The Smarter Vitamin D supplement is a robust plant-based vitamin D3 that provides 5,000 IU per day, so it’s great to add to your diet if you're at risk for osteoporosis.
If all of that doesn't work, or you’ve already started developing osteoporosis, don't worry. There are some things you can do to increase your bone density with treatments, including prescription medications.
The first type you might take is in a category called bisphosphonates; Fosamax is an example. There are other categories in the same realm, but that's one of the most common options. These medications are usually pills that you take either once a month or once a week, and they can help get calcium into your bones if they are already really porous. There are risks associated with these medications though, so talk to your doctor before starting them. One of the risks involves issues with the jaw — if you have any jaw problems or you're having dental procedures, talk to your doctor about that, as you might not want to be on that kind of medication. Overall, though, bisphosphonates are an important category helping get calcium into your bones.
There are shots that you get every six months or so in the skin — Prolia is one example — and these can really help beef up the calcium in your bones. It's typically something that would be prescribed if your case is more severe, or if medications in the first category are not working.
If neither of those are options that you want to try and you'd rather try something a little more natural, there are hormone treatments. Depending on how severe your osteoporosis is and what your hormone levels are, you can opt to be treated with estrogen if you're postmenopausal and get those estrogen levels up to try to support your bones. You can do the same with testosterone if you're a man with osteoporosis. So, talk to your doctor about maybe hormone replacement therapy to fortify your bone density.
If that doesn't work and your bones are so demineralized that doctors worry about the possibility of a fracture, then there are some bone-building medications that are reserved for severe cases. Those are typically given for one to two years, and they're usually injections. They can really help get additional calcium into your bones fast, and then you stop taking them and move on to maintenance treatments. So those are all treatment options for osteoporosis.
The bottom line is, it’s always best to try preventative measures first. You can prevent osteoporosis by living a healthy lifestyle, not smoking, not drinking in excess, avoiding a sedentary lifestyle, or counteracting it by exercising, as well as doing your best to get calcium in your diet with vegetables and dairy products. Also, taking a calcium supplement or vitamin D supplement can help give your bones the best chance of staying healthy and keeping osteoporosis at bay.