By Amanda Mittleman, M.S.
How do you know if your bones are strong or brittle and weak? Unless you have Superman’s X-ray vision, or you have a bone density test, you actually won’t really know. However, there are many factors that determine the health and strength of your bones and the good news is, most of those factors are up to your lifestyle choices. You may not have thought much about osteoporosis unless you or a family member has been diagnosed with osteopenia or osteoporosis. But you should know that osteoporosis is a silent killer and can take away your independence in your old age. How do you live a high quality, independent life until the very end of your life? By creating a lifestyle that supports a LONG healthy, independent life, starting today.
It’s NOT normal to be sick for the last years of our lives. It’s NOT normal to depend on home health care and home health care and assisted living facilities ARE INCREDIBLY EXPENSIVE. I don’t mean to be morbid here, but your health in the last years of your life starts today. Jack Lalanne died at age 98. He was sick for a few days. He had plans for Thursday but went to sleep on a Wednesday and didn’t wake up. That’s the way we are supposed to go. Do you want anyone to be wiping your rear when you are 99 years old? Ummmm Nope!
You start taking care of your body today.
There are three parts to this What You Need To Know About Your Bones series. Part I will focus on osteoporosis; what it is and factors that can lead to osteoporosis. Part II is about the anatomy of your bones and how healthy bones are made and maintained throughout you life time. Part III will provide you with an action plan to help you prevent, or at least prolong osteoporosis if you have been diagnosed with osteopenia, you are genetically predisposed or your lifestyle habits have been leading you towards degenerative diseases such as osteoporosis.
Ultimately, the good news is, you can change your life trajectory today.
Many people don’t find out they have osteoporosis until it’s too late. Often a fractured wrist, vertebra (bone in your spine) or a hip fracture while tripping over a dog, coughing or reaching for the toilet paper is how someone finds out they have frail bones or osteoporosis. Hip fractures are generally the most dangerous types of fractures. Six months after a hip fracture, only about 15 percent of patients are able to walk across a room without help. Women who have fractured a hip also have four times greater risk of sustaining another bone fracture. You should also know that 24 percent of Americans over the age of 50 who fracture their hip die within one year. It makes sense that vertebral fractures are also highly linked to increased risk of death.
Patricia, one my clients and a very good friend had worked out for her entire life. She was one of the tiniest but strongest women I had ever known. Pat had to have a hip replacement in her sixties and doctors just assumed she would need to be sent directly to a convalescent hospital immediately after her surgery. Did you know this is protocol? Crazy right? Pat was always a Wonder Woman to me, but her status was projected to super Wonder Woman when she called the evening after her surgery, furious. She wanted to walk! She had to fight to convince the doctors that she was ready to walk. The doctors let Pat walk about 20 feet and then decided she could go home the next day. She texted me two days later that she had been vacuuming that morning and was feeling great!
I tell this story to remind you the importance of a lifetime of physical activity. Pat wasn’t competing in the Cross Fit games. She had tiny bones but she was not at risk of fractures. Her hip was replaced because of an old injury. She simply exercised every day, some days lightly, some days with more intensity. Pat was physically active throughout her days (even after she had exercised) with her dogs and hobbies. She was an incredibly strong woman inside and outside.
Unfortunately, Pat was an outlier, meaning she was a rare case. She was a woman over the age of 65 who was also in great shape because she had exercised and taken good care of her body for many, many years. There are definitely more women like Pat, and many of these women are at Mo-Mentum Fitness! But we still need more. My goal is to make this the norm. Most women over the age of have to spend another two to six weeks in a convalescence home recovering from a hip replacement or a hip fracture. To be honest, I’d rather gouge my eyes out than have to spend one day in a convalescent home. Let’s just be honest, if you want to feel old and get completely depressed, get yourself checked into a convalescent home. My goal is to transform women’s’ thinking (or confirm women’s thinking) that exercise is an ESSENTIAL part of living a high quality life and like brushing your teeth, it must be done daily to make you stronger.
The Human Body Is Designed For a Lifetime Of Sturdiness
The human body is designed to live on this Earth, well supported by our bones from birth until old, old age. However, I hear these words on a daily basis, from clients, friends, strangers and family members, “It sucks getting older!” But did you know that there is nothing innate in the condition of being human or in the postmenopausal woman that specifically causes our bones to weaken and break as we get older? In other words, disintegrating bones are not a given in the aging process. Instead, weak bones and aches and pains are much more associated with your lifestyle choices and those choices can be modified today.
Osteoporosis is a degenerative disease, just like hypertension, obesity and coronary heart disease. These types of illnesses are not experienced or are VERY rare in indigenous people who live hunter-gatherer lifestyles characterized by regular exercise, whole food diets and lower stress associated with a strong connection with their basic needs for love, the sense of belonging, safety, family and happiness above having more “things.” Unfortunately, the American culture teaches us to regard our bodies as unreliable and out of our control disconnecting us from the wisdom of our bodies. So it is not surprising that an enormous number of young women are losing bone at earlier ages as a side effect of a highly processed-food diet, low nutrient intake, and highly sedentary lifestyle.
What Is Osteoporosis
In part II of this bone series we’ll jump into “How” osteoporosis happens and what it is. To understand this more fully we’ll have to get into the anatomy of your bones. Don’t worry; this part won’t be a bunch of crazy science terms.
What Osteoporosis Can Look Like
It’s probably safe to assume, you’ve seen older women who are shrunken and hunched over with the Dowager’s hump and potbelly. She didn’t wake up one morning like this. It took years of ignoring the hump on her neck and the pain associated with that hump. Not because she wanted to ignore it, but because she didn’t know she had options to stop the process. But you will understand that you HAVE OPTIONS TO STOP THIS PROCESS NOW. The answers may not be “easy” like taking a drug but the answers are simple. A Dowager’s hump is the result of vertebral crush fractures in which the bones (vertebra) in the neck/spine actually collapse. Vertebral crush fractures result in pain, disability and disfigurement. If your mother or grandmother looked (or looks) like this you could be seeing picture of your future unless you take action to change some things about your lifestyle today.
Osteoporosis Is Expensive
The total average expense for hip fractures averages about $35,000 per patient (this is just for the surgery). That’s a lot more expensive than $129 a month or even $200 a month to exercise in a safe and effective environment (you had to know I would throw that in here! IT’S SUCH A SIMPLE TRUTH!).
Females Are More Prone to Getting Osteoporosis
Females have higher rates of osteoporosis than men and tend to develop it earlier than men for two basic reasons:
- Women have smaller, thinner bones than men
- Estrogen is a hormone that protects bones. It greatly decreases when women reach menopause, which can lead to bone loss. This is why women tend to have increased rates of osteoporosis after menopause.
Men have thicker, stronger bones than women due to their genetics and the higher levels of testosterone (which is a bone-building hormone) circulating in their bodies. Generally, osteoporosis in men is often related to heavy alcohol consumption over a lifetime or steroid use.
Women and Osteoporosis Facts
- It is estimated that 10 million Americans have osteoporosis, and about eight million (or 80%) are women.
- Approximately one in two women, over the age of 50, will break a bone because they have osteoporosis.
- The risk of breaking a hip, for a woman, is equal to her combined risk of breast, uterine and ovarian cancer.
- By the age of 85, most Caucasian women in the U.S. will have at least one partial deformity of their spine.
The risk of getting osteoporosis for African American women is much lower than for Caucasian women and the risk for Latina and Asian women falls in between. The reason for this general difference in fracture risk is partly due to the fact that women with more pigment in their skin have a thicker collagen matrix to build their bones.
Misconceptions About Osteoporosis
There are many misconceptions about osteoporosis. For example, it is quite possible for an eighty-year-old women to have the bone density measurements of an average twenty-five-year-old; and unfortunately it is also possible for a twenty-five-year-old to have the bones of an average eighty-year-old. The most important thing for you to know today is that osteoporosis does not happen over night. It’s a process. It’s kind of like a cucumber becoming a pickle. Once a cucumber becomes a pickle, it can never be a cucumber again. So don’t become a pickle! There are several actions you can take today to help you either maintain the bone you have or build it to new, healthier levels and prevent or greatly delay the onset of osteoporosis. Just don’t wait until Monday, start today!
You would be correct to associate brittle easily broken bones with osteoporosis. But the bigger problem with osteoporosis is actually not broken bones: it’s being bedridden. People who are bed ridden die more easily than active people because they are more susceptible to infection and depression. When your body is unable to move, your immune system becomes vulnerable to diseases and infections. Your arteries also become less elastic and more prone to injury and your blood pools in your veins instead of being shuttled back to your heart and lungs to be deoxygenated. Finally, bed ridden and highly sedentary people are also at very high risk of severe mental depression.
Are You At Risk Of Getting Osteoporosis?
The following list of osteoporosis risk factors is from Doctor Christiane Northrup’s book, The Wisdom Of Menopause (Revised Edition): Creating Physical and Emotional Health During the Change. If you relate with only one or two of these risk factors, your bones are probably fine. If you can identify with several of these risk factors, it’s time for you to make changes today and probably push for a baseline bone density test. Don’t wait.
It is also important to know that many of these risk factors are also risk factors for heart disease. You can chose to change the trajectory of your life today and get a handle on your bone AND heart health! And keep in mind that whether you are at risk for osteoporosis or not, just like the rest of your body bone is a dynamic, living work in progress. This means that you have a choice to make the necessary changes for your bone to become more healthy. But you have to take action for the changes to happen.
- Your mother has been diagnosed with osteoporosis or has had a hip or other osteoporotic fracture. Osteoporosis tends to run in families, but there’s still a lot you can do to prevent it.
- You have fair-skin and blue-eyes. Genetically, blue-eyed blondes and those with red hair have less collagen in both their bones and skin than do those with brown, black, or yellow skin tones. Black women have the least risk for osteoporosis because they tend to have thicker bones and more robust collagen stores than Caucasian women.
- You are tall and thin, or have a tiny build and/ or less than 18 percent body fat. Tall women, especially those with small bones, may be at higher risk for purely mathematical reasons: they enter menopause with less bone to lose.
- You smoke. Chemicals in cigarette smoke poison the ovaries and decrease your hormone levels prematurely. Estrogen, testosterone, and progesterone all have bone-protective effects.
- You spend most of your time indoors. Women who are exposed to very little natural sunlight may be deficient in the natural vitamin D normally produced in sun-drenched skin. Vitamin D is an essential ingredient for bone mineralization. Research supports than women with serum vitamin D levels of 20 or lower are at highest risk of osteoporosis and fractures. The sunlight–bone health link is so important that I’ve devoted an entire section to it later in this chapter.
- You are sedentary and spend fewer than four hours per day on your feet. Bones respond to gravitational forces (vertical vectors of force) placed on them regularly. A sedentary lifestyle simply does not provide enough weight-bearing exercise to stimulate bone growth. Many studies have shown that bed rest is associated with osteoporosis. In contrast, weight training has been shown to build bone density even in postmenopausal women who aren’t on estrogen.
- You have over-exercised for much of your life. The lifestyle of the over-exercisers includes dieting for weight loss and/ or engaging regularly in strenuous exercise such as marathon training without enough recovery. The chronic stress of overtraining combined with dietary restrictions and can impair mineral intake and absorption. It also screws up the hypothalamic-pituitary-ovarian-adrenal axis—the very finely tuned feedback loop between the brain, the body, and our hormone levels. Chronic overexercise without adequate caloric or mineral intake results in stress fractures. These kind of fractures are currently on the rise in young athletes and can set the stage for later osteoporosis.
- You have a history of amenorrhea (no periods) associated with anorexia and / or excessive exercise. Amenorrhea results in the imbalance of the hypothalamic-pituitary-ovarian-adrenal axis similar to that seen in depression. The end result is lower estrogen, androgen, and progesterone that leads to osteoporosis and other degenerative diseases.
- You drink more than 25 g of alcohol per day. (The following servings each contain about 10 g of alcohol: 12 oz of beer, 4 oz of wine, and 1.5 oz of 80-proof beverage.) Alcohol inhibits the function of your bone builders (osteoblasts) and bone demolition crew (osteoclasts).
- Your liver is overstressed. Your liver’s ability to produce and metabolize estrogen is essential for the growth and maintenance of strong bones at any age. Taking medication known to be hard on the liver (such as certain cholesterol-lowering drugs), drinking more than two alcoholic drinks per day and infection with viral hepatitis are among the significant liver stressors that can harm bone health.
- You drink more than two units of caffeine per day (8 oz of coffee = 1 unit; 12 oz of cola = 0.4 units). Caffeine results in increased urinary excretion of calcium; the more you consume, the more calcium you lose. Note: Even though tea contains caffeine, both green and black tea have been shown to build bone mass—probably because of their phytoestrogen content.
- You eat mostly processed foods (poor diet)—meaning you eat very little fresh food, few leafy green vegetables, and lots of junk food. Highly processed foods don’t provide your body the minerals and other nutrients necessary to support the growth and maintenance of a solid bone.
- You went through premature menopause (before age forty), have had your ovaries removed surgically, went through menopause as a result of radiation or chemotherapy, and/ or have prematurely gray hair. A woman who enters menopause early for any reason is at increased risk for osteoporosis unless she gets adequate hormone therapy during the years when her body would normally have been producing higher levels of hormones. According to Dr. Christiane Northrup, nonsurgical premature menopause, and the premature graying of the hair that often accompanies it, are the result of an autoimmune reaction affecting the ovaries and hair follicles. The cause of these reactions isn’t clear.
- You take steroid drugs regularly for conditions such as asthma or lupus. Steroid drugs result in accelerated breakdown of all tissue in the body—including the collagen matrix for both skin and bone. Steroids reduce calcium absorption by diminish the sensitivity of the bowel to vitamin D. Prolonged steroid use may also significantly decrease estrogen and androgen levels.
- You’ve taken high doses or been on a long-term regimen of any of the prescription or over-the-counter drugs known as proton pump inhibitors (PPIs), including esomeprazole (Nexium), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), rabeprazole (Aciphex), dexlansoprazole (Dexilant, Kapidex), or pantoprazole (Protonix). These popular drugs, which block the production of stomach acid, are commonly used to treat gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus. Research shows that they may increase risk for hip, wrist, and spine fractures. The problem with Acid blockers is that having some acid in the stomach is crucial for absorbing bone-building nutrients such as calcium. Your digestion impaired when you take acid blocking drugs.
- You’ve begun to lose height. Be sure to be very careful and have someone you trust measure your height regularly. Researchers have found that women who lost 4 cm or more in height have a significantly higher risk for vertebral fracture.
- You have a thyroid disorder. Women who suffer from hyperthyroidism are at risk because the excess thyroid hormone (thyroxine) that their bodies make stimulates the cells that break down bone (osteoclasts). Those with hypothyroidism may also be at risk if their dose of thyroid medication is too high. If you have thyroid disease, make sure you are on the lowest dose of thyroid replacement possible for your situation, and follow a sound program for maintaining bone health. (For a holistic approach to thyroid disease, see The Thyroid Solution: A Mind-Body Program for Beating Depression and Regaining Your Emotional and Physical Health [Ballantine Books, 1999], by Ridha Arem, M.D.) MEASURING BONE DENSITY
Stay tuned for Part II (Anatomy Of Your Bones) of the What You Need To Know About Your Bones: Part I Facts About Osteoporosis series.