Bone is alive.
Bone is a living and growing tissue. Throughout life, bone is constantly being renewed in a process called remodeling. During remodeling, old bone is removed and it is replaced with fresh new bone. Bone building occurs when more bone is laid down than removed. Bone mass is maintained when bone formation equals bone removal. Bone loss occurs when more bone is removed than replaced.
At what age do I need to be concerned about my bones?
Bone healthy actions should begin in childhood and continue throughout your lifetime. However, it’s never too late to take action to promote healthy bones.
Bone healthy actions are the keys to enable you to build and maintain strong bones. These include:
•eating a well-balanced diet rich in calcium and vitamin D;
•participating in regular exercise;
•taking safety precautions to protect your bones and prevent falls;
•limiting alcohol intake;
•maintaining normal hormonal balance in premenopausal women;
•avoiding excessive dieting and excessive thinness; and
•talking to a medical professional about promoting healthy bones
Why does calcium matter?
Think of your bones as a bank account in which you “deposit” and “withdraw” calcium throughout life. Calcium is a mineral that makes bone dense (thick) and strong. During childhood, the teen years and early adulthood you build your bone bank. The skeleton grows and bones become larger, denser, and stronger especially when you practice bone healthy actions.
Peak bone mass, defined as the maximum bone density you will ever have, is largely determined by your genetics. Peak bone mass is reached between 18 and 25 years of age. In youth and young adulthood, consuming enough calcium each day, participating in regular exercise as well as taking the other actions to promote healthy bones is necessary to reach peak bone mass. People who attain higher peak bone mass have larger and heavier bones and are less likely to get osteoporosis later in life. After age 25, bone healthy actions help maintain bone mass. Throughout your life, if your dietary calcium intake is too low, your body will “withdraw” the calcium it needs from your bone bank. Over time, if more calcium is taken out of your bones than is put in, the result may be thin, weak bones (osteoporosis). In your senior years, usually after age 70, then weak bones may break more easily during normal activities. It is important and easy to meet your daily calcium recommendation by choosing a well-balanced, calcium rich diet. See “Calcium for Healthy Bones” and “The Food Pyramid”.
Why is Vitamin D important?
Vitamin D is necessary to build and maintain strong bones. It helps your body absorb and use calcium. It is important to be sure that you get the proper amount of vitamin D. See “Vitamin D for Healthy Bones”.
Get moving!
Regular exercise at any time in your life is good for your heart, muscle tone, flexibility and coordination. In children and young adults, exercise may actually build stronger bones. After peak bone mass is reached, exercise plays an important role in maintaining bone mass. Exercise builds strength, improves posture, promotes balance to prevent falls and increases muscle mass to cushion bones in the event of a fall. Seniors, people with medical conditions, and those with physical disabilities can benefit from supervised exercise. To ensure your safety, consult your medical professional before beginning an exercise program. This is especially important if you have (or have a history of) a medical condition or if you have been diagnosed with osteoporosis and/or fracture. If you have osteoporosis and/or fracture, it would be beneficial to get a prescription from your medical professional for a physical therapy consultation before starting your exercise program. Taking these precautions will help make sure that your exercise program follows principles of safe movement while you promote healthy bones.
An ideal program combines weight-bearing, muscle-strengthening, postural and balance exercises. Weight-bearing exercise is any physical activity in which your body works against gravity. It simply means that your feet and legs are supporting or carrying your weight. This type of exercise builds bone mass in youth and maintains it in adulthood. Some examples of weight-bearing exercises include walking, racquet sports, team sports, dancing and climbing stairs. Muscle strengthening exercises build muscle that helps support your bones. Lifting weights, using resistance bands and exercising on resistance machines are ways to strengthen muscle. Proper body alignment and postural training exercises promote correct posture and may help to minimize kyphosis (stooped posture) resulting from osteoporosis. Tai Chi is an example of a type of exercise that teaches balance and may be beneficial to reduce the risk of falling.
Keeping your bones safe.
Safety strategies to protect your bones are important for individuals of all ages. It is imperative for everyone to protect their bones and overall health by wearing seatbelts in any moving vehicle and by using appropriate protective equipment when participating in sports.
If you have been diagnosed with osteoporosis, you may be more likely to break a bone as a result of a fall. In fact, most broken bones happen as a result of a fall. Falls happen for many reasons, most of which can be avoided.
It is important to do a home safety check on a regular basis to identify and modify falling hazards. There are many fall precautions that you can take in your own home. For example, securing throw rugs, using nightlights, and installing grab bars in your bathroom are just a few steps that you can take to fall-proof your environment. It is also very important to prevent and avoid wet, slippery floors both in your home and in public areas.
Clothing and footwear need to be selected with safety in mind. Choosing sturdy shoes with non-skid, rubber soles are a wise choice for safe movement. Poor vision and hearing loss are common reasons for falls. It is important to have your hearing and vision checked on a regular basis by your healthcare provider. If you take medications, it is important to know the possible side effects. Some medications can cause dizziness or lightheadedness and increase your risk for falls. For more information about the potential side effects of your medication, speak to your pharmacist.
There are many assistive devices such as canes, walkers and grabbers to help individuals who are at increased risk for falling. A consultation with a physical therapist or occupational therapist is often beneficial to find the right assistive device for a person who is more likely to fall. It is important to speak to your medical professional about your personal risks for falling and about the fall prevention steps you should take.
Make the choice to stop smoking and limit alcohol intake.
Tobacco products are bad for your overall health, including your bone health. If you are a smoker and decide to continue to smoke, you are taking the chance of developing osteoporosis and may be increasing your risk for fracture.
Drinking alcohol to excess may also be harmful for your bones. People who consume too much alcohol tend to have poor nutrition and an increased risk for injury related to falling.
How do hormones affect bone health?
It is important for women to have regular menstrual cycles before menopause. The hormone estrogen regulates the menstrual cycle and promotes healthy bones. It is important for you to speak to your medical professional if you are a woman with infrequent or irregular menstrual cycles. See “Osteoporosis Risk Assessment for Premenopausal Women”. A woman is considered menopausal when she has not had a menstrual period for 12 months in a row, without a medical reason. Menopause may occur naturally, usually between the ages of 45 and 55, or following surgical removal of both ovaries. In the five years following menopause, women lose bone rapidly due to the sharp decline in the bone-protective hormone, estrogen. In fact, women may lose up to 15% of their lifetime skeleton in the five years following menopause (without estrogen).
If you are postmenopausal, after consultation with your medical professional, you may choose to take estrogen therapy (ET) or hormone therapy (HT). Both ET and HT prevent the rapid loss of bone after menopause. However, this benefit to bone must be weighed against your personal risks associated with taking ET or HT. It is also important to understand that the same rapid loss of bone (up to 15% over 5 years) will occur when you stop taking ET or HT no matter how long you have been on it. See “FDA Approved Medications for Osteoporosis Prevention and/or Treatment”.
Men also get osteoporosis and are affected by hormonal changes. Testosterone is the bone-protective hormone for men. For most healthy men, testosterone levels fall later in life. After age 65, men tend to lose bone mass at the same rate as women. It is important for you to speak to your medical professional if you are a man with any medical condition (such as prostate cancer or testicular cancer) that affects normal testosterone levels.
How do weight control practices affect bone health?
For overall health, it is important to achieve and maintain ideal body weight. Unfortunately, many teens and adults are preoccupied with weight and practice unsafe weight-loss methods to achieve an unrealistic thin body image. These methods may include purposely-restricting food intake, over-exercising, purging (vomiting after eating or chronic use of laxatives, diet pills, and/or water pills) and/or use of smoking as an appetite suppressant. Excessive thinness often disrupts normal menstrual cycles in women. Eating disorders in both men and women can lead to bone loss and osteoporosis as well as other life-threatening problems. It is imperative to speak to your medical professional if you think that you may have an eating disorder.
How do I know my risk for osteoporosis?
You can assess your risk for osteoporosis by using the appropriate NYSOPEP Osteoporosis Risk Assessment. See “Osteoporosis Risk Assessment for Postmenopausal Women”, for “Premenopausal Women” (C10) or “for Men” (C11). Risk assessment should increase your awareness of your potential for osteoporosis and motivate you to discuss your concerns with your medical professional. If you have any chronic diseases, medical conditions and/or take any medications commonly associated with bone loss, it is important to speak to your medical professional about how to stay healthy as well as promote healthy bones.
Promoting healthy bones and is a lifelong commitment. Your bone healthy actions can make a difference in the prevention of osteoporosis.
(c) Helen Hayes Hospital/NYS Department of Health – 11/03
