Bone density and bone health is such as strange topic. The stats tell us that with a globally aging population, declining bone health and Osteoporosis is on the rise and costing the developed world a lot of money on a daily basis, and contributing the an increase in mortality for those who survive breaks and a dramatic loss of independence and quality of life otherwise.
Remarkable then, that paying attention to ones bone health is still viewed very much as 'an old persons problem' when in fact it's very much a 'issue' that we really need to start addressing in our 30's onwards and not just in terms of 'weight-bearing-exercise' and 'build more muscle'. And because we're not really talking about bone health, we're also not talking about the everyday habits and factors that could be robbing you of your bone health and the really simple steps you could take to ensure you support your bone health on a much deeper level.
A few Osteoporosis/Bone Health Facts and Figures (taken from the 3rd Age Woman Certification Module on Bone Health by Michelle Lyons)
- Bone remodeling is a lifelong process, but unfortunately bone loss starts to outpace bone gain as we age. This starts to happen around aged 34 when peak bone mass is achieved for most people….this is no an ‘old person’s issue’! If ever there was a poster child for PREVENTION being better than cure….bone health is it!
- The decline in Oestrogen production also has a negative impact on bone remodelling activity for both sexes, this isn't, as many think a 'female only ' issue. Men are less susceptible to developing Osteoporosis but their stats are still pretty compelling.
- The first 3-5 years following the onset of menopause are associated with an accelerated period of bone mass loss before the decline settling to a more linear decline as menopause progresses. Most women are hitting Peri-Menopause in their late 40’s and Menopause in their early 50’s.
- We also need to consider the Hysterectomy patient whether she loses her ovaries immediately or has them preserved. If the woman experiences a Bilateral Oophorectomy, she'll literally come round from her procedure 'in Menopause'. If the ovaries are preserved then there is also a high risk of ovarian failure typically within 4-5 year post op.
- As bone mass declines and the threshold for osteoporosis is approached and exceeded the risk of fractures to the hip, spine and other fall fractures is also greatly increased.
- In the UK and the US 1 in 2 women and 1 in 5 men over 50 will experience a fracture.
- Research by the National Osteoporosis Society estimate that the daily cost of caring for those who experience disability due to hip fractures is somewhere in the region of £6 Million PER DAY!!
- The mortality rate for those who experience hip fracture increases by 20% in the 12 months post fracture.
- There are actually more ‘fragility fractures’ – (300,00) in the UK than strokes (275,000) and heart attacks (110,000)
And a few more thrilling Bone Health facts from the International Osteoporosis Foundation (you can find the references here).
- Hip fractures cause the most morbidity with reported mortality rates up to 20-24% in the first year after a hip fracture [33,34], and greater risk of dying may persist for at least 5 years afterwards . Loss of function and independence among survivors is profound, with 40% unable to walk independently, 60% requiring assistance a year later . Because of these losses, 33% are totally dependent or in a nursing home in the year following a hip fracture [34,37,38].
- A 50 year old woman has a 2.8% risk of death related to hip fracture during her remaining lifetime, equivalent to her risk of death from breast cancer and 4 times higher than that from endometrial cancer .
- Studies have shown that bone mineral density in postmenopausal women can be maintained or increased with therapeutic exercise [112,113,114].
Bone Health Thieves - We Can All Do Something About......
- Excess Salt - excess salt is excreted in the urine along with Calcium.
- Chronic poor head, neck and thoracic postures caused by technology use. The technology train has left the station....our job now is to manage our use and how we position our bodies when we are using both mobile phones, tablets and desk computers and be totally aware that the loads that we expose our bodies to, also shape the function of our bones and soft tissues. If we're using phones, tablets and desktops for most of our waking hours, we owe it to ourselves to SERIOUSLY consider or posture as we do so AND positively adjust as necessary. Three tech posture hacks below....a) Make a standing desk and bring your screen up to eye level b) learn to touch-type if you type a lot so you need to look down a whole lot less c) bring your phone up to your face as opposed to your head down to your phone -doh! 😉 Also, is it time for reading glasses? Are you peering towards your screens because your eyesight is declining?
- Contraceptives and 'hormonal adjusters' such as Depo Provera (brand name) - Depo Provera works by releasing the hormone Progestin slowly into the body, suppressing Oestrogen and other hormones and can be used in the treatment of Uterine Fibroids also. Low Oestrogen = anti-bone health. See more here.
- Alcohol - Chronic alcohol consumption increases level of the Parathyroid hormone, which leads to a leaching of Calcium from bone and alcohol also has a role in decreasing Osteoblast (the bone-making cell) formation.
- Medications such as Steroids - Steroid Induced Ostoeoporosis
- Phosphoric Acid - found in Coca-Cola type drinks. Phosphoric acid has been linked to lower bone density in some epidemiological studies - great information in this blog via Healthy But Smart and it's also been included in a discussion in the American Journal of Clinical Nutrition.
- Immobility - Bone is reactive not proactive….to induce remodelling bones must experience stress, the less stress applied, the less remodelling. Having and active muscle mass and hitting the ground = stress but unfortunately in the post Menopausal woman pelvic dysfunction is also a common barrier to impactful exercise when there is a fear of 'leaking' or aggravating a Pelvic Organ Prolapse.
- Smoking - Research also suggests that smoking impedes the hormone Calcitonin, which helps build bones and Nicotine and free radicals generated whilst smoking destroy Osteoblasts.
- Excess Sugar + Diabetes - High blood sugar slows new bone formation, accelerates bone resorption and impairs fracture healing.
- Being underweight and having a low muscle mass as you age
- Chronic stress and lack of sleep that lead to elevated Cortisol levels - elevated cortisol levels interfere with Osteoblast formation and dramatically decreases bone building—resulting in reduced bone density. Therefore, more bone tissue is broken down than deposited leading to an increased risk for Osteoporosis.
- Vitamin D deficiency - Between being indoors for most of the daylight hours, living in a country where there isn't much sun anyway and wearing sunscreen or protective clothing because where you live has very little Ozone.....it's a given for many people on this planet that they aren't getting enough Vitamin D to support bone health. First get your levels checked professionally, then look at food options and supplementation to help bring you up to optimum.
Phew, so....are you now convinced that a) we need to be talking with our clients about their bones health NOW and that b) taking action on the bone health thieves is probably a lot simpler than you think? I hope so.
If you enjoyed this blog and are working with Peri to Post Menopausal Women or those who've undergone Hysterectomy, I think you'll be interested in these two courses from Burrell Education. Created with with two of the worlds top clinicians in these fields, Jessica Drummond of the Integrative Women's Health Institute and Michelle Lyons, Global Women's Health + Physiotherapy Educator.