The silent killer
/Osteoporosis has for years been known as “the silent thief”. But silent killer? It may seem a bit dramatic, but take a look at the numbers.
Specifically, if one is 70 years old and they break their hip, 10% will be dead in three years. For those over 80 years old, the mortality is close to 33% within a year[i].
“By the time you are 75, the risk of death from a fall is enormous. It’s not as high as Alzheimer’s disease, cancer or heart disease, but it comes in pretty much just after that.” Dr. Peter Attia
Where does osteoporosis come in? 80% of all fractures over the age of 50 are caused by osteoporosis, defined in the Oxford Dictionary as “a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D”.
Almost 2 million Canadians are living with osteoporosis, with 1 in 3 women and 1 in 5 men suffering from an osteoporotic fracture within their lifetime.
Now before you say, “Phew!” because you aren’t even close to that age, think again. It may seem like an “old age” problem, but it is not an “old age” problem.
It's all about bone mineral density (BMD), which starts to decrease in our mid 30s. One doesn’t want to wait until they are 60 to start thinking about bone health, as by then our bone density may already be below normal. Especially in women.
We have to take steps to now to prevent injury later.
A quick bone recap
Bone is a heavily vascularized, living tissue. It’s actually an organ that plays a very important role in a number of different things – support, mobility, protection of our organs, and mineral storage - especially calcium, which plays a role in every one of our cells.
Our bone marrow, found in the centre of bone, is beyond critical. It produces our white and red blood cells. As well, in our “post” COVID world, it’s key to remember that the immune cells that keep the virus at bay (memory B cells and memory T cells) reside in our bone marrow.
What is the difference between osteoporosis and osteopenia?
The difference between the two is all about progression of the reduction of BMD. With osteoporosis, the reduction in bone mineral density is approximately 25%, whereas in osteopenia it is approximately 10%.
And although both men and women start to lose BMD in their mid 30’s, the pace for women increases as they approach menopause, with anywhere from a 2-5% BMD reduction per year.
Why “the silent thief”?
The reason osteoporosis is known as the silent thief is because there aren’t any symptoms associated with it. Often the way people find out is by… breaking a bone. And if you are 50 years of age or older, as mentioned above, there is a good possibility it is due to osteoporosis.
How and when do we test for Bone Mineral Density?
We are able to determine our BMD with a DEXA scan. They are safe (very low radiation), painless and effective. It takes about 10 minutes for your body to be scanned.
In Canada, it is recommended that all men and women 65 years of age and older get a bone mineral density test (which, in my mind, is too late). One exception is for younger, post-menopausal women who have other risk factors for fractures, including parents who have had hip fractures and parents with a history of osteoporosis; high alcohol intake, and low body weight (under 132 lbs). It’s definitely worth reading the full list.
So what to do?!
Increase your awareness
Overall, we should always be thinking about bone health rather than taking it for granted (which is easy to do, especially with no symptoms). And not only thinking about us, but also laying the foundation with our kids (all ages) is very important.
Menopause
As women, we want to REALLY start thinking about our bone health during both perimenopause and menopause, but especially during menopause. Estrogen plays a key role in bone health. It promotes the activity of osteoblasts (cells which build bones), and slows the natural breakdown of bone.
Estrogen levels fluctuate during perimenopause, and then decrease dramatically during menopause, the 12 consecutive months of no period.
Given that the average age of menopause is 51, if you have a fragility fracture (a fall from standing height or less) between the ages of 50-65, ask for a DEXA scan (although your doctor should automatically suggest it in these instances).
Men and Estrogen
Men lose estrogen as they age as well, but at a far more gradual rate than women, which is why women experience more bone loss, putting us at a great risk of osteoporosis and osteopenia.
Things that lower bone density
Family history – red flag if either parent has a history of a hip fracture
Genetics – accounts for up to 50%
Smoking
Alcohol
Low calcium intake (from diet)
Low vitamin D intake
Female endurance athletes
Certain medications (including corticosteroids (ie – prednisone), “heartburn” drugs (ie – proton pump inhibitors over the long term), breast and prostate cancer drugs, antiepileptic drugs, excessive thyroid replacement therapy, etc.)
Lack of exercise
Lifestyle steps to take to increase bone mineral density
1. Resistance Training – the single most important tool
LOAD YOUR MUSCLES – muscles are attached via tendons to your bones, so when you are loading your muscles your bone senses they need to support a greater force, and in response to that it remodels by depositing more and more bone tissue.
Bone mass increases in the presence of stress. The more it strains your muscles, the better it is for your bones. Dr. Peter Attia
Examples include:
Strength training
Lifting heavy objects
Climbing stairs or walking uphill
Walking downhill
Rucking (my new favourite way to walk!) – walking with weight on your back, as in a backpack with weight in it (use your own pack and be creative with what you pack it with).
Unfortunately, low weight bearing, low impact, aerobic activities and sports like walking (without weight), swimming and cycling don’t really seem to maintain or improve BMD much. Even the data on running isn’t all that positive, although some studies say that low to moderate running has a slight positive impact on BMD. Long distance endurance running, however, may have adverse effects on BMD.
2. Nutrition and Supplements
There are three important micronutrients, and one macronutrient when it comes to bone health:
Calcium
Vitamin D (D3 specifically)
Magnesium
Protein
Calcium
We should be getting 1000mg-1200mg per day. I strongly recommend (as does Osteoporosis Canada) to get your calcium from food. It is best absorbed that way, and we never have to worry about getting "too much" calcium if from food. Best sources include:
Dairy
Dark green, leafy vegetables, including broccoli, kale, collards
A serving of canned salmon or sardines (it’s the small bones that contain calcium)
Calcium fortified soy, almond and rice beverages
If you eat dairy, you should be able to get enough – if not, you may have to look at supplementing. Calcium citrate and calcium carbonate are two good options. Speak to your health care practitioner before taking, and definitely don’t take too much. There are many who don’t support calcium supplements. Finally, if you do need to supplement, don’t take more that 500mg at a time as our body can’t absorb more than that in one sitting. NOTE – read this and this before you start supplementing.
Vitamin D3
Vitamin D3 is essential for the absorption of calcium into our bodies, hence is essential for bone health. Due to its limited availability in food, and our limited exposure to sun in Canada, it’s recommended that we supplement. Osteoporosis Canada suggests 19-50 years of age supplementing between 400-1000iu’s, and if over 50 (or with a history of osteoporosis, fractures, etc.) supplementing with 800-2000iu’s.
Magnesium
60% of the magnesium in our body is found in our bones. It is essential for bone health with respect to how it interacts with calcium and vitamin D (as well as phosphorus and our parathyroid hormone, which in itself is responsible for regulating calcium in our body). In effect, bone health is a team effort of nutrients!
Many of us are deficient in magnesium, and although we can get it from foods (including certain nuts, seeds, legumes and whole grains) it’s often tough to get the recommended amount (minimum ~500mg daily), so I often recommend people supplement with it. Magnesium carbonate and glycinate are what I suggest, but magnesium citrate and oxide are also good especially if you want to speed up your bowels!
Protein
Protein gives our bones strength and flexibility, and the nutrients it needs for building and repairing. As we age we tend to eat less protein – especially women. Less protein means more fragile bones and weaker muscles – both of which can be serious issues as we get older.
We want to eat protein at every meal - our body and brain need it on demand, plus protein is utilized as soon as it is ingested and can’t be stored, so having it all at one meal doesn’t work.
The MINIMUM we want to have is .36 x body weight (in lbs). So if you weigh 140lbs, you would need a MINIMUM of 50g of protein per day, evenly distributed over the course of the day. But most experts in the field say that is not enough, and recommend anywhere between .5g and 1g per pound of body weight.
Did I mention minimum?! I’ve included a list of foods with protein amounts here.
3. Menopause Hormone Therapy aka Hormone Replacement Therapy (HRT)
As many of you know, this is becoming more widely accepted nowadays, after it’s been shown that the Women's Health Initiative Study was flawed in many ways (this was the study that purported that the risk of breast cancer and cardiovascular disease went up with the use of HRT).
Having said that, within the study, there was no ambiguity that fracture risk was decreased in the women taking HRT.
This is all to say that one might want to consider taking HRT, to help with peri and menopausal symptoms, which are debilitating for many, as well as to help with bone health. There are two good books on the topic of HRT, Estrogen Matters and The Estrogen Window . You may want to consider reading one or both of these books to get a better understanding of it all.
If you are considering HRT, talk to your doctor, and/or, if you’d like to talk to a menopause specialist, reach out to Teresa Isabel Dias at MenopausED. She is excellent.
Summary
Whew! I know I've just thrown a lot of information at you, but I feel it’s so necessary to get the word and information out there so one knows both the risks and the steps one can take. I don’t feel that bone health is spoken about enough given the risks, but also given the fact that it can be addressed through lifestyle.
If you have any thoughts or feedback on the above information, please feel free to share with me.
Thanks for reading :)
Gillian xx
PS - for those of you in Toronto and surrounding area who simply want an intro-session on nutritional and lifestyle recommendations, think about booking my Walk & Talk Wellness Reset. A one hour walk - you talk, I listen. Let me help you set some goals - nutrition, sleep, cognitive health, stress management, and movement - and put some systems in place to help take your health to the next level. You can reach me by replying to this email or at gbwellness.ca.