by Nancy Alexander, PT, CSCS
May is National Osteoporosis Month and that makes it the perfect time to learn more about bone health and how you can help improve your bone density at any age.
Approximately half of all women and a quarter of all men over the age of 50 will break a bone in their lifetime due to osteoporosis, according to the National Osteoporosis Foundation. Please know, however, that osteoporosis is not a normal part of aging. Lifestyle factors, including a healthy diet and exercise can largely impact your bone health at any age. As debilitating as osteoporosis can be, you have the power to do something about it.
“Good bone health can and should be a family priority,” said Claire Gill, CEO of the National Osteoporosis Foundation. “There is no shortage of things that everyone can do each day to build stronger bones. It is our hope that National Osteoporosis Month motivates everyone to take simple steps toward improving their bone health and living active, independent lives.”
(The following is an excerpt from Chapter 7 of my new book, “Get UP! Defy Aging with Movement.”)
Osteoporosis
What is it?
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both, according to the National Osteoporosis Foundation (NOF). (NOF, What is Osteoporosis and What Causes It?) As a result, decreased bone strength and mass significantly increase your risk for fractures. About 54 million Americans have osteoporosis and low bone mass, called osteopenia, and though scores are not as severe as those with osteoporosis, people with osteopenia are still at increased risk of fracture. A bone density test, called a DEXA scan, can assess bone density at specific body sites and is considered the gold standard for diagnosis. Barring any family history or other comorbidities that may warrant more frequent testing, the NOF recommends women over the age of 65 and men over the age of 70 be tested. Typically, follow-up testing occurs every 2 to 3 years and will be determined by your physician.
Characteristics
Unfortunately, osteoporosis is often called a silent disease, because we can’t feel our bones weakening. Some are first diagnosed with this disease because of an injury where they sustained a fracture. Others with low bone density often experience pain, especially at the spine, which most write off as occurring due to something else. This is why testing and knowing your numbers are so important.
With advanced stages, a stooped posture is noted and a scoliosis can appear as vertebrae compress. Vertebrae and the ends of our long bones, such as the femur in the leg and the radius in the arm, are more prone to low bone density because of their composition.
Movement’s Impact
Exercise is usually the first line of defense for those with low bone density. Thankfully, you can improve your bone density at any age. The most effective regimen includes weight-bearing exercise, such as walking. Impact helps build strong bones, so standing exercises, such as marching, can also be beneficial. Core strengthening to protect your spine as well as balance training to reduce risk of falls should also be incorporated into any exercise program. Resistance training also helps, since the bones where muscles and tendons insert get stronger with each lift of a weight.
When you put all of these exercise components together, it becomes a powerful tool to help build strong bones. There are programs designed to do this but there is one I know very well and that is called Buff Bones®. I have been a licensed Buff Bones® instructor for almost five years now and have seen the benefits first hand through my class participants. As a physical therapist, I can get behind the principles of this program as they are sound and well thought out.
Exercise is often the most desired treatment strategy for bone loss, especially if discovered early. There are medications that can help, but their side effects are not desired by most people. If you have advanced osteoporosis, however, you are likely on some kind of medication dose. Regardless of whether you take medication for this or not, targeted and prescriptive exercise can help.
(The following is an updated blog article I originally published in August, 2018.)
Know Your Numbers
When I teach my exercise classes to adults over 50, I frequently ask how many of them have had a bone density scan done. Thankfully a large majority of them raise their hands – as many as 80% of them. Then I ask how many of them know their numbers. The results change significantly. They stop and think. They look at one another and then lower their hands. Typically, only 20-30% of them say they know. But knowing your numbers can be crucial to your health. I’ll explain why.
According to the National Osteoporosis Foundation (NOF), 10 million Americans have osteoporosis: Another 44 million Americans have low bone density or osteopenia. One half of women and one in four men over the age of 50 will break a bone due to osteoporosis. Osteoporosis is the underlying cause of approximately two million fractures every year.
Unfortunately, people with low bone density are more likely to break a bone compared to people with normal bone density. Without a scan and without knowing your numbers, you cannot possibly undergo treatment for this disease. Which, in turn, creates risk.
I want you to meet Sam. He is a former patient of mine (name has been changed for privacy). He came to me at an outpatient clinic recovering from breaking his shoulder blade when he fell skiing. As a physical therapist and skier, I was interested in how he fell to cause this. Sam proceeded to tell me. Later that day I was thinking about what he said. I was left with the feeling that I could not see how such a fall could produce a fractured bone. I began wondering about his bone density. He was an active man in his early 50’s. During his next visit I shared with him my concern. A half smile crossed his face and he said, “You know… my wife and I just had this same discussion last night.” I asked him if he had ever had his bone density assessed. He hadn’t. By the end of the visit, he was planning to schedule it. Turns out, Sam had osteopenia or low bone mass. This is often considered the early stage of osteoporosis. Thankfully he was not more seriously injured and healed well. Even more importantly, Sam discovered he had this disease and was able to begin treatment right away while incorporating some lifestyle changes to help improve it.
As an aside, rates of osteoporosis among men are rising, projected to increase 50% in the next 15 years. That seems quite remarkable but it is also true that with increased awareness now, more men are being scanned.
The DEXA Bone Scan is considered the gold standard for measuring bone density. The World Health Organization (WHO) Classification for bone density is called the T-Score. This is the number you are given as a result of your scan. Lower scores (more negative) mean lower bone density:
Here is the breakdown of key levels:
- -1 to (+) = healthy bone
- -1 to -2.5 = osteopenia
- <-2.5 = osteoporosis
Consider also Kim’s story (again name has been changed for privacy). She said she was last scanned over four years ago and was diagnosed with osteopenia. She started thinking about it again and thought she should get a follow-up scan. She promptly scheduled one. She was screened and now has “severe osteoporosis” at several locations in her body. Her lowest number is -3.6 at her fourth lumbar vertebra. Remember -2.5 is the level at which osteoporosis starts. How could this be? When she inquired about her numbers from four years ago, she found out they were -2.4 – just .1 point from osteoporosis. Knowing that may have brought about treatment options she and her physician didn’t otherwise consider. In the end though this is not about placing blame. This is about learning the importance of getting scanned and knowing your bone density score so you can make the best choices for you at the time.
Here’s another example: Linda (again name has been changed for privacy) had her bone density checked about three years ago and discovered she had osteoporosis. She was given her scores at that time. She immediately began treatment and engaged in multiple exercise classes incorporating strength training and impact exercise. She also began a walking program. Three years later, her numbers revealed only osteopenia, not osteoporosis. Her numbers improved. This is huge! This can mean the difference of not having to take prescription medication for osteoporosis (which is often not desired) vs opting for more conservative treatment of vitamin supplements and exercise programs as noted above.
Getting scanned and knowing your numbers can lead to better health. True these are only examples and do not in any way illustrate what can happen to you and to others. Always consult with your physician for treatment options and other recommendations and always consult with them prior to starting any new exercise program. Other health concerns may also need to be considered. It is important to remember that bone remodels throughout your life… it is a continuous process. You can strengthen your bones at any age.
Exercise is important and fall prevention is especially critical for those with osteoporosis. Research shows that fractures are more common in bones with low bone density vs normal bone. Fall prevention must include movement and exercise to maximize range of motion, strength and function. For those with osteoporosis or osteopenia, seek out safe bone strengthening strategies that integrate alignment and balance techniques. Even if you don’t have osteoporosis or osteopenia, strengthening your bones is important and can and should be done at any age.
In summary, movement and exercise on a regular basis is critical for your overall long-term health, fitness and quality of life. Building strong bones may not be at the top of your wellness list, but perhaps it should be. Get scanned, know your numbers, and act now to improve your health and wellness.