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Q&A – Bone Disease

Dr. Amanda Martin – Bone Disease

 

1. What role does exercise play in prevention of bone disease?

Exercise is very important in all aspects of health. It not only promotes a healthy heart and lungs, but also is critical in developing strong, healthy bones. Weight-bearing exercise (i.e. walking, jogging, weight lifting, etc.) helps bones to improve their density (strength). Bones respond to stress by absorbing calcium and fortifying themselves. Exercise is the best form of healthy stress we can apply to our bones. Muscles attach via tendons to the bones, thus the pull of muscles during exercise on bone causes a stress reaction that tells the bone to absorb calcium from the body and get stronger.

2. Myths

One of the most common mistakes people make is to assume osteoporosis is an old person’s disease. In reality, 98% of our bone mass is obtained by the age of 30. After that we lose our bone density each year until death. Bone loss rapidly increases in post-menopausal women due to a decrease in estrogen. The single most important thing we can do is eat a balanced, healthy diet, rich in calcium and vitamin D, exercise, avoid carbonated beverages, alcohol and smoking as teenagers and young adults. The supplement commercials are targeted to women over the age of 50 who certainly do need to use them. However in reality, teenage girls should be encouraged to obtain 1300 mg/day of calcium and 600 mg/day of vitamin D daily so they build the strongest bones possible during the density formation years. The calcium requirement then drops to 1000 mg/day during adulthood (19 yrs-50).

Often, teen girls shy away from healthy eating habits out of body image concerns. They severely restrict their diet from healthy lean meats and dairy and consume empty calories in preprocessed “diet” foods in attempt to conform to an unrealistic thin body type. They consume far more soda pop than 20 years ago, and are pressured into smoking and drinking alcohol. These pressures can render them with substantially weaker bones as young women. It’s much easier to develop osteoporosis at a young age when the threshold you start with is already much much lower. This is why we must educate young women on the importance of healthy eating and exercise habits for life.

Another myth is that only women are affected by osteoporosis. It is true that Caucasian and Asian women are affected in more substantial numbers, however anyone (including men) can suffer from osteoporosis that puts one at risk for vertebral (spine) fractures, hip and wrist fractures.

3. Is it ever too late to start exercising?

No! Weight-bearing exercise can help slow the rate of bone loss. It won’t make the bones stronger after peak bone density is reached around the age of 30, but it will slow the rate of bone density loss. In addition, a healthy lifestyle that includes exercise will improve strength and balance, which are key to preventing falls, improve the cardiovascular and respiratory systems, and help prevent diabetes, and a number of cancers that are linked to obesity. You don’t need a lot of money for a gym membership or fancy equipment. Lace up your sneakers, grab a friend (or your dog) and hit the pavement. Walking is a brilliant routine that anyone can do anywhere.

4. What won’t help?

Bone density is adversely affected by smoking tobacco products, excessive alcohol intake, excessive intake of soda pop, and diets rich in sugar and processed foods rather than lean meats, lean dairy, and lots of vegetables and fruits.

Swimming is a wonderful cardiovascular exercise, but it won’t help with bone density as it isn’t weight bearing. Many people with arthritis prefer the water because it is less painful on the joints. My message to them is to keep up the water aerobics, but add a weight lifting and walking routine a couple of times a week to help build a strong skeleton.

5. Other important facts

Many medications used to treat osteoporosis are available and your doctor will prescribe them to you based on your bone density. A bone density test is a simple, noninvasive scan that your physician can order to help define your personal bone density. If it is low, they may recommend a number of treatments including Calcium and Vitamin D supplements, or medications like Bisphosphonates.

Long-term use of Bisphosphonates has been associated recently with femur fractures. They are very important for bone density, but like all medications, should be monitored closely by a primary care physician. Currently, recommendations are being made for “drug Holidays” every three years instead of taking the medication indefinitely to prevent negative consequences associated with the medication. A primary care physician should actively monitor liver and kidney functions as they would with any medical intervention.