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How Strong Are Your Bones?

By , SparkPeople Blogger
One of the most serious problems associated with menopause is the increased risk of bone loss as a result of hormonal shifts. This is the first of series of four blogs I'll be writing on bone health, and in this blog I'll cover information on osteoporosis risk factors and diagnostic measures for determining bone density.   

It's important for women to understand what their risk of osteoporosis is, and the ways they can reduce their chances of a bone fracture later in life.  Most women don't think about their bone strength the same way they think about muscle strength.  We can see our muscles become more defined with use or atrophied when an injury immobilizes a limb.  In contrast, our bones are hidden and we don't worry about their strength until a fracture from weak bone structure occurs.  Like our muscles, our bones are constantly being broken down and rebuilt.  The degree of building for both muscle and bone is dependent on several factors such as nutrition, stress/ stimuli effect (ie., how weight training stresses the muscles in a positive way that stimulates stronger rebuilding of tissue) and genetics.  

The breakdown and rebuilding of bone is a necessary part of keeping bone strong, but when either part of the process slows, bones can become weakened.   Bones are composed of a hard outer layer, called the cortical bone, and the inner, honeycombed like portion called the trabecular bone.  The outer portion provides the bone structure, but it's the inner portion that provides the majority of a bone's strength.   As we age, the ability of our bones to maintain mass and normal structure is reduced as bone starts to be reabsorbed faster than it can be laid down.  

The continued net loss can cause bones to lose their strength and increase the risk of fracture.  We all start losing bone mass after 30 years of age, but whether the bone loss leads to fracture risk depends on a variety of influences.  For example, a woman that starts out with thicker bones will not develop menopause related weakness as quickly as women who didn't get enough bone building nutrients in their formative bone-building years.   

After menopause there is an acceleration of bone loss, so it's important for women to get a baseline assessment of their bone mass when they reach menopause.  There are several tests used to measure bone mineral density (BMD), but the most accurate test is dual-energy X-ray absorptiometry (DEXA).  It uses a very low level X-ray to detect bone mineral levels and can diagnose whether a person has osteopenia (a precursor to osteoporosis) or osteoporosis.   The earlier osteopenia or osteoporosis is diagnosed, the better your chances are of slowing bone loss through lifestyle changes and medication.  Many healthcare providers are suggesting that their female patients have the DEXA test done earlier than the prior guideline of 65 years, as by that age the degree of bone loss can be substantial.

Along with having a DEXA scan, you can see if you are at risk of bone weakness by determining whether you have risk factors associated with increased bone loss.  The following are risk factors that can be reduced with lifestyle changes:
  • Smoking
  • Drinking alcohol
  • Low activity level
  • Low calcium and vitamin D intake
  • Eating disorder
  • Some medication use (corticosteroids and some types of anticonvulsants can increase bone loss, but don't stop taking these medications before discussing your options with your doctor)
Smoking affects both hormonal functions related to bone health and diet, as some smokers substitute healthy food choices with cigarettes.   Alcohol use, especially daily drinking, affects normal calcium absorption and can, over time, decrease the rate of bone deposition.  

Exercise is an important component in bone health as the stress/stimuli of weight bearing and strength training activities causes bones to remodel at a great rate (I'll be covering this topic in more depth in the next bone health blog).

A diet rich in calcium and vitamin D, especially early in life, during the greatest time of bone building, is vitally important for strong bones later in life.  All women should focus on getting the daily requirements for calcium and vitamin D (there's a link below that provides these guidelines), and increase their intake during and after menopause.  If you're a mom with young children and teenagers, keep in mind that the majority of your children's bone strength is determined by the age of 20.  Visit the websites listed below to see how much calcium and vitamin D your children need for optimal bone growth.  There are many ways to provide these nutrients besides milk and milk products, so if your children aren't milk drinkers check out the list of foods that can be good substitutes.   Also, a daily multimineral supplement can ensure adequate calcium and vitamin D intake.

Risk factors that can't be changed include:
  • Family history for osteoporosis
  • Ethnicity: Caucasian and Asian women are at a greater risk
  • Small body size (thin, fine bones)
  • Age
  • Gender
  • Early menopause or removal of ovaries prior to menopause
There's a very useful osteoporosis risk factor test that was developed by the World Health Organization called the FRAX tool.  The test can help you determine what your risk level is for bone fracture related to osteoporosis, and can help you determine what level of intervention you may need.  

If you are in the age group where bone loss is a concern (peri and postmenopausal) I invite you to take part in this series of blogs that will explore ways to improve bone health and reduce fracture risk later in life.  You can start by taking the FRAX test here (click on the calculation tool), and if you haven't had your bone density tested, call your healthcare provider and request to have the test done.  

I also welcome any questions you may have concerning bone health that can be included in this series, so feel free to post your questions or comments.

Information on calcium and vitamin D recommendations:
Have you had your bone density tested? Why or why not?

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Oh, this is scary. I have small bones and haven't done as much strength training as I could have at all!
Thanks for this article!! I will be asking my MD for a screening right away. I will also look forward to future installments. Report
I had a bone density screening at the age of 39 at a health screening fair. The line was long and I thought "Why am I bothering? I have strength trained 3-5 days a week for almost 10 years.?" But, I stayed and had it checked. It showed me osteopenic. I was shocked!!!!

Fortunately, I had my annual female physical exam soon after. The doctor ordered a DEXA test, and it confirmed what the screening had shown. Almost simlutaneously with this, I was suffering from extreme hip pain. Well, to make a long story short, after working with a very good sports medicine doctor who was open to my research, she ordered tests pertaining to celiac disease, and it was confirmed. After being on a gluten free diet and taking calcium and vitamin D, I did increase the bone density. Now, in menopause, I am slightly osteopenic, but holding steady.

The sports doctor told me if I had not been doing the strength training I had been, I would have had much worse results. Report
I had a DEXA scan a couple of years ago. I asked my doctor about it and he ordered one. No osteoporosis in my family, but I am deficient in vitamin D and that worried me. Scan came out fine and now I have a baseline for the future. Report
Had a scan 15 years ago (@35) due to my rheumatologist thought I should get a baseline (long hx of RA & steroids). It showed osteoporosis and he prescribed fosamax (which I could not take). Fast forward to this year and a new scan which showed I had reversed everything thru diet, exercise, supplements of vitD/calcium/magnesium. Kind of a shocker to find out that I am healthier now@51 than 35. Report
I had a bone density scan for the first time at age 24 (last year) and was diagnosed with osteoporosis. While I have a lot of the risk factors that you cannot change (Caucasian, small bones, etc.) the biggest factor in my being diagnosed so young was that I was suffering from anorexia. At the time, I was four years into the horrid disease and while I am now on the road to Recovery, it is still difficult knowing that I have done this to myself.
Thank you so much for bringing this topic to the forefront. I often wonder whether or not I would have tried to get better sooner if I had known all of the risks and consequences to my body. This is such an important topic for men and women of any age, shape or size. THANK YOU! Report
I had my first scan done five years ago and at that time was told I had osteopenia. I have been taking calcium with vitamin D since and have had 1 bone scan since. The results have been the same. I feel fortunate to have caught it early and if nothing else had it remain stable. Report
I'm 60 and have been having bone density tests for 10 years. I take 2,000 mg of vitamin D daily and Actonel once a month for osteopenia. I have slacked off from my weights over the summer but do water aerobics about 3 times a week. I need more calcium in my diet. This was a great article. Report
This is a super important topic for anyone who has the risk factors named. Thank you!! I have watched for research linking weight loss with increased risk also, as I was first diagnosed about 11 years ago after having lost about 20+ pounds. The diiet I used was not a good one (weigh down workshop) and the dexasccan tuned me into better nutrition and weight bearing activities. I am on track now and take medication weekely for prevention of further deterioration. So far, I have found no reseacrh linking the two (weight loss and bone loss). Eat right and do your weight bearing exercise!! Thank you for the words of wisdom! Report
I had a DEXA scan done 2 years ago and found that I had osteoporosis at age 38. Luckily mine is reversable because it was caused by an overactive parathyroid gland. I Had the gland removed in May of this year and I will go in for a new scan next year. I am also going into early menopause because of this and I hope I can get my bones back in shape before it is too late. Report
I probably should have a bone density test done. I'm 48 have broken 49 bones during my lifetime. Possibly there is more of a problem that I should be aware of. Report
Yes, and mine is fine. Report
Robine, the best way to tell if you need additional Vit. D is to have your physician do a simple blood test. That way you'll know exactly where you stand.

Archimedes, I don't know what your age is but osteopenia can be a silent condition. If you're over 50 I'd say have it done and have the baseline readings on which to base future calcium needs, etc. If you're not pushing 45-50 it can probably wait but be sure to do it as you reach that range. Report
How important is it to supplement with vitamin D if you are fair skinned and live somewhere known for having 360 days of sunshine a year? I wear spf 15 sunscreen on my face and arms when out for errands or whatever during the most intense sun times of year, and spf 50 all over when swimming or otherwise being right out in the sun. I have always figured my sun exposure should be more than enough, coupled with whatever milk I drink, for me and my kids for vitamin D. Is this not the case? Report
I am 47 and I have had my bone density tested twice in the last few years. I have breast cancer with bone mets, and I have osteopenia in one of my hips from the cancer and from the chemo. I am on the drug Aredia, which is for my bones, that I get through an IV once a month at my oncologist office, and on his advice, I also take calcium and D3.

I also went into menopause early because of the cancer and treatments. Report
I just had a bone densitiy test and the results say I have osteopenia. This was a surprise to me since I am very active and probably consume too much calcium. (I put a lot of milk in my multiple cups of decaf.) Well, I'm 62 so I guess I'm "of age".... Report
I am in my mid 40's and I've had three bone density tests already. The first one was about 10 years ago, the second about 5 years ago and one earlier this year. I suggested the one that occurred earlier this year, however, the first one 10 years ago and the second one, was recommended by the doctor due to some hormonal issues that I've been experiencing for the last 20 years. Praise the Lord - my bones are strong and healthy. Report
My doctor will tell you that I'm in excellent physical condition for my age. Luckily, there has been no need for a DEXA test. However, a cousin of mine who's 14 years older than me was recently diagnosed with osteo-penia. Which was a shock. My cousin has never been overweight a day in her life. despite what she says. eh-hem. She's always been active playing tennis, hiking, skiing, dancing, etc... she eats right. she doesn't smoke.

She's the poster child for clean living ! And yet, she has been diagnosed as having early symptoms of osteoporosis. She's on medication for it now. Her doctor says it's genetic. I guess she could have been in much worse shape if she hadn't led a healthy lifestyle. Still, it's a shock to hear that you do everything right in life and yet, you still end up with health issues.

And that's just the way the genetic ball bounces some times. It truly stinks.

I am so happy to see this blog and await the next ones.

I am 22 years old but take corticosteroids for Crohn's disease. I've been on this lot as various doses since December. I'm working with my doctors on having different drugs, but for now steroids are my only option.

I am so, so worried about bone density since I know these years are so important, and if it gets messed up now there's not a great deal I can do later. So I very much welcome any information on this topic!! I keep speaking to my GP and rheumatologist about it, and they've given me calcium + vit D supplements, but don't have much other advice. Report
I was very surprised to learn last year through a bone scan that I have osteopenia. My MD recommended a scan after a fracture. I was very deficient in Vit. D, which probably contributed to the situation.

The scan is easy, takes little time, and provides valuable information. I'd suggest that any woman age 50 and up request a DEXA. If your MD resists, keep pushing. It's better to have this information now than later. Report
Youd be surprised to know how many Drs dont tell you about bones and when your making them or how. They dont feel tis their job to warn you abotu osteopoross! Until after a Fall then mine made me get a bone density scan! Too late if you ask me! I was not told until after I fell at age 55! I wish I knew how important vitamin D and calcium were when the Dr told me I had Lactose Intolerance ( as to why I was pooping my brain out!) He failed to tell me to take calcium and vitamin D! Why arent Drs informing their patience BEFORE a fall? Becasue they cant make money off you unless you do fall! Its a racket if you ask me! Drs only do whats needed when needed! No prevention! Report
My dr had me get one as a baseline at about age 50 - but she has early osteoporosis herself, so she's fairly attuned to this. She also has me taking extra vit. D. Report
Haven't had a bone density test. Doctors never asked for it, even when I was perimenopausal. It never occured to me to ask for the test - but then, I don't have much cause to go to the doctor's - thank the Lord. Report
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