Building and Supporting Your Bone Health!       
 
Bone health isn't an "old persons' thing".  In 2019, we enjoy living longer, yet we have declining bone health worldwide. 1 in 5 women who fall and fracture will die within a year of their fall; those who survive often experience a loss of independence and reduced quality of life.  Fall prevention with a focus on bone health is really important for a meaningful and fun life!
 
These Quick Facts will help you implement skills that will reduce your bone loss and support your bone building.  Brace Yourself!

• Get Active, Stay Active. Bone is reactive…..in order to create and rebuild strong bones, we must stress bone itself.  Your bone needs to impact the ground (walk, jog, play basketball, go up and down stairs, stomp the ground!).  Your muscles need to pull on your bones, creating stress on them (lift weights, pull theraband, join a dance or exercise class, come to yoga).  Often post-menopausal woman avoid these activities due to pelvic dysfunction, a common barrier to impactful exercise when there is a fear of leaking or aggravating pelvic organ prolapse (descent of your bladder, rectum or uterus).  Seek out a pelvic/women's health physio to help you with whatever challenge is stopping you from getting and staying active!

• Poking Chin with your head forward and a slouched upper back posture is rampant due to sitting too much and using tech….all day, every day.  We need to be aware of how we position our bodies when we are using cell phones, tablets and computers. The demands that we expose our bodies to will shape our bones and soft tissues.  If we're using tech or sitting for many of our waking hours, we owe it to ourselves to consider our posture, then change it to become bone building.

                  Quick checks: stand, sit, perch, move + lift your screen to eye level
                  + learn to type without looking down at your fingers.  Chin in!

• Loss of Estrogen happens due to menopause, estrogen suppressing medications (as part of cancer treatment) and/or hormonal medications given as contraception or for suppressing uterine fibroids/treatment of pelvic pain.  We may make these choices, but we need to learn to protect and support our bone in the meantime!
• Steroids are an amazing medication for "just the right condition/moment" and no other meds will do that job.  But again, "Steroid Induced Osteoporosis" is a real thing.  Learn to protect your bones while you benefit from steroid medications.
• Slim is awesome, skinny is not!  Being underweight and having low muscle mass as you age is highly correlated with bone loss.
• Wine and beer consumption increases your level of parathyroid hormones which leads to a leaching of Calcium from bone; alcohol is also implicated in our bone builders (Osteoblasts) getting lazy, so less new bone is laid down.  Reduce your consumption and you'll even sleep better!
• Reduce your salt.  When you eat excess salt and void (pee), excess calcium joins the excess salt that you're voiding, increasing your calcium loss.
• Phosphoric Acid has been linked to lower bone density in some epidemiological (big number) studies and is found in cola type drinks.  Drink water instead.
• Smoking blocks the hormone Calcitonin, an important bone building hormone. Nicotine and free radicals generated while smoking further destroy bone builders.  Stop smoking.
• Eat less sugar and/or control your diabetes for three reasons:  excess blood sugar slows down your bone builders, speeds up your bone eaters and slows healing of broken bones. 
• Vitamin D deficiency.  We have low sunlight in the winter and we use sunscreen/protective clothing in the summer!  Many people aren't getting enough Vitamin D to support bone health.  You can ask to have your levels checked by your doctor, then learn food options and/or supplementation to help bring you up to optimum Vitamin D levels.
• Chronic stress and lack of sleep lead to elevated Cortisol levels which dramatically decreases bone building so that more bone tissue is broken down than gets deposited.

 
Take control of your bone health by building new bone and losing less bone. Next:  fall prevention + balance building.
 
 
 
 

Fall is here in our chilly mornings, the leaves beginning to turn and our valley enjoying apple, plum and pear season.  But fall brings falls…..evidenced by the an icey film on our sidewalks on the shady side of the street.  Sleuthing out your bone health, understanding a Bone Mineral Density (DEXA) scan and then knowing how to help you enjoy brilliant bone health through every age and stage will help you avoid those pesky fall-induced fractures of your wrists, shoulders and hips.
Our bone health is based on our body's build, our weight management, our activity level and type/frequency of exercise, our diet, our general health and our age.  All of us have our own unique blend of variables; as women, our one commonality is the reduction of bone-protective estrogen as we wander through menopause.  Menopause is reached by a natural reduction and eventual cessation women's hormones in our bodies, through surgery (complete hysterectomy) or through taking estrogen suppressing medication (Tamoxifen or other aromatase inhibitors) or simply through the passage of time.
Women are typically referred every 3 - 5 years for a DEXA scan, available to us at the EK Regional Hospital in Cranbrook.  DEXA is an abbreviation of Dual Energy X-ray Absorptiometry, a targeted xray that measures the bone mineral content or density of your bones, is a reliable predictor of fracture risk.  A central DEXA measures the head of the hip and the mid lumbar (low back) spine (most commonly used and most reliable test).  A peripheral DEXA measures the forearm, the heel, wrist and hand bones.  The modern DEXAs are very low radiation scans, about 1% of a lateral spine xray.  Your height is usually measured so that any loss of height is documented in relation to the xray.  "Prospective Height Loss" tells us that if you lose more than 2 cm. of height over a period of three years, you may have a new compression fracture in your spine.  "Historical Height Loss" tells us that, if you're over 60 and have lost 6 cm. of height or are under 60 and have lost 4 cm. over more than three years, then again, a compression fracture must be considered.  An xray tech performs the test which is painless and takes about 15 minutes; from there, a radiologist interprets the results which are then sent off to your GP to discuss with you and to guide your treatment.
The DEXA test tells you 3 things about your bone mass:
1.    Your bone mass in grams per centimeter squared.
2.    A DEXA score comparing you to a healthy control group, often a 30 year old healthy woman, your "T score".
3.    A DEXA score comparing you to your peers, your "Z score".
Complications to your DEXA score can be caused by osteoarthritis in your spine (pitting or rough joint surfaces can look like bone loss), osteoarthritis in your hip (difficulty rotating your hip inward to the best testing position), compression fractures in your spine (can look like dense bone), obesity (if you're over 350 lbs., some DEXA units can't accurately guarantee that the score won't be skewed by photon passage through extra tissue), being too thin (scores are widely variable for thin women from one test to the next) and switching machines/locations (they are all calibrated very carefully).
In the end, you'll meet your doctor again to discuss the score.  We usually talk about the Tscore which will tell you a number, hovering just above or below 0.

• A T-score of +1 to -1: means you have normal bone mineral density.
• A T-score of -1 to -2.5: osteopenia or weakening bones
• A T-score of -2.5 or lower: osteoporosis or weakened bones
• Severe Osteoporosis is diagnosed when the T-score is -2.5 or lower, and the person has already suffered a fragility fracture.

These two words, osteopenia and osteoporosis carry concern, but they also bring you a job to do.  The next article will discuss ways in which you may address bone loss including posture, breathing patterns, exercise, activities of daily living recommendations, dietary suggestions and information on medications as well as evidenced based resources to look up online.  Cheers to strong bones!
 
 
 
 

Written by Joanne Gailius, May 2018

Spring is here, along with the greening and blossoming of our valley. Sunshine and Vitamin D help this season along…..these factors are integral to support women's bone health. In addition, how we move, how we sleep, how eat and manage our stress impact our bone health!
 
Women have a lifetime risk of hip fracture of 1 in 6, compared to 1 in 8 for breast cancer. Our risk of dying from a hip fracture is equal to our risk of dying from breast cancer.  If we include all women worldwide, we have a 1 in 3 risk of osteoporotic fractures.  Within one year of our first fracture, 1 in 8 women will go on to a second fracture. 1 in 5 women who fracture their hip will die within the year.  These statistics show the very real effect of bone health on our quality of life and longevity.  When you have osteoporotic changes in your spine (weakened bones + forward bent posture = the "Dowager's Hump), you also may experiences changes in your breathing, your cardiac function, your digestion, your mobility and increased pain, your continence and your emotional health.
 
How do you know you have osteopenia or osteoporosis?  Talk with you doctor, especially if you've finished menopause.  There is a special xray called a Bone Mineral Density test that gives you a number that represents a comparison to other women, called a T score. It will tell you if your bone is dense, somewhat less dense (Osteopenia) or with substantial loss of density (Osteoporosis).  To complicate things, bone density isn't the whole picture…..dense bone may be thick but not responsive.  Your bone needs to be able to respond to stressors and to have good muscular and joint support.  
 
Exercise can change your bone health.  Your bones are alive and will respond to exercise. Swimming, biking and walking will support your heart health, but will not build bone.  We're talking HIIT, Circuit and Crossfit classes, strength training, yoga (think Downward Facing Dog) and sudden weight shifting exercise like tennis, jogging and martial arts.  Bones respond well to surprise physical stressors.  The most common fractures from osteoporosis are in the spine, hips, wrists and shoulders, so ponder on exercise that challenges these! Think about balance.  We all lose balance capacity as we age (due to muscular, postural, fitness and visual changes), but balance training is amazingly quick and beneficial.  Better balance reduces your fall risk.  Small nudges reap big rewards in balance, strength and bone support.

Bioavailable bone nutrients are in salmon (especially canned with the crunchy bones in the tins), dairy (cheese, yogurt or kefir), dark and leafy greens (kale, chinese greens, spinach) and phytoestrogens (as in seaweed, miso or tamari).  A traditional Japanese diet supports bone health by providing extra Vitamin K and Calcium in the generous use of all the above ingredients. Think sushi! Alcohol (more than 5 oz/day) and caffeine (more than I c./day) do not support bone health.  Calcium supplements are no longer generally recommended due to their potential detriment to our hearts.  Smoking promotes bone loss, so it is time to quit!
 
Stress management is important in bone health as, when we're stressed, we have elevated stress hormones coursing through our bodies. When we eat well, sleep well and exercise, our stress is reduced.  The challenge is perhaps, for each of us to be aware of our own bespoke stressors and to put stress reduction and management on the front burner!  Make self care a priority to support your bones!
 
Here's hoping that spring's arrival will bring bone health to you.