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We are all familiar with the image of the elderly woman who can't look up due to loss of bone mass in her neck and the elderly man whose broken hip keeps him in a wheelchair. This doesn't have to be you. Here are four simple ways to prevent osteoporosis.

Osteoporosis, the disease of brittle bones, isn't an inevitable consequence of aging. Not everyone can prevent osteoporosis, but these four measures help.

1. Eat! Regular nutrition is essential to keep bones strong

Bones have to get calcium to make the mineral crystals that give them strength. Dairy products are a great source of calcium, but if you don't eat dairy, then you need to get fish (the kind with small edible bones is best), or at least your daily greens. Calcium supplements of 1,000 to 1,500 per day for your entire life after about age eight will help, but calcium is not enough. Your body needs vitamin D, magnesium, and vitamin K2 to keep calcium in bones where it belongs. Bones also need protein to build the collagen scaffold that holds them together. It's important not to fast too long or too often.

Excessive fasting depletes bone marrow and weakens bones. Intermittent fasting for 12 to 24 hours twice a week is OK, but fasting longer than 48 hours is something you should only do under medical supervision.

2. Play! Changes in exercise build new bone

The bone building and recycling process is triggered by changes in exercise patterns. Impact sports build bone. Your bones reshape themselves to accommodate dribbling a basketball, or hitting the floor when you jump rope, or snatching a heavy weight, or, for that matter, moving the couch from the living room to the den on a Saturday afternoon. Doing the same old exercise over and over again does not require bones to clear out old bone and build up new. And although repetitive aerobic exercise like ellipticals and swimming are great for your heart, they don't help your bones. It's variety in physical activity with stress on your muscles, but not so much stress that you break bones, that keeps bones healthy.

3. Supplement! Calcium and vitamin D are a must for healthy bones

Most people around the world don't get enough calcium and vitamin D to keep bones in good shape. Just about everyone benefits from 1,000 to 1,500 mg of calcium per day (even the least absorbable kinds of calcium, like calcium oxide, benefit bone health) and 1,000 to 5,000 IU of vitamin D. If you get lots of green vegetables and you eat bright orange egg yolks and dairy products from grass-fed cows, or you are an aficionado of the Japanese fermented soy food natto (it is an acquired taste), then you may not need supplemental magnesium and vitamin K2. But most people benefit from 200 to 600 mg of magnesium per day plus 45 mg of menaquinone, vitamin K2. The M-7 form of vitamin K2 is more effective than the M-4 form.

Don't worry about getting the very most absorbable (and expensive) form of these supplements, especially when finances are tight. Just be sure you take them every day.

4. Don't smoke!

Smokers get tired of other people's trying to get them to quit. We non-smokers know that. But the simple fact is that smoking is related to myriad health conditions. They aren't guaranteed to happen to you if you smoke. They are just more likely.

But there are a variety of reasons that smoking is tied to brittle bones:

  • If you smoke more, you tend to eat less. That's because nicotine (and nicotine patches) suppress appetite. Low-weight people are more likely (not less likely) to develop osteoporosis because their muscles do not send growth signals to bone. Their bodies also have fewer fat cells. It's fat cells that manufacture a lot of the estrogen that powers the growth of bone, especially in men. (Yes, men make estrogen too. Just less of it.)
  • Women who smoke tend to go through menopause two years earlier. That is two more years of diminished estrogen production that results in less rebuilding of bone.
  • Men who smoke have higher testosterone levels. That sounds like a good thing. The problem is that higher testosterone is accompanied by deficient estrogen, which is needed by bone.
  • Nicotine has dose-dependent effects on bone. If you smoked one or two cigarettes a day, we have to confess, you might actually stimulate the production of new bone. But most smokers don't smoke just once or twice a day. If you smoke five or more cigarettes a day, nicotine suppresses the formation of new bone minerals and weakens bones.
  • Free radicals released in hot tobacco smoke suppress the formation of new bone.
  • Polycyclic aryl hydrocarbon compounds from tobacco smoke get into circulation and are directly toxic to bone.

Smoking increases the lifetime risk of a fracture to the spine by 13 percent in women and by 32 percent in men. Smokers are also more likely to get fractures of the forearm.

The risks of smoking also apply to second-hand smoke. If you won't curb your smoking for yourself, consider those people you love and make sure they don't pay the price for your habit.

  • Al-Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms. J Osteoporos. 2018 Dec 2.2018:1206235. doi: 10.1155/2018/1206235. eCollection 2018. Review. PMID: 30631414.
  • Belibasakis GN, Bostanci N. The RANKL-OPG system in clinical periodontology. J Clin Periodontol. 2012 Mar. 39(3):239-48. doi: 10.1111/j.1600-051X.2011.01810.x. Epub 2011 Oct 24. Review. PMID: 22092994.
  • Burckhardt P. The role of low acid load in vegetarian diet on bone health: a narrative review. Swiss Med Wkly. 2016 Feb 22.146:w14277. doi: 10.4414/smw.2016.14277. eCollection 2016.
  • Photo courtesy of SteadyHealth

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