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“I want strong bones!” – Part 1

In this first part of the Stronger Bone series, let's look at:

- What is Osteoporosis and Osteopenia?

- How does your diet affect your risk of developing this disease?

What is osteoporosis?

Osteoporosis is the disease of the bone where there is a reduction in bone mass. It is a result of either:

(1) the body not making enough new bone,

(2) the body loses too much bone tissue….or worst,

(3) the combination of both.

Due to the reduction in bone mass, the bones become weak and may fracture easily during trivial trauma.

If you have watched enough advertisements on television, you most likely would have encountered enough adverts promoting the sales of high calcium beverages to counter the effects of osteoporosis….and very likely these adverts will feature an elderly lady. Thus we tend to view osteoporosis as a geriatric female disease…something that should only be concern about by women in their old age. But unfortunately that viewpoint is extremely flawed as osteoporosis (and its preceding condition, osteopenia) can affect both women and men, and it can affect younger age groups as well.

But first, what is the difference between Osteoporosis and Osteopenia?

Both terms are used to indicate a reduction in bone mass and bone density but the term itself denotes the severity of the disease. To quantify the amount of bone mass and thus its density, a DEXA (Dual-energy Xray Absorptiometry) is usually done. The DEXA scan results are presented as a T-scoring, which reflects the statistical measure of difference between your bone density and compares it to the average bone density of healthy young population of the same gender. In the T-score, a result that falls in between -1 and above is considered “normal bone density”, where as -2.5 to -1 is considered Osteopenic and less than -2.5 is considered Osteoporotic.

A good way to view this is as a spectrum of progression of the bone mass losing disease.

Many do not know that osteoporosis (and osteopenia) can be prevented and like most preventive measures, it has to begin earlier in life. Most people (especially ladies) reach their peak bone density in their early 20s. Factors such as activity level and nutritional level will affect how dense their bones will be as well. The bone density will plateau (or even undergo a slow decline) in the 30s to 40s.

But once menopause arrives, there will be a sharp decline in bone density. Of course, if you start off at a higher density before plateau-ing or slowly declining, the longer time you will have before arriving at bone density level of osteopenic or osteoporosis when menopause hits. Think of this in terms of the “Bank Account Balance” Analogy – the more money you’ve accumulated throughout the years during good economic times, the longer you have before bankruptcy when economic times are bad.

Why preventive measures are important?

People with osteoporosis or even osteopenia have very high risk of bone fractures when they suffer from trauma (and some can be minor) such as fall from bed or chair, bump against the corner of table or door, slipped and fall etc. It does not help that we tend to be more imbalance and unsteady as we get older (which is also something that can be prevented).

Fractures in osteoporotic or osteopenic bones also may not heal well despite surgery. All these lead to prolonged immobilization, loss of function and independence and all the issues related to prolonged immobilization such as pressure sores, orthostatic pneumonia, deep vein thrombosis etc.

Most people wonder why this is an important issue to tackle right now when the actual problem will only rear its ugly head much later in life.

Well….there are so many things you can do and should do right now to prevent suffering later on (refer back to the “Bank Account Balance” analogy), and most likely many of you are not doing it – your diet, your physical activities and your current lifestyle. All these are within your control and you have the ability to do something that can potentiate your bone health in your golden years.

Your diet

As I have mentioned earlier, we have been bombarded with advertisements extolling the wonders of fortified milk in combating osteoporosis and osteopenia. Many may think that drinking milk is the only way to beef up bone mass and in view that many of East Asian descend are lactose intolerant, that makes consumption of milk sometimes rather difficult.

However have you stopped to consider if dairy products are the only way to reduce the risk of this bone losing disease?

The better question to ask is, “What exactly in milk that is helping to rebuild bone mass?” as this question helps us to zoom in onto the various nutrients naturally present in dairy which is needed to improve our bone health.

According to the Framingham Osteoporosis Study, a multitude of macro and micronutrients (vitamins and minerals) are necessary for optimum bone health (and health in general) as each individual micronutrient performs certain functions in which altogether results in good bone health. Its recommendations are as follows:

(i) Fruits, vegetables, fish and meat: they contain plenty of vitamins and minerals that show promise in reducing the risk of developing osteoporosis and reducing risk of osteoporotic fractures, such as Vitamin C, Carotenoids, Folate & B12 and Vitamin K.

(ii) Dairy products: dairy such as milk has a complex combination of essential nutrients such as Calcium, Magnesium, Vit D, B12, Vit K, Zinc, Riboflavin etc and is also a source of protein.

(iii) Protein: previous studies had shown differing results (some studies of higher protein intake showed improved outcome, which some did not) but of late, studies suggest that higher intake would be beneficial for bone health and protective against risk of fractures in adults with adequate calcium intake. In fact, Morton, Murphy et al. (2019) published a study recommending high quality protein intake of 1.5 to 1.6g/kg/day for physically active older population who want to build lean body mass. Acquiring and maintaining as much lean body mass as possible as you age is important in osteoporosis and osteopenia prevention, as we shall explore further in the second part of this series of articles.

How many of us actually eat a diet rich in produce and whole foods? More likely, many are subsisting on a diet of highly processed food that is devoid of nutrients. Sometimes that may be due to cost of purchasing whole foods but mostly it is due to the convenience of consuming these processed foods. Many only start paying more attention to their health and diet later in their lives when the notion of increasing morbidity and mortality dawns on them.

But whatever your age is right now, it is never too late to want to care about our bone health. So it is imperative to care about what you consume daily and to make sure that it is nutrient dense.

Next….Let's look at how physical activities help in reducing risk of osteoporosis.

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