Ask anyone, especially a senior, What is a sign of wellness? What tissue epitomizes strength? The answer is your bones and skeletal health. Never have we known so much about bone health, and never has it received so much attention. Our understanding of bone as an organ and a tissue has deepened, especially in the last few years. The public’s level of awareness has been raised as well, and people want to know what they can do to improve their bone health. They know about the problems that result from osteoporosis, especially the potential for fractures and bone injury.
Bone is truly a remarkable tissue, with amazing abilities and wonderful reparative properties. Bone has the principal responsibility of supporting the load imposed upon itclinical herbalism, the human body. The demands placed upon our bones require enormous strength and resilience, while still being relatively lightweight. Bone is a very responsive tissue, altering its shape and configuration depending on the forces it endures, responding to physical stress by becoming stronger.
Bone requires physical forces be placed upon it, at least partially in the form of resisting gravity, to survive and thrive.
We know more about this process than ever before. At last, we begin to grasp how bone responds to physical activity. Advances in technology have allowed us a better, more thorough understanding of the biology and physics of bone. We know its healing abilities are excellent, at least partially because of its well-endowed blood supply.
As we are all aware, aging affects bones, as it does every part of the human body (and everything else). But certain eras are associated with more significant bone changes. Bone loss begins or accelerates at midlife for both men and women. The goal during this time of life is to keep bone loss to a minimum. For example, between the ages of forty and fifty, bone loss may progress more slowly in both sexes with effective interventions. Unfortunately, during menopause, there is a period of more rapid loss in women. Both sexes may lose a total of 25 percent of bone during this period. This phase can occur anytime between the ages of fifty and seventy.
The frailty phase typically occurs in adults over age seventy. One common occurrence in this phase: bowing of the spine, called kyphosis, due to spinal fractures secondary to osteoporosis. But, be aware these phases are generalized. It is important to know fractures are not a natural consequence of aging. They can be avoided, to some extent. Your chronological age, as an individual, is a given, so we must focus on those factors over which we have some control—our diet and physical activity.
Osteoporosis is the excessive, or “pathologic,” thinning or loss of bone density.
With this common disease, bone substance is lost, making the bone lighter, thinner, and, of course, weaker. When progressive, it can lead to loss of height, stooped posture, humpback, and severe pain. Osteoporosis is characterized by the systemic impairment of bone mass, and strength, resulting in increased risk for fragility fractures, disability, and loss of independence.
Falls frequently result in fractures when thinning of bone has occurred. In seniors, or anyone with certain risk factors, falls are a real and ever-present threat. One approach to the problem is participating in a fall prevention program, helping us to protect our bones by reducing the risk of injury. Programs such as these, addressing muscle strengthening, balance, and gait training, and home hazards evaluations, all help to reduce the number of fractures that occur.
Gait-assistive devices are important, although patient acceptance can be a real issue. Bracing and supports can be beneficial, but are utilized far too rarely. Re-evaluation of prescribed and over-the-counter medications being taken for possible unexpected consequences is also recommended. Oftentimes, one person may receive prescriptions for multiple medications from multiple providers. Many pharmaceuticals have the potential to have psychotropic qualities, meaning they alter perception or mental acuity in some way, and should be reduced or replaced.
Osteoporosis is the most common and most well-known of the bone diseases.
Sometimes referred to as the “fragile bone disease,” this loss of bone mass is often caused by a vitamin deficiency, particularly calcium, vitamin D, or magnesium. Its development usually starts with osteopenia, the precursor to osteoporosis, in which there is early bone thinning.
According to the National Osteoporosis Foundation, osteoporosis affects 54 million Americans, mostly women. Millions more Americans are estimated to have the low bone mass of osteopenia, putting them at risk for osteoporosis. The morbidity and resulting expense is incalculable. For starters, we know that almost two million Americans a year suffer a fracture attributable to osteoporosis.
It’s well-recognized and proven that physical activity is important for bone health.
Exercise, in all of its varied forms, helps to reduce the risk of falling in later years. This is common mantra holds true throughout the many phases of life. Exercise helps to increase or preserve bone mass. Resistance training, whether with machines or weights, is especially helpful.
We can improve our own bone stock. Still, we have no control over some of the most important factors in developing healthy bone. Studies indicate that genetic factors are responsible for determining fifty to ninety percent of our body’s bone mass. Heredity issues not only limit how much bone a person may acquire, but also affect bone structure, the rate of bone loss, and the skeleton’s response to environmental stimuli, such as certain nutrients and physical activity.
Healthy, sufficient nutrition is important in maintaining optimal bone mass.
We also know the optimal type of nutrition and activity will vary across our life spans. A person’s nutrition over the years is clearly essential to preventing this debilitating disease. It is widely accepted that adequate calcium and vitamin D intake are necessary for good bone health, and the nutritional benefits of these two nutrients go far beyond their boon to bone health.
Because the average American consumes levels of calcium far below the amount recommended for optimal bone health, it has been singled out as a major public health concern today. Vitamin D aids in the absorption and utilization of calcium. There is a high prevalence of vitamin D insufficiency in nursing home residents, hospitalized patients, and adults with hip fractures.
Some estimates claim that over 40% of Americans have a vitamin D deficiency.
Although sunshine is the best method of increasing your levels, supplementation is recommended for most of us. Current guidelines suggest 400–800 IU per day is adequate, although many scientists say this is not nearly enough. Another controversy surrounds which type of vitamin D is best, D2 or D3. The former is from plant sources and the latter from animals. Most experts believe D3 is better at raising tissue levels.
It is essential we value the impact we can have on our own bone health. While genetic factors are important in determining bone mass, we each need to understand we have a critical part to play. In fact, controllable lifestyle factors, generally referring to diet and physical activity, are responsible for ten to fifty percent of our bone mass and structure.
But too many of us are too sedentary. Many of us know, in a general sense, that exercise is important. Yet how many of us are able to incorporate it into our average day and make it a regular practice? A little self-knowledge has not achieved great gains in levels of personal fitness. It may be time for a different approach. When exercise is prescribed like a drug by one’s family doc, it acts as a prescription medicine. And it is the healthiest kind.
Dr. Conway McLean is a physician practicing foot and ankle medicine and surgery in the Upper Peninsula (Marquette and Escanaba). McLean is triple board certified in surgery, wound care, and orthotic therapy. He has lectured internationally on many topics. Dr. McLean welcomes questions at drcmclean@outlook.com.
Excerpted with permission from the Fall 2020 issue of Health & Happiness U.P. Magazine. Copyright 2020, Empowering Lightworks, LLC. All rights reserved.
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