Bones are living, evolving cells that respond to not only the nutrients put before them but also to certain environmental influences. Namely, applying pressure to bones or “weight-bearing” activities actually causes the bones to respond by becoming stronger. It’s not dissimilar to the idea of using weight lifting to grow your muscles. This is why larger framed and overweight people are generally at lower risk for low bone density; the weight they carry around on a daily basis actually helps build their bones. Those who have slighter frames and less body mass have less resistance on a regular basis to keep nudging their bones to strengthen. To be clear, we are not telling you to gain weight to build your bone strength.
This can actually be achieved by doing proper weight-bearing exercises. Routinely putting pressure on your bones will help increase bone density. The good news is that most exercise is weight bearing in some way. You can enhance the upper-body effect of using an elliptical or walking by using your arms more vigorously and adding one-pound wrist weights (these can be purchased at any local fitness store, or Target, or Wal-Mart).
The one exercise that does not really “count” as weight bearing (though it is a good calorie burn) is swimming. The water reduces resistance so your bones don’t get the pressure they need to promote bone density. However, some people do water-aerobics classes that use light weights, and these do qualify as weight bearing. In addition to weight bearing for the sake of strengthening bones, strength training and balance training are great for those with low bone density. Not only do strength and balance training help build bones themselves, but they inherently help with fall prevention. Activities like yoga, martial arts, and tai chi are great ways to get exercise that strengthens bones and at the same times teaches balance techniques that will in turn help prevent falls and fractures.
Patients with an established diagnosis of osteoporosis or osteopenia (lower-grade bone loss) have numerous prescription treatment options, though these options are highly individualistic and necessitate a discussion with your physician. Especially in cases of osteopenia, a tool called the Fracture Risk Assessment Tool (FRAX®) score should be employed to determine the likelihood that an individual will sustain a fracture. If the likelihood of a fracture in the next ten years is high enough (experts say 3 percent for a hip fracture or 20 percent for a nonhip fragility fracture), guidelines advise treatment with a bisphosphonate. These drugs—the most common of which is Fosamax®—have received somewhat of a bad rap over the years. Lots of lay press has enjoyed touting their nasty side effects. They certainly can have associated side effects—the most common and untoward of which is GI and esophageal symptoms—so they should be taken on an empty stomach accompanied by a full glass of water, and you must remain upright (not lying down) for thirty minutes to an hour after taking them and not eat during this time. So it’s a bit of an ordeal, but there are once-weekly or once-monthly doses available that help
most people find it doable.
Bisphosphonates’ much rarer and dreaded complication of “osteonecrosis of the jaw” is often talked about but almost never seen (it occurs in one in a quarter of a million people or fewer who take bisphosphonates). The majority of cases have been seen in patients who are receiving higher-than-typical doses for specific cancer conditions. In most, it can be avoided if you obtain good dental care and stop the medication around times of tooth extractions. Check with your dentist on this one.
Another headline about bisphosphonates relates to fractures said to be caused by these treatments for osteoporosis. Further examination of these atypical types of femur fractures has revealed that they typically occur in people who have osteoporosis associated only with long-term steroid (prednisone) use. People with osteoporosis due to chronic steroid use may benefit from another type of treatment. A final word on osteoporosis treatment and prevention, and the role of HRT. At one time, it was standard to put women automatically on hormones when they hit menopause. There is no doubt that hormone replacement (the estrogen component) does strengthen bones and essentially slow the normal postmenopausal decline. However, this is no longer considered enough of a reason to start HRT. It may be a factor in a decision, but there are too many potential negatives to using HRT (increased rates of breast cancer, stroke, and cardiac disease) to endorse using it for bone density alone. That being said, for some women with specific circumstances or conditions, HRT is the correct choice and bone density will likely benefit. This is a conversation to have with your physician since it is such an individual decision.
Do note that “compounded” or non-FDA-approved treatments for menopausal symptoms, commonly called “bioidenticals,” have not been sufficiently tested for their role in treating bone density, or any other conditions, nor have they been tested sufficiently to be considered safe in anyone. In addition to those we have discussed here, there are a number of other prescription treatments for osteoporosis. These medications are beyond the scope of this article, but suffice it to say, there are a whole host of options for treating bone density today, most of which did not exist fifteen years ago. Bone density is a slow-to-change condition, but that does not mean it should be ignored. Be sure to have a discussion with your physician about what treatment may be best suited to your needs.
It is also important to take the right blend of supplements. A personalized vitamin assessment will tell you what you need and the right amounts. These online assessments are readily available through online personalized vitamin brands. You should search for reputable brands with trustworthy credentials, such as physicians involved in the assessment process. It is superior to get a personalized vitamin compared to shopping in the confusing vitamin aisles with a “do-it-yourself” methodology. These personalized vitamin brands will also support your routine through easy, recurring subscription fulfilment and supportive communication with rich education and adherence coaching. It is a good time to consider moving from mass market vitamins into personalized vitamin solutions. Over the long-run, your bone health is important and taking the right set of vitamins is critical to achieve strong bones for the future.
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