Regardless of whether we are young or old, male or female, the health of our bones is an important consideration in an overall integrated approach to health.
The dairy industry tells us that calcium intake is the most important way we can avoid osteoporosis, but apart from the obvious issue of relying on advertising to inform us about health, research has shown that calcium intake, while important, is just one of several nutritional and lifestyle factors we need to consider.
In Australia, osteoporosis affects one in two women and one in three men over the age of 60. In real terms, this means that osteoporosis affects over two million Australians today, and by 2021 it is predicted this figure will rise to more than three million people. If we are to enjoy long and productive lives, then taking care of our bones right through our years can make an important contribution to our quality of life as we age.
Bones, throughout our lives and throughout our bodies, are in a constant process of being broken down and rebuilt, but as we age we may not rebuild bone matter as quickly as it is lost. This is osteoporosis, a very common skeletal condition. Generally, in the first 30 years of life, we build bone density, a process in which calcium and other minerals are deposited in the trabecular, or inner part of the bone, creating reserves for later life, or times when blood calcium is low. After the age of 30, there is a gradual loss of trabecular bone. We also have calcium stores in the outer bone, called the cortical bone, and these stores also go into decline after the age of 40.
A reduction in bone mass (through loss of both inner and outer bone density) means bones can become porous and brittle, and consequently are more easily fractured. While there are numerous risk factors for osteoporosis, we will focus here on specific lifestyle factors that can be modified. Regardless of our age, these lifestyle modifications are good indicators of how we can reduce or prevent the development of osteoporosis in later life.
The most important lifestyle modifications are:
Genes – It appears the risk of developing osteoporosis is higher in white or Asian populations. Darker skinned populations are at higher risk if they have indoor occupations with minimal sunlight exposure.
Gender, hormones and aging – Three to seven times more bone is lost in women in the first 7-10 years post-menopause, compared to men of the same age. Osteoporosis starts 5-10 years later in men compared to women.
Medical conditions and medications – Some diseases may predispose the body to osteoporosis. Anorexia, liver and kidney disease, coeliac disease and hyperthyroidism are some examples. Many medications, such as corticosteroids, thyroid drugs, lithium and chemotherapy, can affect bone density.
Life stressors/depression – May affect bone density and studies suggest cortisol, the stress hormone, can play a role.
Physical activity/weight bearing exercise – Walking and weight bearing exercise work to both prevent and treat osteoporosis. Resistance exercise is particularly beneficial in building muscle mass and improving balance, which can reduce the incidence of falls. A lack of exercise can compromise skeletal integrity and any exercise done when younger will help build bone stores for later in life.
Nutritional status and diet – Diets high in animal protein, severe dieting/calorie restriction diets, high sugar diets and high soft drink consumption are all known to have an effect on bone mass density. A lack of, or inability to absorb, vital nutrients throughout life will significantly influence bone health. Obesity can also increase the risk of osteoporosis.
Depleted vitamin D – Lack of sunlight can cause a vitamin D deficiency, which has been linked to many serious chronic diseases. Research shows depleted vitamin D is the most significant contributing factor to osteoporosis.
Smoking – Many studies have shown that smoking reduces bone mass density, increasing the likelihood of hip fractures in women by 31 percent and in men by 40 percent. The more a person smokes the greater the risk of osteoporosis developing.
Low body mass – Smaller framed people have an increased risk of osteoporosis.
Osteoporosis can be a silent disease that is only revealed once a fracture has occurred. In an integrated approach to health, there are many ways we can take care of bone density that also contribute to our total wellbeing. It’s never too late or too soon to take a preventative and proactive approach to bone health.
A good place to start is to use the list of modifiable risk factors above as a checklist for bone health. What areas in your life need attention? What risk factors can you attend to personally? What might you need the support of a health professional for? What daily changes to diet can be made? What deficiencies require supplementation? Can you walk more each day? Smoke less?
It is important to understand that the metabolism associated with bone and muscle strength, and in particular for bone formation, does not rely solely on calcium. Vitamins such as vitamins D, C, B and K, and minerals such as phosphorus, boron, zinc, iron, fluoride, copper, magnesium, manganese, selenium, iodine, silicon and chromium are critical. Integrative GPs or health professionals will be able to consider your dietary and nutritional status and make suggestions as to the dietary modifications and vitamin and mineral supplementation that may be required. It is, in fact, controversial whether calcium supplementation alone can prevent or treat osteoporosis. In post-menopausal women, some research shows that neither milk nor a high calcium diet appears to reduce the risk of osteoporotic fractures.
Vitamin D, however, has a pivotal role in bone metabolism; it controls intestinal calcium absorption plus its deposition into the bones. Vitamin D is involved in virtually every system in the body. Vitamin D supplementation, in conjunction with a quality calcium citrate supplement has an important role to play in managing osteoporosis. A deficiency in vitamin D is common in those who spend large amounts of time indoors, such as the elderly or those in nursing homes, and especially in darker skin people. The case for vitamin D supplementation is very strong for anyone who works indoors or who has an inadequate exposure to sunlight.
A fresh food diet with plenty of fruits and vegetables, moderate daily weight bearing (resistance) exercise, appropriate supplementation, prudent sun exposure and minimisation of other risk factors such as smoking can be highly beneficial in the treatment and/or prevention of osteoporosis. These lifestyle modifications are also important adjuncts to pharmacological/drug therapies and can improve bone health for life.
Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM).