Understanding and Maintaining Bone Density

This newsletter focuses on the important topic of bone health as we age. It's a natural process for bone density to decrease over time, which usually doesn't cause any immediate discomfort. However, this can potentially lead to osteopenia and osteoporosis, increasing the risk of fractures (ouch!).

In this edition, we will cover how bone density changes as we get older, what steps can be taken to prevent its decline, and available treatments if bone loss occurs.

Bone Density: What You Need to Know

Bone Loss Statistics:

• Generally, after the age of 30, individuals tend to lose about 0.5% to 1% of their bone mass annually. This rate can accelerate in women after menopause due to reduced estrogen levels.

  
  

• 66% of vertebral fractures have NO SYMPTOMS or pain at all 

Prevention Strategies for Bone Loss:

Taking proactive steps can significantly help in maintaining bone strength. Here are some key strategies:

1. Nutrition Tips:

   
   

   Calcium: This is essential for strong bones. Adults should aim for 1,000 mg daily, with an increase to 1,200 mg for women over 50 and men over 70. Good sources include dairy products, leafy green vegetables, and calcium-fortified foods. While supplements and gummies are available, they are not considered as effective as dietary sources.

   
   

   Vitamin D: Vitamin D plays a crucial role in the body's ability to absorb calcium. Dr. C generally recommends around 2000 IU daily. While fatty fish, fortified milk, and egg yolks contain Vitamin D, it's often challenging to get sufficient amounts through diet alone. In this case, supplementation is often more effective.

   
   

   Protein: Adequate protein intake is vital for bone strength. Include sources like egg whites, lean meats, beans, and dairy in your diet.

2. Lifestyle Modifications:

   
   

   Regular Exercise: Weight-bearing exercises send signals to your bones, encouraging them to build density. Activities such as weight lifting, walking, jogging, and resistance training are particularly beneficial.

   
   

   Avoid Smoking and Limit Alcohol: Both smoking and excessive alcohol consumption can negatively impact bone health. Reducing or eliminating these habits can contribute to improved bone density.

Medications for Bone Health:

For individuals at a higher risk of osteoporosis or those who have already experienced significant bone density loss, medical intervention might be necessary. Some commonly recommended medications include:

• Bisphosphonates: Medications like Alendronate (Fosamax) and Risedronate (Actonel) help to slow down the rate of bone loss. These meds do not build bone. There is some evidence showing that it may be beneficial to start off with an agent that builds bone first before beginning a bisphosphonate that only prevents bone breakdown.

• Selective Estrogen Receptor Modulators (SERMs): Raloxifene is an example that mimics the positive effects of estrogen on bone density.

• Parathyroid Hormone Analogs: Teriparatide (Forteo) can stimulate new bone growth and is often used in more severe cases.

• Denosumab (Prolia): This is a monoclonal antibody that works by slowing down bone breakdown and is very convenient dosing, once every 6 months. However, abrupt discontinuation of this agent sharply increases the risk of fracture, so you have to make sure to have a plan for what to switch to if you switch off this particular med.

Final Thoughts

Taking care of your bones is a lifelong commitment.  For enrolled patients, talk to Dr C about building a prevention or treatment plan for protecting your bone density, if you haven't already. If you are looking for a book to read, Dr C recommends the book "Facing Osteoporosis" by her colleague Dr. Bolster (no affiliation) - check it out!

Aditi Correa, MD, MSCP

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