Everything You Need to Know and What to Do
Osteopenia & Osteoporosis
Bone Health Basics
What do bones do?
Bones give our bodies support, allow us to use muscles for movement, protect our organs, and store and release calcium that is vital for building strong bones but also for the function of all cells in the body. Bone is a living tissue that can rebuild itself throughout life. While the outside of bone looks like rock, the inside more closely resemble lacy coral surrounded by a hard, thick shell.
How does bone grow?
The skeleton forms and grows throughout life in a process called remodeling, or more simply, removing and replacing bone tissue. As we age, this remodeling process can shift out of balance and result in more removing of bone, and less rebuilding which leads to OP and higher risk for fractures. Before age 25, our body is rapidly making bigger, thicker bones. After age 25, weight-bearing exercise can help slow the loss of bone strength and mass, but it’s much more difficult to make bigger bones. Nutrition and exercise are critically important factors in all life stages.
Osteopenia and Osteoporosis
What is Osteopenia?
Osteopenia is Low Bone Density - bones are becoming weak compared to others of the same age. While osteopenia does not often cause symptoms, it may increase the risk of osteoporosis. Treatment can help prevent the condition from progressing.
What is Osteoporosis?
People with osteoporosis have even lower bone density than those with osteopenia. Osteoporosis leaves bones fragile, which can mean that even minor falls may cause bone fractures. Fractures can also cause significant health problems. If you have osteoporosis, you should work with a healthcare provider to decide on the best treatment plan.
HEALTHY BONE
OSTEOPENIA
OSTEOPOROSIS
Are You At Risk?
The first part of preventing Osteopenia and Osteoporosis is understanding your individual risk factors. Individual risk factors include:
Gender
Diabetes
Smoking
Age
Inflammatory and auto immune diseases
Certain Medications
Inactive Lifestyles
Diet low in calcium and Vitamin D
There are some risk factors we cannot control - like gender and age. But there are many risk factors we CAN control. Bone loss from osteopenia and osteoporosis can be prevented or slowed down by healthy lifestyle behaviors. There are things you can do every day that will reduce your risk.
Get Screened
It is important to get screened with a dexa scan. A dexa scan measures bone strength and is the gold standard for osteoporosis screening. It is quick, painless, noninvasive, and is usually covered by insurance.
A dexa scan can be ordered by the Wellness Center, your PCP, or your gynecologist. After getting an order for the dexa scan, you can call any location (see pg. 8) or use the MyUPMC app to schedule the test. When your test results are available, the ordering physician will discuss them with you. The Wellness Center team can review your results and work with you to develop a personalized plan to prevent or slow the development of osteoporosis.
Osteoporosis is a “silent disease,” meaning, most people don’t know they have it until a painful bone fracture occurs.
Osteoporosis causes 2 million broken bones each year.
1 out of 2 women (and 1 out of 4 men) will break a bone due to osteoporosis.
Osteoporosis accounts for more hospital stays than diabetes, heart attacks, and breast cancer.
Nutrition for Bone Health
Good nutrition is essential to ensuring that the body has the protein, minerals, and vitamins needed to make and regenerate bone, and prevent osteopenia and osteoporosis.
Calcium and Vitamin D play an critical role in building strong bones. You can get calcium from food (best) or supplements (talk to your provider). Vitamin D helps your body absorb and use the calcium it gets from food and supplements. Your body stores calcium in your skeleton and then releases to cells that need it. If we do not have enough calcium coming in to supply all of the cells in the body, calcium gets removed from the skeleton and bones get weak.
Calcium and Vitamin D are crucial to preventing osteopenia and osteoporosis in both women and men of all ages.
Calcium
You can get calcium through your diet or with supplements, but dietary intake is ideal. Focus on eating a variety of calcium-rich foods and beverages throughout each day. The best dietary sources for Calcium are: Daily recommended amounts are:
Dairy (yogurt, cheese, etc.)
Soy products
Vitamin D
During your growing years, your body needs calcium to build strong bones and create a supply of calcium reserves, so building bone mass when you are young is a good investment for your future. Calcium continues to be an essential nutrient after growth because your body loses calcium every day.
Daily recommended amounts are:
Males and females 9 to 18 years: 1,300 mg per day
Women and men 19 to 50 years: 1,000 mg per day
Women and men over 50: 1,200 mg per day
Cereals
Dark green leafy vegetable
Your Wellness Center team can provide you with a list of calcium-rich foods and recipes that incorporate calcium and vitamin D-containing ingredients. If you are having trouble reaching the recommended daily amount of calcium through the foods you eat, you can also take a calcium supplement. Work with your provider to determine which supplement is right for you.
Vitamin D also plays a crucial role in bone health because it helps your body absorb calcium. Without vitamin D, your body will not absorb the calcium you get, and it will start “robbing” your bones to get the calcium it needs. The recommended daily amounts of vitamin D are:
Adults under age 50: 400-800 International Units (IU) daily
Adults age 50 and older: 800-1,000 IU of vitamin D daily
You get Vitamin D from sunlight (your body makes Vitamin D when exposed to UV rays in sunlight), dietary intake, and supplements. Foods naturally rich in Vitamin D are fatty fish (salmon, tuna, sardines, swordfish) and egg yolks, and many dairy products, cereals, and orange juice are fortified with it. Supplements can be taken if your diet does not contain enough Vitamin D, but consult a provider.
Small Nutrition Changes for Bone Health
A well-balanced diet with plenty of dairy, fish, fruits, and vegetables will provide the nutrients you need, but it is also important to pay attention to the small things that can have an impact on bone health.
Beans and legumes contain things you need like calcium, magnesium, and fiber, but they are also high in phylates which interfere with your body’s ability to absorb calcium. Soaking beans in water for several hours, then cooking them in fresh water reduces the phylates.
Salty foods – excess sodium (salt) causes your body to lose calcium. To decrease your salt intake, try to limit processed foods, canned foods, and added salt. Look at your food labels – if it lists 20% or more for the % daily value, it is high in sodium. Aim for 2400mg or less of sodium each day.
Alcohol – drinking heavily can lead to bone loss. Limit alcohol to no more than 2 – 3 drinks/day.
Caffeine can decrease calcium absorption. Try switching to decaffeinated beverages.
Physical Activity and Bone Health
Staying active and following a regular exercise program with weight-bearing movement are important for maintaining bone health. Bone cells respond to increased stress – stress on a bone from weight-bearing exercise leads to improved (denser) bone structure. Regular physical activity also improves muscle mass which helps to prevent falls.
Weight-bearing activity is anything you can do on your feet that works your bones and muscles against gravity. There are many examples of weight-bearing activity that you can do every single day:
Walking or hiking
Dancing
Climbing stairs
Aerobics
Housework or yard work
Weight training or using resistance bands
Weight-Bearing Activity
Physical Therapy (PT) can help prevent and manage osteopenia and osteoporosis, as well as help rehabilitate related injuries. A Physical Therapist is specially trained to develop a program for you that:
✔ Targets bone and muscle strength
✔ Reduces your risk of falling
✔ Safely improves your balance and stability
✔ Improves your mobility
Weight-bearing activity helps to prevent osteoporosis and falls because exercise works on bones in the same way it does on muscles - it makes them stronger. Because bone is living tissue, it changes over time in response to the forces placed upon it. When you exercise regularly, your bone adapts by building more bone and becoming denser and stronger.
Another benefit of weight-bearing exercise is that it improves balance and coordination – extra protection against falls! Weight-bearing activity is anything you can do on your feet that works your bones and muscles against gravity. Many types of weight-bearing activities offer benefits.
An effective program for bone health includes 30 minutes of weight-bearing activity, four or more days a week. Your 30 minutes can be done all in one stretch or broken up into shorter intervals. Get movement in wherever and whenever you can throughout your day. Do not be afraid to move! All movement is good movement!
Weight-Bearing Activity: Why Gender Matters
The musculoskeletal systems of women and men are different:
Women have less muscle mass and different muscle fiber composition.
Testosterone and high levels of physical activity increase muscle mass in men.
Women have a wider forefoot and shorter arch, thinner cartilage in foot/ankle joints, greater range of motion on gait analysis, lower center of gravity, and increased quadriceps angle.
Women have weaker quadricep and hip abductor strength.
Developing an activity regimen that targets these areas will help improve your strength and balance, and will prevent falls. Choose activities that are enjoyable to you. Your Wellness Center provider can help you identify the exercises that are best for you.
Can Physical Therapy help?
Physical Therapists are licensed and trained to develop a program for you that is both safe and effective. Not all exercises are right for every person and some could be unsafe for some people. In Physical Therapy, you will learn movements that you can continue to practice at home. Some examples are:
Balance exercises like getting up from a chair without the use of the arms
Weight-bearing aerobic exercises like stomping
Movements that help you improve your posture and alignment
Using weights, resistance bands, or gravity to target specific muscle groups
Reduce the Risk of Falling
A fall in your home or in your community puts you at risk for serious injury. Each year over 3 million adults are treated for serious fall-related injuries, and falls are the leading cause of injury among older adults. Physical changes, health conditions, and some medications can make you more likely to fall as you age. There are simple things you can do to prevent falls:
Make an appointment with the Wellness Center to discuss:
Your medications – make a list of all prescription and nonprescription medications including any supplements.
Any previous falls – write down the details including when, where, and how you fell. Include any examples of times your “almost” fell but managed to grab hold of something or someone just in time.
Your health conditions – dizziness, blurry vision, joint pain, and shortness of breath are just some of the common health conditions that can increase your chance of falling.
Exercise regularly.
Activities that improve balance, coordination, and flexibility will decrease your risk.
The Wellness Center can help you find a physical therapist or monitored exercise program that’s right for you.
Check your feet and footwear.
Wear properly fitting, sturdy, flat shoes with non-skid soles.
Avoid high heels, floppy slippers, and slick soles.
Fall-proof your home:
Clear walkways of boxes, papers, cords.
Remove unnecessary area rugs or secure with double-faced tape or slip-resistant backing.
Store necessities within easy reach.
Use nonslip mats in the shower/tub. Prevent wet or slippery floors.
Make sure rooms are well lit. Use night lights in bedrooms, bathrooms, kitchens.
Keep flashlights in every room in case of electrical outage.
Use a cane or walker if recommended by your health care provider.
