January 26, 2015
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Strong Bones, Healthy Joints


Ms. Colberg is an exercise physiologist and associate professor of exercise science at Old Dominion University in Norfolk, Virginia. A diabetes researcher with almost four decades of practical experience as a type 1 diabetic exerciser, she is a Fellow of the American College of Sports Medicine, a professional member of the American Diabetes Association, and the author of three books on diabetes.

Editor's Note: You wouldn't buy a house without checking the foundation and support structures to make sure they are sound, so you already know why keeping your bones healthy is so important. As you age, you have to do more to offset the bone loss that begins as early as age 25.

The following is an excerpt from a new book by The Doctor's Senior Living specialist, gerontologist, Dr. John Morley: The Science of Staying Young, 10 Simple Steps to Feeling Younger than You Are in 6 Months or Less, written with Sheri R. Colberg, Ph.D. (McGraw-Hill, 2008). Used by permission.

Healthy bones and joints are crucial to your mobility and extended youthfulness, as well as living a pain-free life as you move around. Some largely effective strategies exist to prevent and limit potential bone problems, no matter what your age is, including adequate calcium and vitamin D intake, regular weight-bearing exercises, avoidance of phosphorus-filled sodas, moderation of protein intake, and in some cases hormone replacement therapies. All of these options for improving bone health will be addressed in this [article], along with how to maintain healthy joints in order to reduce and minimize pain from any arthritis you may develop to help you stay feeling younger than your chronological age.

Thinning Bones: Risk, Screening, Prevention, and Treatment
Unfortunately, everyone is experiencing slow bone demineralization throughout adulthood starting around the age of 25, which can eventually lead to fractures and a lower quality of health. This process, known as osteoporosis, can lead to a greater incidence of fractures, especially of your hip, wrist, or spine, at whatever age you finally reach a critical minimum bone density. According to the National Osteoporosis Foundation, 50 percent of women and 25 percent of men over 50 will have an osteoporotic fracture in their lifetime. Moreover, the Surgeon General's report issued in 2004 predicted that by 2020 half of all Americans age 50 and over will have weak bones without significant changes to the nation's diet and lifestyle as a whole. At present, an estimated 10 million Americans — 80 percent of them female — already have this disease, and another 34 million have significantly reduced bone mass (a condition known as osteopenia). Thus, it's not a problem to be ignored if you want to live long and well.

The term "osteoporosis" was originally coined in the early 19th century, but it wasn't until 1940 that the loss of estrogen in women at menopause was identified as playing a role in its development. It has often been asserted that osteoporosis is actually a pediatric disease because the amount of calcium you ingest during your childhood likely is a major determinant of your bone mineral density later in life. Regardless of when it actually starts, it's undeniably a chronic condition that causes bones to gradually lose their stored calcium, leaving them porous and brittle. Over time, this process of demineralization causes the skeleton to become weaker, and when it reaches a critically low level, bone fractures can occur and recur from seemingly minor impacts.

[O]steoporosis is actually a pediatric disease because the amount of calcium you ingest during your childhood likely is a major determinant of your bone mineral density later in life.

Whereas bone loss occurs over many years, you will likely only become aware of having this condition when fractures are blatant or postural changes are well advanced. For example, repeated, undetected compression fractures in the vertebrae of the spine can lead to stooped posture and backaches, both of which are common characteristics of older women (and some men). Hip fractures resulting from this disease can be immensely debilitating, often signaling the start of a downward trend of reduced strength and a lower quality of life.

Who Is at Risk for Osteoporosis?
Certain immutable factors increase your risk of developing osteoporosis. Among them are small frame size, female sex, age, hereditary factors, Caucasian or Asian race, early menopause, prolonged immobilization, low levels of estrogen or testosterone, excess thyroid hormones (e.g., overactive thyroid gland), and extended steroid use (such as prednisone). Other contributory behaviors like cigarette smoking, excessive alcohol consumption, physical inactivity, and inadequate intake of calcium and vitamin D can be controlled and modified to lower risk.

Women have an inherently greater risk for osteoporosis than men because men's skeletons contain a larger reserve of bone minerals, but also due to faster rates of loss in females. After menopause, women lose bone at an average rate of two to three percent per year, while men of a similar age are losing only 0.4 percent annually. The most visible sign of this bone loss is a gradual shortening in overall height over time. In Caucasian and Asian women in particular, bone mass starts to decrease in the femur (thigh bone) in their mid-20s, followed by spine losses in their mid- to late-30s, and arm bone demineralization after 40 years of age.

Screening for Osteoporosis
Due to recent advances in the way bone density is measured, it's now easier than ever to find out if you have already significant bone loss, if you're pre-osteoporotic (i.e., you have osteopenia), or even if you're at risk for osteoporosis in the future. Testing methods include single-photon absorptiometry (SPA), dual-photon absorptiometry (DPA), dual-energy X-ray absorptiometry (DEXA), computed tomography (CT) scanning, and ultrasound. If you have already suffered a bone fracture of the wrist, back, or hip seen on X-ray, you don't need to have a special test done before being treated for osteoporosis; it's assumed that you already have it.

All women reaching the age of menopause should have their bone mineral density measured, along with at least one more check at 65 years of age. Since they lag behind, men should ideally have testing done when they reach 65 to 70 years old. The actual diagnosis of osteoporosis is made when you have a bone mineral density that is more than 2.5 standard deviations below the young adult average (a T-score of 1.0 to 2.5). Your bone mineral density should be repeated after two years to determine your rate of bone loss, and the testing should always be repeated at the same time of year, as seasonal changes in bone density are common.

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