Keep Your Bones Healthy

Matthew T. Drake, M.D., Ph.D.: Welcome to the Mayo Clinic. My name is Dr. Matthew Drake. I am one of the doctors who works in the Endocrine Clinic, where I provide care to patients with skeletal related issues. Bone loss occurs in both men and women with aging but can also occur for other reasons such as medications or lifestyle factors. While nearly everyone will lose bone over the course of their lifetime, there are several simple steps you can take to help maintain a strong skeleton and to limit your risk for having a broken bone.

Over the next several minutes, we will review some general ways in which you can optimize your bone health. These include making good choices to limit your risk of having a fall. Using good technique when lifting to avoid having a back fracture. Staying active with regular weight bearing activities such as walking. And ensuring you get enough calcium and vitamin D. Beyond these important factors which you can control, you and your provider may decide it is best to take a medication to limit your risk for bone loss and fractures. This question and others can be discussed with your provider today during your appointment. Remember, keeping your bones healthy and preventing fractures are important things for all adults. We hope the information you will view over the next several minutes will help you to better understand your own bone health and ways in which you can keep yourself fracture free in the future.

Woman: Bone loss occurs with aging in all adults. This can lead to osteopenia, which is moderate bone loss, or osteoporosis, which is severe bone loss. In both conditions, bones become thinner and more porous due to the loss of minerals stored in the bones.

Osteopenia and osteoporosis are usually painless until a bone breaks or fractures. These fractures usually occur in the spine, hip, or wrist, but can happen in other bones as well. Without medical treatment, men and women lose 1 to 3% of their bone mass each year over the age of 50. As bone strength or density decreases, people are much more likely to develop osteoporosis or have fractures.

Osteoporosis may develop over many years. As you age, you are more likely to develop osteoporosis. Loss of estrogen in women due to menopause, and lower testosterone levels in men also increase bone loss. Women who experience early menopause or have their ovaries removed at a younger age are more likely to have increased bone loss. Some medications, drinking too much alcohol, and smoking may also increase your risk.

People who have taken medications that are bad for the bone, have hypogonadism, have had a transplant, or have had a weight loss surgery, are more likely to have rapid bone loss. There are many other risk factors for osteoporosis, including a family history of osteoporosis, Caucasian or Asian descent, a small body frame or low dietary intake of calcium or vitamin D.

To help you have strong bones and prevent or slow bone loss as you age, there are two main things to focus on, keeping your bones healthy and preventing fractures. Everyone can take steps to help keep bones strong and healthy throughout life. You can start today. The top five things to keep your bones healthy are, being active or exercising, eating calcium rich foods, getting enough vitamin D, stopping smoking and limiting alcohol.

Exercise helps strengthen bones, slows bone loss, and improves fitness. Aim for 30 to 60 minutes a day with a combination of weight bearing, aerobic, muscle strengthening, and non-impact exercises. Weight bearing exercises are activities done while on your feet with your bones supporting your weight. Some of these types of exercises include walking, jogging, and dancing. Tai Chi is a good example of non-impact exercise. Talk to your doctor about what exercise may be best for your situation.

It is best to get calcium from your food rather than a pill. Dairy products, certain green vegetables such as spinach, broccoli, or kale, and calcium fortified fruit juices and soy beverages contain good amounts of calcium. Generally, the goal is to get at least three servings per day from your diet. You may have to take a calcium supplement if you are not getting enough calcium from your diet. Supplements are absorbed well, are typically inexpensive, and are easy to take. If you take a calcium supplement, it is best to combine it with vitamin D.

Vitamin D is important for calcium absorption and maintaining bone health. Vitamin D is normally made in the skin with enough sun exposure but is also found in some foods and vitamin supplements. Ask your health care provider for more information about how much vitamin D you need and what to do about supplements.

If you smoke, stop. Smoking increases your risk for osteopenia and osteoporosis. Alcohol use can also increase your risk for developing osteoporosis. Limit alcohol intake to one drink a day if you are a woman, and two drinks a day if you are a man.

You can help prevent fractures. The two main things you can do to help are avoiding falls and taking medications. Falls are the number one risk factor for fractures. Take steps to prevent falls in your home, have well-lit rooms and hallways. Do not climb ladders, keep electrical and phone cords out of the walkways, and remove rugs when possible.

Be careful of activities that put you at risk for fractures, such as lifting too much weight and snow shoveling. Use proper lifting technique and talk to your doctor about your specific lifting restrictions.

Several types of medication may prevent further loss of bone density by up to 5 to 10%. This can significantly reduce the risk of a fracture. Most osteoporosis medications can help stop bone loss. Other medications help build bone formation. Your provider can help you decide which treatment may be best for you.

Matthew T. Drake, M.D., Ph.D.: Osteoporosis and osteopenia are common conditions affecting over half of all people 50 years of age and older in the United States. It's often without symptoms until a bone breaks or someone develops deformity of the spine. Think about how many people you know, who have suffered a fracture and how it affected their life. Breaking a bone can be prevented. First, make sure you're getting enough calcium between diet and supplements. For most with osteoporosis or osteopenia, this will be around 1,200 milligrams.

The problem is, is that the average dietary calcium intake for people 50 years of age or older is half of what's recommended. Several studies have shown that calcium, combined with low daily doses of vitamin D reduces fracture risk and increases bone density.

Vitamin D is also important to help you absorb calcium efficiently. Vitamin D deficiency is very common, especially as you age. Weight bearing exercise combined with strengthening, also helps keep your bone strong. However, for some people who are at high risk, taking calcium and vitamin D along with exercise isn't enough to prevent fractures. Your provider may recommend taking medication in addition to calcium and vitamin D.

If your risk is high enough for fracture, then the benefits of taking medication will almost always outweigh the risks associated with medications. Your provider and pharmacist can review medication use with you. Remember, as you age, your risk for falls goes up, too. Most fractures occur after a fall. Did you know that 5% of falls result in a fracture, 10% result in serious injury, and 30% result in any type of injury? Don't fall. I often tell my patients if it looks like a bad idea, it probably is a bad idea. Do you really need to climb the ladder to remove the leaves from the gutter or can someone else help you? Do you really need to leave the light off, so you don't disturb your husband when you go to the bathroom in the middle of the night? Make sure your home is safe for you.

Balance exercises such as Tai Chi have also been shown to prevent falls if you do them at least twice a week. Keeping your bones healthy and preventing fractures are important for everyone as they age. I hope this information helps you and your bones stay healthy in the years to come.

Woman: If you have any questions about this information, talk with your healthcare provider.