Today morning, when I was about to start my yoga practice, I marveled at the design of the butt. I thought how wonderful it is that nature has given us a cushion to soften our fall. Imagine how painful it’d be to land on our bones each time we fell. Ouch! Speaking of bones, the topic of osteoporosis has been on my mind lately. Why? I suppose it’s because I know so many people who are approaching menopause that I wanted to learn more about what can we do to prevent it.

Have you ever wondered what the bone is exactly? Bone is made of mostly collagen that provides the soft framework for calcium phosphate to be deposited. Included in the framework are bone cells. There are two types of bones in the body – cortical and trabecular. Cortical bone is the dense and compact outer layer that covers the inner spongy honeycomb-like trabecular bone. Most bones also contain bone marrow where blood cells are made. This combination of collagen and calcium makes the bone strong and flexible enough to withstand stress. More than 99% of the body’s calcium is in bones and teeth, the remaining 1% is in blood circulation.

Hard as it looks, the bone is constantly being sculpted with bone formation and bone withdrawal. During childhood and teenage years bone tissue is added faster than it is removed. In fact, osteoporosis prevention begins in childhood, when a bone healthy diet and plenty of exercise helps children achieve highest possible ‘peak bone mass’. For women, early prevention is important. This is because when menopause hits at around age 50, the drop in estrogen levels leads to rapid bone loss.

Osteoporosis – as the name implies means porous bones. This happens when bone loss is more than bone formation. The trouble with it is that one doesn’t know one has it till something happens – like a fracture. The honeycomb like bone under the outer cortical bone might be thinning without you even noticing it. It is not a condition to be taken lightly as there are physical, emotional and economic consequences to it. Early detection is rare. Some early symptoms to watch out for are: receding gums- which can happen when there’s bone loss in the jaw, weaker grip strength and brittle finger nails- though this can happen due to other reasons too. The best way to detect it in early stages is to go to doctor especially if there is a family history of osteoporosis. Later stage osteoporosis shows up as stooped posture- especially in the upper back, loss of height, back or neck pain due to collapsed vertebrae that can pinch on nerves causing radiating pain and fracture due to fall. One is more likely to develop osteoporosis, if one doesn’t reach peak bone mass during bone building years.

Although both men and women can be affected by osteoporosis, it develops earlier in women. Traditionally, causes of osteoporosis have focused on estrogen, vitamin D and calcium deficiency, lack of exercise, smoking and drinking. But new research shows that gut microbiome, inflammation and cellular aging also play a role in its causation. Here are the things you can do to improve your bone mineral density

  1. Consider taking Vitamin D plus vitamin K supplements- Vitamin D plays a main role in absorbing calcium from the intestines and vitamin K helps in gathering calcium to bones and teeth. However, if you are on anticoagulant therapy like warfarin, it is recommended that you take this combination under professional guidance as warfarin competes with Vitamin K. This can lead to excess calcium being deposited in blood vessels and soft tissues. The effectiveness of Vitamin D supplementation is dose and frequency dependent. It is best to get levels of circulating vitamin D checked and then decide on dosage. Generally, the older population requires a higher dose of Vitamin D.
  2. 2. Eating a fiber rich diet- Fiber feeds the gut microbiome. The gut microbiome is known to influence the absorption of nutrients, including calcium that is required for skeletal development. Moreover, fermentation of fiber by the gut microbiome releases short chain fatty acids (SCFAs). These increase the absorption of calcium and also influence bone formation positively.
  3. Exercising- Like most living things, in order to thrive, bones need to be stimulated to maintain existing bone density and for new bone formation. The types of exercises for osteoporosis include: weight bearing, resistance training and flexibility. These include walking, dancing, hiking, jogging stair climbing, and lifting free weights at home or at the gym. For flexibility, regular stretches, yoga and Tai Chi should help. However, if one has osteoporosis, caution must be exercised in twisting around the waist and in bending forward. Exercises that keep the spine straight or arched slightly are generally safer. It is best to work with a trained professional to prevent injury.
  4. Preventing inflammation- Recent research shows that factors involved in inflammation can affect bone too. Inflammation doesn’t just happen in response to injury or illness. When you don’t eat healthy, don’t get enough exercise or have too much stress, the body responds by triggering inflammation. When an inflammatory response occurs without infection or injury, the immune cells have nothing external to attack. So it begins to destroy healthy arteries, organs and joints. Aging also increases inflammation. The good news is you can prevent and even reverse inflammation through a healthy anti-inflammatory diet and lifestyle. Eating more fruits and vegetables and whole foods such as whole grains, controlling sugar intake, avoiding trans fats containing foods like margarine, processed foods and white foods such as white bread and white rice, getting regular exercise, losing weight and learning to manage stress are some of the ways through which you can control inflammation. Research has also shown that fermented foods are anti-inflammatory. Incorporating these in your diet is delicious and easy.
  5. Maintaining a healthy body weight- Being too thin (BMI under 19) is detrimental to bone health. Disorders such as anorexia and bulimia result in extreme weight loss. In young women it results in estrogen deficiency and very low calcium intake, with resulting rapid bone loss.
  6. Nutrition-A diet rich in calcium, protein, fruits and vegetables benefits bone health. Few foods are naturally rich in Vitamin D. The best sources are the flesh of fatty fish, fish liver oils and dairy and plant based milks fortified with Vitamin D.
  7. Get some sunshine-As Vitamin D is very important for bone health and it can be synthesized in the body by sun exposure, it’s a good idea to spend some time under the sun. Most people can make enough vitamin D from being out in the sun with their forearms, hands and lower legs uncovered without sunscreen from late March or early April to November, especially between 11am and 3pm. Dark skinned people and older people may need longer sunshine exposure for vitamin D synthesis.
  8. Avoid drinking alcohol and smoking- Drinking more than 2 units of alcohol increases the risk of fracture and smoking almost doubles the risk of hip fracture. So this is a good reason to avoid/limit these.

Of course there are factors which predispose one to osteoporosis which are beyond ones control like age, gender (women are more likely to develop osteoporosis than men), family history, previous fractures, menopause, hysterectomy, certain medications and certain diseases and disorders like rheumatoid arthritis, inflammatory bowel disease, kidney disease, hormonal disorders, cancers, HIV/AIDS, and nutritional disorders like lactose intolerance, coeliac disease etc. But if we incorporate the things we can do to prevent osteoporosis in our daily lifestyle, we can enjoy a good quality of life till we die. Exercise, good healthy food and sunshine are good for mental health too!