How To Move Without Pain

How to make Bones Strong

by Meghan Griech, PT, DPT, cert MDT, CKTP

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Osteoporosis is a progressive loss of bone density that occurs mainly as we age but also can be due to many systemic or disease processes within our bodies. Most reach peak bone density by 30 years old, where the body’s ability to replace bone cells equals the body’s depletion (breakdown) of bone cells. After age 30, bone remodeling continues, but you lose slightly more bone mass than you gain. Once the cycle is uneven long enough or bone depletes to a certain level, osteopenia can be diagnosed.

Osteopenia is when our body is losing bone mass or density. The bones are weaker than normal but not so brittle that they break easily. Osteopenia can be considered a precursor diagnosis to osteoporosis.

With osteoporosis, new bone creation doesn’t keep up with old bone removal, causing them to become brittle and more easily break.  Osteoporosis affects men and women of all races, yet white and Asian women, especially older women who are past menopause, are at the highest risk. 

There is no physical symptom of osteopenia.  In order to diagnose osteopenia, your doctor will do a bone density test. Bone density measures bone mass and bone strength. One type of test is dual-energy X-ray absorptiometry (DEXA or DXA). It measures bone density in your hips, spine, and wrist. The result can tell if you have osteopenia or osteoporosis, or if your bones are normal.

The lower your score, the higher your risk of bone breakage. A T-score between -1 and -2.5 is labeled osteopenia. A T-score lower than -2.5 is labeled osteoporosis.  Using the FRAX Assessment Tool can also be a helpful, initial step in determining osteoporosis risk and whether further testing should be completed.

Bone health should be considered at any age, yet once over the age of 45years old, being proactive with bone health should be a priority. Beginning or implementing weight-bearing exercises, increasing calcium, Vit D, and magnesium intake should be considered. Weight-bearing exercise can help strengthen bones, build muscle, and improve your balance.

With a diagnosis of osteoporosis (T-score lower than -2.5), your doctor may consider medications to assist your body in managing and preventing the loss of bone density. Which medication your doctor prescribes will depend on the level of osteoporosis found within your bones. Medications for bone loss are not meant to be a singular treatment.

Most osteoporosis medications work by reducing the rate at which your bones break down. Some medications work by speeding up the bone-building process. Either goal for medication use is to help strengthen bones and reduce your risk of fractures. It is recommended that all medications for bone loss be combined with proper exercise, nutrition, and activity level to increase bone strength. Bisphosphonates are usually the first choice for osteoporosis treatment. These include Alendronate (Fosamax), a weekly pill, Risedronate (Actonel), a weekly or monthly pill, Ibandronate (Boniva), a monthly pill or quarterly intravenous (IV) infusion, and Zoledronic acid (Reclast), an annual IV infusion. Which medication is right for you will be determined with the help of your doctor. All medications have side effects and may interact with other medications you are taking. Understanding the possibility of side effects will be important in determining which medication is right for you. 

Some medications are for bone boosting and work to build bone within the osteoporotic bones. These medications include Teriparatide (Forteo), Abaloparatide (Tymlos), Romosozumab (Evenity).  These drug types are typically reserved for people who have very low bone density, who have had fractures, or whose osteoporosis is caused by steroid medication.  These drugs are injectable, at either a daily or monthly frequency. 

Medications are only part of the process to improve bone health and density. Medication in combination with weight-bearing exercises is best to improve bone health, balance, and overall reduced risk of fractures.  A daily 30-minute walk, increasing calcium, Vitamin D, and magnesium in the diet combined with prescribed medication should all be parts of a plan to improve bone health. 

Recommendations for osteoporosis prevention and reduction apply to men and women.

Some of the most important aspects of preventing osteoporosis include eating a healthy diet, getting regular exercise, and avoiding smoking. Eating foods that contain a variety of vitamins, minerals, and other important nutrients helps keep our bodies healthy. Two nutrients, in particular, calcium and vitamin D, are needed for strong bones. Calcium is needed for our cardiac system, muscles, and nerves to function properly.  Inadequate calcium significantly contributes to the development of osteoporosis. The body needs vitamin D to absorb calcium. Without enough vitamin D, one can’t form enough of the hormone calcitriol (known as the “active vitamin D”). This in turn leads to insufficient calcium absorption from the diet. 

Vitamin D can be absorbed into our bodies in multiple ways. through the skin from sunlight, from our diet, and from supplements. Experts recommend a daily intake of 600 IU (International Units) of vitamin D up to age 70. Men and women over age 70 should increase their uptake to 800 IU daily, which also can be obtained from supplements or vitamin D-rich foods such as egg yolks, saltwater fish, liver, and fortified milk.

Weight-bearing exercise in combination with medication may decrease fracture risk by improving bone mass in premenopausal women and helping to maintain bone density in women who have been through menopause. Maintaining strength in the bones and muscles helps to reduce injuries like falls.  Most experts recommend exercising for at least 30 minutes five times per week for a total of 150 minutes a week. Exercise done properly can help to rebuild bone and reduce the likelihood of fracture.  There’s no one-size-fits-all prescription. Workouts should involve weight-bearing exercises, like walking, dancing, or yoga; with progressive increases in the intensity as long as the muscles are given proper time to recover between sessions. 

Osteopenia and osteoporosis are referred to as the ‘silent disease’ because you can’t feel that it is occurring. Yet up to 50% of women and up to one in four men will break a bone in their lifetime due to osteoporosis.  Diet, exercise, and a proactive healthy lifestyle are keys to preventing and managing the disease. Maintaining muscle strength, joint mobility and balance are keys to reducing the risk of falls and the chance of an osteoporotic fracture.

*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result.  This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional.  No guarantees of specific results are expressly made or implied with this article.

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