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Bone Health: Considerations for You from Your 30’s To Post-Menopause

by Carmen Andrews - Physiotherapist

This is part two in a series on bone health. In our first post we began by explaining the basic process of bone building by looking at Considerations for Your Children and Teenagers.

You need your skeleton to last for as long as you do. You reach your peak bone mass (the total amount of bone present when the skeleton is fully mature) in late adolescence. Your bones are being continually renewed throughout your life, with your body breaking down old bone (resorption) and replacing it with new bone (bone formation). The rate and ratio of bone formation and resorption effects bone mass and varies during the stages of life, as does the effect of diet and physical activity. If there is more bone resorption than formation you have bone loss or a decrease in bone mass and this is a normal part of aging. In a nutshell, for optimal bone health, your adulthood should be a time of bone conservation and minimization of bone loss.

In your young to mid-adult years, your bone formation and bone loss are in balance. In this stage of life, optimising your bone health means maintaining your bone mass. Your focus should be maintaining your bone mass through regular physical activity and a good diet (see hints at the end of the post). Studies have shown a modest but consistent positive effect from exercise on bone mass during these years (see link at end of post). Ideally, you want bone maintenance to last from the end of puberty until age- or menopause-related bone loss begins.

Accelerated bone loss, or normal age-related bone loss, usually starts after age 40-50 for both men and women. When women go through menopause they have a period of more rapid bone loss. Bone loss continues in both men and women after age 70. During age-related bone loss, you can lose 25 percent of your peak bone mass. Your goal at this stage is to minimise bone loss and to recognise threats to your health such as illness and falls. (See hints at the end of the post.)

Specific kinds of physical activity can maintain or increase your bone mass even during the period of normal age-related bone loss by stimulating bone formation (see studies in link at end of post). These include aerobic exercises in weight-bearing (walking, jogging, aerobics, dancing), strength-training (weights, elastic tubing exercises, body weight exercises), and exercises with high-impact (jumping, running, tennis). Two areas that often show bone loss and are at risk for fractures are your spine and your hips. The most accessible form of exercise is walking and walking for exercise has positive effects on bone mass at both your hips and spine.

Keeping your bones healthy also means preventing bone injuries and fractures resulting from falls. Physical activity that helps to improve strength and balance can lower the risk of falling. Mindful exercise practices like restorative yoga, Pilates, and tai chi can also be helpful in improving your strength and balance. Your physiotherapist can create a tailored exercise program for you that incorporates the balance, strength, and weight-bearing aerobic exercises that will benefit you most.

Calcium intake works in synergy with physical activity: physical activity is more beneficial if you have higher calcium intake (1,000 mg per day) than if you have lower calcium intake. Here diet is key. You will get most benefit from eating calcium rich foods at each meal. A good source of dietary calcium is fat-free organic Greek yogurt which gives you 450 mm of calcium per serving, plus vitamin D and protein. Other sources of calcium include: dairy products, leafy green veggies like spinach and kale, legumes and beans, sesame seeds, sardines, fortified foods like soy and almond milk, orange juice, and salmon with soft bones. Remember that you also need vitamin D to absorb calcium, so try to spend 10 minutes in the sun daily.

Hints to optimize your bone mass: (Bailey et al. 2000)

Download an infographic here

  1. Physical activity:
    • A program including weight-bearing aerobic exercise (walking, jogging or aerobics) and weight lifting can maintain bone mass; walking for exercise can improve BMD of the hips and spine
    • Balance exercises and functional strength decreases the risk of falling and associated fractures

  2. Well-balanced diet:
    • Body weight: Very low body weight is linked with low bone mass and increased risk of fractures
    • Calcium: eat calcium rich food; recommended daily intake is 1,000 mg per day age 19–50, 1,200 mg per day over age 50. NOTE: excessive amounts of calcium can increase the risk of heart attack and stroke
    • Vitamin D: In South Africa skin exposure to sunlight (short periods without sunblock) usually allows the body to make enough vitamin D; where sun exposure is limited, recommended levels of vitamin D intake are 400 IU per day age 50–70, 600 IU per day over age 70.
    • High protein diets can limit the amount of calcium absorbed by the body

Resource used in writing this post: See link to Bailey et al eBook for further reading

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