From a public health perspective, bone thinning ranks just below lung cancer in terms of its destructive impact. However, bone thinning prevention and treatment have not received nearly as much attention as the fight against cancer.
Below, we provide a comprehensive overview of what to do to keep your bones healthy and strong? Why does bone thinning, or osteoporosis, occur, and how can this serious disease be prevented and treated?
What is bone thinning?
Bone thinning, or osteoporosis, is a chronic skeletal disease in which bone density and bone quality decrease. As a result of bone thinning, bones become weak and brittle, making fractures more likely. Bone thinning develops slowly over the years and is often diagnosed only after the first bone fracture occurs.
Why does bone thinning occur?
There are two ongoing processes in the bones – bone building and bone breakdown. Bones are strongest in young adulthood, around the ages of 25-30. During this period, bone building outweighs breakdown. After the age of 30, bone mass decreases by about 0.5% per year.
A sudden and rapid decrease in bone density occurs in women with the onset of menopause. During this period, the breakdown of old bone tissue is faster than the formation of new, strong bone tissue. Be aware that after menopause, you can lose up to half of your bone density in 10 years. Menopause is therefore the most critical time for a woman’s skeletal health.
It is estimated that one-third of women over 60 in Estonia have osteoporosis. As the average life expectancy continues to rise, the prevalence of this disease is expected to increase as well.
How to prevent bone thinning?
Bone thinning prevention should start in childhood, when bone tissue is continuously renewing. The stronger and denser the bones become in childhood, the slower the process of bone thinning will be in later life. Bone thinning prevention is easy if you keep the following tips in mind:
- Be physically active
- Consume calcium-rich foods and, if necessary, calcium supplements
- Consume Vitamin D year-round
- Don’t smoke
Risk factors that promote bone thinning
Bone thinning can affect anyone, but women are more at risk. The risk factors for osteoporosis include:
- Female gender
- Menopause
- Family history
- Low calcium intake
- Vitamin D deficiency
- Smoking
- Lack of physical activity
- Use of certain medications
- Being underweight
- Certain diseases – inflammatory bowel disease, rheumatoid arthritis, etc.
Bone thinning or osteoporosis symptoms
Bone thinning is called a creeping disease because it doesn’t cause any noticeable symptoms in its early stages. Typically, osteoporosis is only discovered after the first bone fracture. However, there are also early-stage signs of bone thinning that should be addressed as soon as possible. Early detection leads to better treatment outcomes.
Symptoms of osteoporosis in the early stages:
- Receding gums
- Weak and brittle nails
- Teeth that break easily
- Weakened grip strength
- Back or hip pain
Symptoms of osteoporosis in later stages:
- Body height reduction – more than 3 cm
- Hump on the back
- Spinal curvature
- Bones that break easily
What are the complications of bone thinning?
Bone thinning most often occurs in the spine, hip joints, and wrist bones. The most dangerous is the femoral neck fracture. A femoral neck fracture is one of the most severe fractures, experienced by one in every six women during their lifetime. The femoral neck fracture causes serious complications that can result in the loss of mobility and even death.
A femoral neck fracture leads to death in 25% of cases due to complications. In 50% of patients, they can never manage independently again and will need a caregiver for the rest of their lives. Only 25% recover, but they will experience chronic pain, loss of work ability, and reduced mobility.
Diagnosis of osteoporosis
If osteoporosis is suspected, the doctor will refer for densitometry or DEXA – scanning. This is a painless and quick test to assess bone thinning, which measures bone density in the spine and femoral neck areas. The result of this test provides a score called the T-score.
Interpretation of T-score:
- -1 or higher – normal bone density
- -2.5 to -1 – osteopenia or decrease in bone density
- Below -2.5 – osteoporosis or bone thinning
How is bone thinning treated?
As mentioned earlier, preventing bone thinning is easier than treating it. If the risk of fractures is not high, treatment focuses primarily on reducing the impact of risk factors that decrease bone density and preventing falls. It’s important to know that a vitamin D level of at least 95 nmol/L in the blood reduces the risk of falling.
Osteoporosis treatment involves medication and hormone replacement therapy. This means using female hormones that the body no longer produces after menopause. Regular calcium and vitamin D intake is crucial.
Vitamin D and bone health
Vitamin D plays a critical role in bone health as it increases calcium absorption. The result is healthier and stronger bones. Additionally, regular vitamin D intake helps reduce the incidence of fractures. For calcium to be effectively absorbed, the vitamin D level in the blood should be at least 85 nmol/L year-round.
The recommended daily doses of vitamin D are as follows:
- Under 1-year-old children: 400 IU and a maximum of 1000 IU
- 1-3-year-old children: 600 IU and a maximum of 2500 IU
- 4-8-year-old children: 600 IU and a maximum of 3000 IU
- From 9 years to 70 years: 600 IU and a maximum of 4000 IU
- Older adults and indoor adults: 1200 IU and a maximum of 4000 IU
Calcium and bone health
Although several factors can cause bone thinning, the disease is closely related to calcium metabolism. Bone thinning occurs when the amount of calcium obtained from food is insufficient or its absorption is hindered.
Bones consist of calcium, and therefore calcium plays a very important role in making bones stronger and denser. Calcium is also essential in achieving maximum bone strength at a younger age and later maintaining it.
The skeleton loses about 500mg of calcium per day. This needs to be replenished with food or calcium supplements. Vitamin D plays a crucial role in calcium absorption in the intestines. Without vitamin D, only 10% of calcium is absorbed in the intestines. The ideal vitamin D level for calcium absorption is at least 85 nmol/L.
In older age, calcium absorption is disrupted, and therefore the Health Development Institute recommends that women over 50 take an additional 500mg of calcium daily, regardless of their diet.
Which calcium supplement to choose?
When choosing a calcium supplement, it’s important to know that there are two forms of calcium available on pharmacy shelves – carbonate and citrate.
Calcium carbonate is a cheaper form of calcium but can cause several side effects – constipation, gas, bloating, or a combination of these. Its absorption decreases significantly with age and with drugs that neutralize stomach acid, such as Omeprazole.
For calcium, it’s important to ensure that it is in an easily absorbed form. This is crucial so that calcium strengthens the bones maximally, not causing constipation, which is a common issue with supplements that have mediocre absorption. Therefore, prefer calcium citrate, which absorbs up to 16 times more effectively compared to carbonate.
Strong bones for life! Sounds like a plan?
