Bone Density and Bone Quality
What is it that makes bones more susceptible to fracture as we age? Is it poor bone density, poor bone quality or both? It seems that all we hear about is bone density. This is because bone density can be measured, but bone quality cannot be measured. Bone density is part of overall bone quality, but not the entire picture. This is one reason why some people with the same low bone density may fracture while others do not. However, if bone density is significantly low (such as a T-score of -3.5 SD which is 40% less than an average 30 year old) that alone decreases the bone quality. For some this can result in osteoporosis related fractures. Osteoporosis related fractures are breaks that occur with minimal trauma. The larger picture regarding things that can impact bone quality include: digestive health, healthy nutrition, bone robbing medications such as proton pump inhibitors (Nexium, Prilosec) and prednisone to name only a few. These factors and many more contribute to the overall health (quality) of our bone. Your bones are what you eat and also reflect your lifestyle. Smoking for instance impacts bone quality and bone density due to lack of circulation in the bone itself. You can improve bone quality by improving nutrition, digestive health and by maintaining a healthy lifestyle. Improving bone quality reduces fracture risk.
Some facts about bone
Bone is alive and dynamic – it is a reservoir of nutrients
• 80% of our lifetime bone mass is laid down by the age of eighteen.
• Our peak bone mass is achieved by the age of thirty.
• After the age of thirty it takes more effort to maintain bone mass.
• Age related bone loss is .5-1% per year. Post menopause years can boost bone loss to 1-3% each year.
• Woman with small bones and low body weight are most susceptible to age related bone loss. We learned from astronauts going into outer space that gravity impacts bone. An astronaut can lose 10-20% bone mass after being in space for a prolonged period of time. They also lose muscle mass that is why they need assistance walking when they first step on earth again. Low body weight can contribute to bone loss.
• If any product claims to build bone mass be skeptical. Everyone is different. One person may have osteoporosis due to parathyroid disease, gluten intolerance any many other conditions. Make sure you have had a thorough evaluation.
• The diagnosis of osteoporosis does not mean active bone loss is occurring. This is surprising to many people when they first hear it. Let’s take the example of a 55-year-old woman who has just had her first bone density exam. She has borderline osteoporosis – is she losing bone? Maybe she never gained a good bank account of bone in her teens, she may have had an eating disorder, smoked cigarettes or ate a diet that did not build her bones. Active bone loss can be a serious problem while stable bone may be just fine.
• Some patients have told me that they have osteoporosis in their neck, thinking it is their actual neck, above their shoulders. The neck refers to the neck of the hip.
• Will exercise and a healthy diet reverse serious osteoporosis. This is very important question. My first question always is why does an individual have serious osteoporosis in the first place? Are they presently losing bone or is their bone stable. There are two ways to determine this. 1. Two bone density exams from the exact same machine that have been compared correctly. 2. Lab tests including bone markers or other specific tests for the parathyroid or kidneys may be necessary to sort out if and why bone loss is occuring. Bone is complex there is no one size fits all. Unfortunately, it all to common to see osteoporosis evaluated incorrectly.
Most importantly evaluating bone takes time and in our age of managed care many patients are simply offered a prescription rather than a complete and thoughtful evaluation.
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