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Strong Bones Start Young: and Why It Matters

Ageing is typically accompanied by health-related changes in body composition - decrease in muscle mass, increase in body fat and decrease in bone mineral density which increases the risk of sarcopenia, metabolic disorders and osteoporosis. However, regularly measuring and monitoring of body composition, particularly as we get older, allows us to use potent tools such as exercise and nutrition in an efficient and effective manner in order to significantly slow these changes and lower the risk of associated diseases. 


Our bones are not simply supportive structures but dynamic, living tissues which are in a constant state of remodelling which also serve to store minerals, create new blood cells as well as support and protect body and allow movement. This bone remodelling is a result of the delicate balance of constant bone breakdown and bone formation. Up until our 20s or 30s bone formation typically exceeds breakdown and therefore there is an increase in bone density. However, after the age of about 50 bone breakdown outpaces bone formation, hence the decrease in bone density. 

Bone mineral density (BMD) is a measure of the amount of minerals such as calcium within bone. The more minerals a bone contains, the more dense it is and therefore the stronger and less likely to break. Typically BMD peaks between the ages of 20 and 30, remains more or less stable till about age 50 and then decreases thereafter. This decline in bone strength and increased risk of osteoporosis is often wrongly perceived to be a female disease. Skeletal ageing occurs in both males and females, the rate in women is just faster between the 5th and 6th decade of life due to the menopause. Nevertheless, after the age of 50, 1 in 3 women and 1 in 5 men will experience an osteoporosis-related fracture in their lifetime. Osteoporotic fractures are associated with increased mortality, especially within the first year of injury. Studies have shown that osteoporotic hip and femur fractures are associated with up to 20 and 30% increased mortality, respectively, within the first year. Preserving bone density throughout life is therefore vital to our health span, from optimising children’s bone health to monitoring BMD and consistently making healthy lifestyle choices as we age. 


Bone density measurement.
Bone density measurement.

Though regular exercise targeting cardiorespiratory fitness, muscular fitness, balance and mobility is central to our overall well being throughout our lives, it is strength (or resistance) training which promotes increased bone mass and density. Exposing our bones to increased mechanical loading increases bone formation making resistance training perhaps the most potent tool in mitigating accelerated bone loss typically seen with ageing. This includes numerous different modalities including free weights, resistance bands and weight machines in order to elicit an adaptive response to mechanical loading of sufficient magnitude, intensity and frequency. Although exercise programs would need to be individualised, these weight-bearing activities would typically include compound movements targeting all major bones and be multi-directional, with progressive overload central to the program. Of course such strength training is also highly beneficial to preservation of muscle mass, function and strength which in turn protects bones as it lowers the risk of falling.


Nutrition also plays an important role - getting enough calcium and vitamin D(3) in particular. Calcium is the primary component of bone tissue; getting sufficient amounts reduces risk fracture. Good sources of calcium include dairy products and certain vegetables. Calcium supplements are also important if dietary intake is insufficient. In order for our bodies to ensure maximal absorption and use of calcium ingested it is also essential that we get enough vitamin D. This can be obtained through sunlight exposure, certain foods and supplements. Supplementation may be particular useful during the winter months. Protein, magnesium, potassium and phosphorous are also especially important for bone health. 

As is currently evident with the boom in weight-loss drugs, weight loss may also negatively impact bone health. Significant weight loss does not only reduce fat mass but often also reduces muscle and bone mass. It is particularly important for individuals losing a significant amount of weight (be it through nutritional manipulation or the use of drugs such as Ozempic) to ensure sufficient protein and minerals such as calcium, as well as to adhere to an appropriate strength training program.


Other important modifiable risk factors include alcohol consumption and smoking. Increased alcohol intake increases your risk of fractures, impairs bone quality and reduces BMD. Similarly, tobacco smoking increases rate of bone loss, reduces BMD and therefore increases risk of osteoporosis and fractures. Reducing alcohol intake and quitting smoking can help mitigate these effects, along with all the numerous other benefits for overall health.


Sex hormones - oestrogen and testosterone - are also known to significantly influence BMD and overall bone health. This is clearly evident in the accelerated bone loss which occurs with menopause - the sudden decline in oestrogen leads to increased bone breakdown and reduced bone formation and therefore an overall loss of bone mass. In males we also see a natural decline in testosterone and oestrogen which leads to decreased bone mass and strength - this decline is however more gradual than in women. Hormone replacement therapy, particularly in women, should be a serious consideration to avert this rapid decline in BMD.


So what can we do to optimise bone health and prevent the associated negative consequences including osteoporosis, disability, reduced independence as well a mortality? As is the case for preventing all chronic diseases of ageing, bone health is a lifelong investment. During childhood and adolescence we should be doing all we can to achieve peak bone health. As we enter adulthood and later life we need to actively take steps to maintain and improve bone health. Monitoring our bone health also becomes vital as we age. This is typically done using a dual-energy X-ray absorptiometry (DEXA) scan which uses low dose X-rays to assess your BMD and compare your scores to individuals of the same age and sex (Z-score) as well as young, health adults (T-score). Apart from allowing an insight into your current bone health, DEXA scans can also help monitor effectiveness of any treatments and lifestyle changes.


If you would like to test your bone density and your personal risk factors for developing chronic diseases of ageing, and find out if you have high markers of inflammation find out more about the Longevity Annual health check and download the longevity doctor guide to healthy living.

 
 
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