Searching for the fountain of youth? Hoping to ‘age gracefully’? When we think about how to best support our bodies throughout our lives, it’s important to consider all parts of the body. One of the most common parts of the body affected by the aging process is our skeletal system, and these effects are more severe in women. More than 200 million people worldwide are affected by osteoarthritis, osteoporosis, osteopenia, and other degenerative disorders, which affect both physical ability and quality of life. Certain lifestyle factors are critical for bone health and density preservation, and often can lead to the degradation process.
Like we have explained when discussing strategies for optimizing health previously, stress management, sleep hygiene, eating strategy, exercise prescription, and self care are determining factors in maintaining and enhancing bone health. There’s one thing to take away – your health is more in your control than you think!
Bone density is generally measured using a T-score, where bone density is compared to young adult density and qualified by either a positive (increased BMD) or negative score (reduced BMD) (Rondanelli et al, 2021). Bone density commonly decreases with age. With lower bone density there is increased fall risk, bone fracture and break risk, and decreased force absorption throughout the body.
Genetics should also be taken into consideration. When genetics are involved, this process can start earlier in life and present a more critical risk. Family studies show heritability of compromised bone mineral density as high as 82%, indicating a need to make the establishment of preventative measures as early as possible a priority. This data was extrapolated from a twin and family study that showed several single nucleotide polymorphisms that align with osteopenia and osteoporosis development. These are pieces of DNA where a single piece of the DNA has been replaced by a different nucleotide, causing a change in how the DNA is read and used (Cerani, et al 2019; Kim et al, 2018).
Oftentimes, these tests can be rather expensive for genetic testing, and family history can be useful information in determining risk of inheriting these traits. But, regardless of genetics, there are ways to combat bone loss and reinforce bone healing and remodeling.
Eating strategy is extremely impactful on bone density. Vegetarians often have decreased bone density compared to those who eat animal products. Other factors such as stress, exercise type and load, hormone status (including thyroid, sex hormones, and pituitary hormones), along with previous activity, are all significant factors in bone density throughout the lifetime and progression of bone changes. In very rare cases, some diseases and illnesses can lead to brittle bones and decreased density.
Malnutrition is one of the most common causes of bone loss and is seen in children and teenagers who aren’t feeding properly for their growth or activity levels (Rondanelli et al, 2021). Other extenuating circumstances to consider when it comes to bone density include certain medications, immobilization over a long period of time, blood and bone marrow disorders, and endocrine disorders (Rondanelli et al, 2021).
Because women tend to develop earlier and experience hormonal changes relatively early in their teen years, they generally reach their peak bone density earlier in life compared to their male counterparts (19.3 for women vs 21.8 for men)(Xue et al, 2020). Certain factors like eating disorders, eating strategy, activity level, and birth control use can affect the peak bone density in women and reduce their peak bone density overall. Men generally reach their peak bone density in their early twenties with testosterone being largely impactful in this bone-building and maintenance process.
The most notable bone density changes generally occur around menopause in women and andropause (manopause) in men, starting in their late forties through fifties and potentially lasting even into their sixties. As you can see in the diagram below, the hormonal drop-off in women is much larger than in men. Women need a sufficient level of estrogen for proper bone density regulation, and if any hormonal changes occur too quickly, can severely affect bone density. With the decrease in androgen hormones through menopause and andropause, bone matrix is not maintained as well and the body does not prioritize density maintenance because of the reduced hormones. While these changes are natural, there are many ways to offset this process and reinforce bones for a healthy, strong life.
1. Eating Strategy and Nutritional Supplementation
2. Weight-Bearing Exercise
3. Lifestyle Choices
Regardless of age, previous injuries, or genetics, there are always options for improving our health and wellness, and especially caring for our bones throughout our life. Starting young, we can reinforce our bone health through activity and practice good habits.
Adequate nutrient intake provides the nutrients for bone building and maintenance, and a structured training program focused on resistance and impact training creates more structural integrity over time. This sets ourselves up for success later in life, allowing us to be more active with friends and family, more mobile in our everyday life, stronger for all of life’s adventures, and healthier through the aging process.
Kemmler, W., Shojaa, M., Kohl, M., Schoene, D., & Von Stengel, S. (2020). Dynamic Resistance Exercise and Bone Mineral Density at the Lumbar Spine in Postmenopausal Women: A systematic review and meta-analysis with special emphasis to exercise parameters. Osteologie, 29(3), 194–206. https://doi.org/10.1055/a-1177-4031
Rondanelli, M., Faliva, M. A., Barrile, G. C., Cavioni, A., Mansueto, F., Mazzola, G., Oberto, L., Patelli, Z., Pirola, M., Tartara, A., Riva, A., Petrangolini, G., & Peroni, G. (2022). Nutrition, physical activity, and dietary supplementation to prevent bone mineral density loss: A food pyramid. Nutrients, 14(1). https://doi.org/10.3390/nu14010074
Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research, 33(2), 211–220. https://doi.org/10.1002/jbmr.3284
Xue S, Kemal O, Lu M, Lix LM, Leslie WD, Yang S. Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005-2014. Bone. 2020 Feb;131:115163. doi: 10.1016/j.bone.2019.115163. Epub 2019 Nov 21. PMID: 31760214.