bone health

Use it or lose it – more on osteoporosis

Posted by Liz on Jul 15, 2011 in bone health, osteoporosis | 0 comments

Bone health and osteoporosis. Yes, I know I keep writing about it. The reason is simple: you ARE at risk of losing your bone density and strength, especially if you are a woman over the age of 35. And if you are 50 or older? You have as much as a 40% risk of suffering a fracture due to osteoporosis during the rest of your lifetime. Moreover, during the first five years after menopause, women can experience as much as a 30% loss of bone density.

I can’t emphasize it enough. The risk is there. It is inevitable. However, you can reduce your risk a little bit by incorporating the following message into your life:

Use it. Or lose it.

In other words, you need to move.

The latest news out of the esteemed Cochrane Collaboration (an international organization that extensively reviews medical research) is that exercise specifically designed to promote bone growth and preserve existing bone mass, namely the type that places mechanical stress on the body, is necessary.  The newly-published review of 43, scientifically sound (i.e. randomized, controlled studies) is an update of a review that appeared in 2000. Of the 4,320 postmenopausal women included in the reviewed trials:

• Those who engaged in any form of exercise had slightly less (0.85%) bone loss than women who did not.
• Those who performed combinations of exercise types, i.e. walking, jogging, dancing, progressive resistance training, vibration platform had, on average, as much as 3.2% less bone loss than those who did not exercise.
• Non-weight bearing exercise, such as progressive resistance strength training targeting the lower limbs, was shown to slightly preserve bone mineral density at the hip, while the combination of exercise, per above, was most beneficial for slightly preserving bone mineral density at the spine. (Did you know that spine and hip fractures are the most common among women with osteoporosis?)

The conclusions are pretty clear: long periods of inactivity lead to reduced bone mass.However, here is a simple way to mitigate some of this loss, albeit slightly, and even help reduce the costly effects of osteoporosis: Exercise.

The best exercises? Those that stress or mechanically load the bones, meaning the type that make the bones support body weight or resist movement, such as aerobic or strength training, walking, or Tai Chi.

Ultimately, your goal is prevent osteoporosis from occurring in the first place. While some amount of bone loss is part and parcel with aging, resistance training is critical.

Move it or lose it.

Wednesday Bubble: wrinkles and bone density – what’s the connection?

Posted by Liz on Jun 8, 2011 in bone health, menopause, osteoporosis | 5 comments

There’s a connection between wrinkles and bones? When I caught wind of the research, I thought immediately of a Wednesday Bubble. But this one appears to be the real deal.

Researchers presenting at The Endocrine Society’s Annual Meeting this past weekend say that severity of facial wrinkles during the early years of menopause may indicate a low bone density (thereby leading to an increased risk for osteoporosis). Wow!

This information comes out of the ongoing Kronos Early Estrogen Prevention Study (KEEPS), which is looking at the effect of oral and transdermal estrogen therapy on measures of the carotid artery that might indicate thickening of the arteries (and eventual heart disease) as well as the build up of calcium in the blood. A subgroup of 114 women in their late 40s and early 50s and within three years of starting menopause were examined for this part of the trial.

The researchers looked at and scored severity and depth of skin wrinkling based on number of sites on the face and neck. They also measured skin rigidity (or firmness) on the forehead and cheek. Additionally, they evaluatd total body bone mineral density as well as at the lumbar spine and left hip.

The findings? Higher wrinkle scores (meaning more severe wrinkles) were associated with lower bone density measures at all sites, while firmer skin on the forehead and face were related to greater bone density, especially at the hip and spine.

The connection? Pun unintended but the researchers say that collagen, protein that naturally occurs in connective tissue in tendons, ligaments and even bones, is the common factor. They add that as women age, changes in collagen not only contribute to sagging skin and more facial lines but may also negatively affect both the quality and quantity of bone.

Although more research is needed, it might be worthwhile to obtain a dermatologic and bone density assessment at the start of menopause to see where you stand. And then speak to your health practitioner about the need for regular follow up and monitoring to insure that fragile bones don’t lead to fractures. Ultimately, if the link between wrinkling and bone quality is proven, it might eliminate or at least lessen the need for costly DEXA ( dual energy X-ray absorptiometry)  that are currently used to measure how tightly calcium and other minerals are packed into bone.

Who would thunk that wrinkles could actually be useful?!

Wednesday Bubble: is there a connection between dry mouth and osteoporosis?

Posted by Liz on Jun 1, 2011 in bone health, dry mouth, osteoporosis | 0 comments

This week’s bubble is neither burstable or good news. But it is important:

Dry mouth and bone mineral density appear to be related.

Say what?!!!

A bit of background is needed…

Osteoporosis is fast becoming a major health problem and as I’ve written time and again on this blog, is a significant characteristic of menopause, namely as the result of waning estrogen levels that lead to an imbalance between the build up and turnover of bone cells. Parathyroid hormone and cortisol have also been linked to bone turnover.

Dry mouth (i.e. a feeling of dryness in the mouth and need to use liquids while eating) and burning mouth syndrome (i.e. burning in the tongue or oral mucus membranes and taste alterations) are also common during menopause, affecting up to 40% of women. Until now, experts have not been able to adequately determine why these symptoms occur and more importantly, effective management strategies.

The link? Recent data have shown that estrogen levels may be significantly lower and both parathyroid and cortisol levels significantly higher in menopausal women who complain of dry mouth. Moreover, as the results of a new study in Menopause show, there may be a true relationship between these two conditions and that bone loss may be the actual cause of oral dryness and related symptoms. In this study, researchers evaluated 60 women in menopause (mean age 56) for the presence and severity of dry mouth and then based on their results, divided them into two groups. Dry mouth was confirmed by responses to a scientific questionnaire and collections of saliva. The researchers also measured bone mineral density at the spine.

Importantly, the participants were not particularly active and none engaged in any sports activity, except walking. The women were also matched by body mass index, age, or years of menopause. And yet, women with low bone mineral density, including relationship to other women in the same age group and 30 years younger, were significantly more likely to experience dry mouth and had significantly less saliva when their appetites were not stimulated.

Clearly, more research is needed. However, there are some things you can do now. The first strategy to combat osteoporosis and bone loss is to get measured for bone loss and disease markers. Steps like calcium supplementation, a healthy diet and regular exercise are critical. And if you suffer from dry mouth? You may want to speak to your dentist about a referral for a bone mineral density scan or better yet, have him or her contact your gynecologist or regular health practitioner for a pow wow. Not only may you help your bones, but you may actually change that dry feeling.

Calcium, vitamin D and heart disease. What’s the 4-11?

Posted by Liz on May 2, 2011 in bone health, heart disease | 5 comments

“Calcium supplements cause heart attacks in postmenopausal women.”

Whoa! What?!

If you saw the headlines last week, you may be wondering what’s up with calcium supplementation. Afterall, don’t medical professionals advise the use of supplements to stave off bone loss associated with osteoporosis? And as a result, the Centers for Disease Control reports that over 50% of adults currently use calcium supplements and more than 60% of women over age 60.

It’s important to get away from the sensational headline and take a closer look at what the research shows and what you need to know.

Previous studies have suggested that there may be a link between use of calcium supplements (without vitamin D) and heart attack; in fact, as Reuters‘ reported last year, calcium supplements were shown to increase the risk of heart attack by as much as 31%, possibly as a result of plaque formation in blood vessels. However, is the risk the same if calcium is used alone versus if it is used in conjunction with vitamin D?  In the Women’s Health Initiative study, the use of calcium and vitamin D did not appear to influence heart disease risk at all.

However, researchers decided to take another look at the data because they say that in this trial, more than half of participants were taking ‘personal calcium’ (i.e. not regulated or standardized to all trial participants) and almost half were also adding Vitamin D.

In this reanalysis, published just last week in the British Medical Journal, the researchers discounted the women who were characterized as personal users of calcium supplements and instead, limited their evaluation to a group of women who were not using personal calcium supplements at the study’s start and previously unpublished data from the trial. The findings? The use of calcium with or without vitamin D appeared to cause a 25% to 30% increase in the risk for heart attack and a 15% to 20% increased risk for stroke. However, the researchers say that even small increases in the incidence in heart disease may manifest substantially, especially in the elderly. They add that if you take a look at the risk-benefit ratio, it is unfavourable, meaning that taking calcium with or without vitamin D for five years would cause twice as many heart attacks or strokes than then numbers of fractures that would be prevented.  Additionally, the data analysis suggests that dosing is not a factor, and that the total amount of calcium taken daily is less important than the abrupt changes in blood calcium levels immediately following supplementation.

Although this research answers a few questions about potential risks about calcium supplementation, it also leaves a key question unanswered:  how does the addition of magnesium and vitamin K, which are often included in commercially-available calcium supplements, affect these findings? Data suggest that these minerals and vitamins are added to keep calcium in the bones where it belongs and out the arteries where it does not.

The best guideline, as always, is to visit a physician to assess your bone health and come up with a plan that works specifically for you. Although calcium supplementation appears to be risky, more data are needed before leading organizations start to change their tune about calcium and bone health. Meanwhile, stay ahead of the headlines and try to focus on increasing the amount of calcium-rich foods in your diet:

* DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration to help consumers compare the nutrient contents among products within the context of a total daily diet. The DV for calcium is 1,000 mg for adults and children aged 4 years and older. Foods providing 20% of more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet. The U.S. Department of Agriculture’s Nutrient Database Web site lists the nutrient content of many foods. It also provides a comprehensive list of foods containing calcium.
** Calcium content varies slightly by fat content; the more fat, the less calcium the food contains.
*** Calcium content is for tofu processed with a calcium salt. Tofu processed with other salts does not provide significant amounts of calcium.

Your bone health: the role of diet

Posted by Liz on Mar 11, 2011 in bone health | 1 comment

Osteoporosis. That scary condition that can result in bone fracture in up to 40% of US women after the age of 50. In the UK, it’s been estimated at least half of women over age fifty will have some sort of osteoporotic fracture. So it’s truly no laughing matter.

I’ve tried to cover osteoporosis extensively since starting Flashfree and you can find many of those posts here. However, I am especially intrigued by novel research that demonstrates that dietary pattern, that is, particular combinations of foods that we eat, may influence bone turnover, a term used to describe the balance between bone formation and bone loss (a process that goes on constantly through our lives) resulting in a net loss or gain in bone tissue. Moreover, dietary pattern may also specifically influence bone resorption, i.e., the process by which cells called osteoclasts break down bone so that minerals (like calcium) can be released into the bloodstream.

The researchers, who studied 3,236 postmenopausal women between the ages of 50 and 59, say that to date, most research has focused on link between specific nutrients and bone health, nutrients such as vitamin D or calcium. However, they point out that most individuals eat a variety of foods the contain combinations of nutrients. Therefore, they believed that there might be value in actually examining how the whole diet and the presence or absence of certain nutrients, affects the skeleton.

Consequently, they took initial body mass index measures, bone mineral density measures, assessed dietary habits by consumption of 98 foods, how often they were consumed and by portion size, and then, based on evaluation of how often these foods were consumed by the participants, further characterized them as the following dietary patterns: “healthy,” “processed,” “bread/butter,” “fish and chips” (the study took place in Scotland!) and “snack food.”

Overall, the women in the study actually consumed a large proportion of fruits and vegetables and on average, at least three cups of tea daily. Bread and potatoes tended to comprise the greatest source (at least percentage-wise) of “energy” to the diet. To a lesser extent, yogurt, cream, fats, oils, biscuits and milk also contributed a substantial amount of energy to the diet. However:

• Of the five types of dietary patterns, a healthy diet was most associated with better bone health, and specifically, a reduction in bone resorption. Specific foods included fruits and vegetables, white meat, white and oily fish and dairy, all nutrients that have been previously associated with beneficial bone health.This combination of foods also provided adequate protein.
• Conversely, eating mainly a ‘processed foods’ (i.e. cereal, processed meats, cake, desserts, dried fruits, soup, bread, and fats and oils) diet, and a “snack foods” diet (i.e. candy/cookies, potato chips, sauces) were both associated with reductions in bone mineral density.
• The results didn’t change when factors, such as whether or not women were taking drugs to fight osteoporosis, were taken into account.

The bottom line is that when it comes to bone health, it’s important to eat healthy, pack your diet with fruits and vegetables, and stay away from junk and processed foods. Focus on foods that are risk in calcium and balanced levels of good protein. Although this may seem intuitive, the findings emphasize that  a poor diet may ultimately result in poor bone health and increase fracture risk as you age.

Time to restock the fridge? No bones about it!

Dem bones! Isoflavones, S-equol and aging

Posted by Liz on Feb 7, 2011 in bone health | 1 comment

I love it when readers of this blog point me to research that I might have missed or just not stumbled across. That happened a few weeks ago after I wrote a post on soy and safety. By following the links, reader Carol Land directed me to a newly published study on S-equol and bone health.

S-equol is a metabolite of a major soy isoflavone called daidzein. It has a particular affinity for estrogen receptors and possesses some estrogen-type activity of its own. S-equol  is produced in the gastrointestinal tract however the ability to actually manufacture it depends on the presence of certain microflora. Consequently, only 30% to 60% of individuals are actually able to produce S-equol on their own (although this figure is believed to be higher among Asians and vegetarians).

The surge in interest in S-equol is related to its potential for augmenting the benefits of isoflavones; in fact, it is possible that women who are naturally producers of S-equol actually experience greater effects from soy products, and this is especially true when it comes to bone health.

I cannot stress enough the importance of bone health as we age. Declining levels of estrogen are a primary cause of bone loss and resulting osteoporosis in women; indeed, one in five American women over the age of 50 have osteoporosis and about half will experience a fracture in the hip, wrist or spine as a result. What’s more, because osteoporosis is silent in its early stages, causing no symptoms, it’s critical that bone loss is halted or at least slowed either before or during the most critical phases strike. There is no time like the present to take preventive measures, even if you are in your 30s and 40s.

Where does S-equol fit in?

For the first time, researchers have shown the daily S-equol supplements taken by women who are not naturally producers of S-equol, may improve bone metabolism and attenuate bone loss!

In this 1 year study of 356 healthy, postmenopausal Japanese women between the ages of 41 and 62, daily intake of 10 mg S-equol via supplement markedly reduced markers of bone resorption in blood and urine compared to women taking placebo pills or 2 mg or 6 mg of S-equol daily. In fact, in women taking the 10 mg dose for a year, declines in a  urinary marker of bone resorption (i.e. DPD) were roughly 21% greater compared to placebo. Measures of whole body bone mineral density also showed that S-equol supplementation protected against bone loss, although not to the extent as bone resorption. These results remained even after changes in height, weight, body mass index, lean and fat mass were accounted for. No participant experienced serious side effects from taking S-equol and hormone levels were not adversely affected.

Does this mean that you should rush out and purchase S-equol supplements?

One of the primary limitations of this study is that the process of bone recycling can take as long as 18 months and the time required to complete a cycle may actually increase with age. Thus, the duration of time that the women were studied might be too short to draw any definitive conclusions. Hence,  you may want to wait before you start taking S-equol. However, the evidence that’s building continues to put the weight on the benefits versus risks side. Only time will tell. Meanwhile – here’s to your bone health. Keep on doing all you can do to keep dem bones.