Your bone health: the role of diet
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!
Read MoreHeart disease, flashes and sweats, oh my!
Heart disease is a major issue in women, especially as they age. In fact, more women die of heart disease than all forms of cancer, including breast cancer. During the time right before and up to five years after menopause starts, cholesterol and low-density lipoprotein (LDL) levels soar, placing women at even greater risk.
I’ve written previously about the link between waning estrogen levels and heart disease risk and steps you can take to address specific risk factors. But what about vasmotor symptoms like hot flashes and night sweats? Unfortunately, in addition to being linked to elevated cholesterol and LDL, researchers are discovering that vasomotor symptoms like hot flashes and night sweats actually cause calcium deposits to build up in the arteries and aorta, negatively blood pressure and increase body mass index compared to women without these symptoms.
In the latest bit of news from the research front (published in February issue of Menopause), it appears that night sweats might be the larger culprit. In fact, when researchers examined data culled from 10,787 Dutch women (mean age 53) participating in another study who were free of heart disease at the start, they discovered that over a period of approximately 10 years, women reporting night sweats had a 33% increased risk for heart disease compared to women who were asymptomatic. In comparison, hot flashes did not appear to increase risk in any significant way. What’s more, risk remained even after the researchers accounted for factors that might influence risk, such as BMI, blood pressure and total cholesterol. Additionally, elevated risk was even seen among women both who had used hormone replacement and had never used hormone therapy or oral contraceptives.
Before you become anxious about these findings, it is important to note that when the researchers did a second analysis that adjusted for sleep and mood (both of which have been linked to vasomotor symptoms and heart disease), and found that while risk was still elevated, it was no longer significant. This implies that factors other than night sweats might also be contributing to heart disease risk, and that the sympathetic nervous system, which is responsible for increases in nervous system activity and blood vessel abnormalities, may also play a role.
Meanwhile, prevention recommendations continue to be fairly straightforward:
- Don’t smoke or quit if you do.
- Exercise…at least an hour daily if you can.
- Eat a health diet, rich in whole grains, fruits and vegetables, healthy fats, fish oils and low fat proteins.
- Maintain a healthy weight.
- Drink in moderation.
Ladies, we are in control of our destinies when it comes to altering how we age in that we can influence certain factors. There are no guarantees. But you can bet that we can change the odds in our favour.
Please, please care for your heart. It matters. A lot.
Read MoreWednesday Bubble: HRT? Everybody must get kidney-stoned
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Everybody must get stoned? If you are using HRT, this may be the case. Straight out of the headlines of the American Medical Association’s Archives of Internal Medicine: Healthy women who use HRT may be at increased risk of kidney stones.
You hear about them. But what are kidney stones?
Kidney stones are hard masses the develop when crystals separate out from the urine. Many factors interact to form stone and they are influenced by both genetics and the environment. Although they are often prevented by naturally occurring chemicals before they actually form, when they occur, they can cause extreme pain. Over time, they may actually damage the kidneys. And while kidney stones more commonly affect more men than women up to a certain age, by the time a woman reaches 50, this discrepancy balances out, possibly because estrogen may have a protective effect up until this time.
So, if estrogen is good and protective, what goes wrong when you add it back to the mix?
The findings...In the latest analysis of what is now becoming the infamous Women’s Health Initiative Study, researchers evaluated over 10,000 women in natural menopause who had taken estrogen only (Premarin), estrogen plus progestin (Preempro) or placebo. After an average of 5 to 7 years (depending on which agent the women were taking), women taking hormones, either alone or in combination, had a 21% increased risk of developing kidney stones. When the researchers excluded women who stopped using hormones during the actual trial from the analysis, the likelihood of developing kidney stones increased to 39%. Moreover, study researchers were unable to attribute the increased risk to any other factors, including age, ethnicity, BMI, prior use of hormones or intake of coffee or thyroid medication. Writing in Annals, however, they did note that the way that kidneys stone are formed is complex, and that estrogen may play a role in several stages of that formation and requires further study.
According to the researchers, about 5% to 7% of women reaching menopause will develop kidney stones. My friends over at Reuters health, who did an excellent recap of this study, note that in combination with hormone therapy, this risk increases up to 10%, despite that addition of progestin.
In addition to avoiding hormone therapy, the best thing to do to prevent kidney stones is to hydrate! If you have a tendency to form stones, the National Institute of Diabetes and Digestive and Kidney diseases recommends that you drink enough fluids, preferably water, to produce about 2 quarts of urine a day. Changing your diet can help too: some experts recommend limiting dairy and proteins that are high in calcium. The best thing to do, as always, is to do some preliminary research and then contact your health practitioner.
So getting stoned? How about losing the HRT? Another bubble burst for a failed therapy.
Read MoreThe Roundup – a few highlights
[Credit: Special thanks to artist Darryl Willison of whimsicalwest.com. Please visit his site and support his work.]
I would be remiss if I didn’t admit that this well-received monthly feature seems to have fallen off Flashfree post list. So, as of today, I am officially reviving it. Rather than list four month’s worth of highlights, I’ve decided to pick and choose a few favourites so you don’t miss anything. Still, my mind isn’t yours’ so feel free to peruse the monthly archives.
Without further ado…
- Female viagra hits a new low in the bedroom. Hypoactive sexual desire disorder is real to many women, who suffering from reduced libido and interest. But can a pill address the underlying issues, such as emotions, relationships, environment and hormones?
- HRT – Wait a moment! Stopping hormone replacement might be bad for your menopause. In fact, it appears that symptoms might suddenly appear out of nowhere.
- When it comes to calcium, think moderation. Women need calcium and vitamin D as they age. But too much of a good thing may be dangerous.
- That ole glass ceiling still isn’t cracked. Want a raise? Some individuals would have you believe that you should let your femininity drive your bargaining.
- HRT – Ask the hard questions. Are you considering starting hormone replacement? Be sure that you know the facts.
- It’s about time…weight, that is. The time of day may determine how much weight you gain as much as what you are eating.
Wednesday Bubble: bisphosphonates…enough to make your jaw drop
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Are you being treated for osteoporosis? Has your doctor told you about a rare but extremely serious side effect of drugs known as bisphosphonates that causes the jaw bone to collapse?
Osteonecrosis is a disease that occurs when the blood supply to bone is cut off. This results can result in pain, limited range of motion and an eventual collapse of the bone in the affected area. According to the American Dental Association, reports of jaw osteonecrosis among very small numbers of patients taking Fosamax for osteoporosis started to emerge in 2003. At higher risk were cancer patients who were receiving intravenous bisphosphonate therapy as part of their treatment. In the majority of patients, osteonecrosis developed after dental surgery.
As I’ve written previously, osteoporosis and low bone mineral density are well-known issues for menopausal women. Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year. However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.
Bisphosphonates are frequently prescribed as an alternative to estrogen therapy for preserving bone mass during menopause. Although less than 1% of jaw osteonecrosis have been reported in patients taking oral bisphosphonates, recent research suggests that the majority don’t know about possible side effects. In fact, in this particular study of 71 women and 2 men, 82% said they couldn’t recall or were unsure if their physicians had told them about jaw osteonecrosis.
What you need to know
Taking care of your mouth is essential at any age but particularly during menopause. During the transition, women are especially at risk for altered taste and burning mouth syndrome. Additionally, we are learning that the drugs that we take to prevent loss may actually cause bone death in some women.
The American Dental Association recommends that patients inform their dentist and hygienist that they are taking bisphosphonates to prevent osteoporosis so that extra precaution can be taken before any routine or major dental procedures. if you start to experience the following signs and symptoms while taking bisphosphonates, call your doctor and dentist immediately:
- pain, swelling
- gum or jaw infection
- gums that don’t heal
- loose teeth
- jaw heaviness or numbness
- impaired range of motion
- exposed bone
Undoubtedly, the benefits of bisphosphonate therapy definitely outweigh the risks. Still, it is unclear whether or not bisphosphonates will ultimately prove to be as risky as HRT, as there have also been reports of hip fractures in a very small amount of women taking these drugs for five years or more.
Unfortunately, there are few medicinal alternatives available in the United States, although a new drug Prolia, was approved for treatment of osteoporosis just yesterday. I don’t know much about Prolia, other than it is an agent that has been widely used in treating cancer patients. However, there are some early indications that Prolia might also cause jaw osteonecrosis. Only time will tell.
Meanwhile, I can’t emphasize enough that physical activity and ample calcium and vitamin D intake are essential. The risk of doing nothing now? Enough to make your draw drop…literally.
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