Reducing Fracture Risk

The best way to prevent osteoporosis in later life is to build strong bones before the age of thirty, long before most women consider bone density a health issue.  In mid life, bone mineral density can be improved only a few percentage points, but fracture risk can be greatly lowered with exercise, nutrition, and good health habits.  Here are the basics:

1.     Bone building exercise is essential for maintaining and regaining strong bone structure or micro-architecture.  Dense but inflexible bones are also vulnerable to fracture.  Lean body muscle mass and overall strength are the best indicators of bone strength.

·       Strength train to increase lean muscle mass using compound exercises two or three times a week for 30-60 minutes.  Include exercises that effectively work hips and back.  Muscle pulls on bone, adding bone-building pressure, tension, and stimulation.  Exercise also delivers nutrients to bone.  Focus on increasing the resistance load over time while maintaining perfect form.  Avoid exercises that curl the spine forward if you have spinal osteoporosis—it’s perfectly safe to bend forward from the hip.

·       Walk, snow shoe, run, or do other weight-bearing aerobics for another hour or more a week divided into 2 or 3 sessions.  Swimming, biking, and using an elliptical machine are not the most effective bone builders because the water or the machine supports your weight and there is low impact.  Increase bone-loading when walking by using a back-pack with a progressive amount of weight in it.  Don’t use hand or ankle weights because they throw off the natural gait.

·       Practice balance exercises to lower risk of falling.

·       Keep flexible with stretching.

·       If you’re pre-menopausal and have strong knees, high impact exercise such as jumping, skipping rope, or volleyball are excellent for increasing bone density.  Post-menopausal women can add these forms of exercise if they've been strength training for six months.

2.     Adult women need 1000-1500 mg of calcium a day from diet and supplementation.  Good sources of 200-300 mg are 1 cup of high calcium cabbage family greens (kale, collards, rapini, mustard, turnip), 1 cup low fat yogurt, buttermilk or milk, 6 ounces of tofu, or 8 ounces calcium fortified orange juice.  See high calcium food lists in Strong Women, Strong Bones and Better Bones, Better Body or look on the web.  Use calcium supplements if you aren't getting enough calcium from food, but try to eat a minimum of two servings or 600 mg of calcium a day from foods and then supplement with calcium citrate and magnesium to fill your requirement.  Divide your supplements into servings of no more than 350 mg calcium (so you’ll be taking calcium a few times a day) and don’t take it with high bran cereals.  Take at least half as much magnesium as you do calcium.

3.     Supplement with approximately 1000 IUs vitamin D in the winter or year round if you use a sun block or avoid exposing your skin to the sun.  Often one supplement will give you calcium, magnesium, and vitamin D.  See "Recent Findings About Vitamin D and Our Health" for more information about this essential nutrient.

4.     Look at my nutrition articles in the bone health section of this website.  You might also be interested in Susan E. Brown’s Better Bones, Better Body or her Osteoporosis Education Project website for more information about bone-supporting trace minerals.  Bones thrive on zinc, manganese, copper, boron, silicon, etc.  A good diet may be all you need to supply these minerals, but a balanced low potency multi-vitamin can be added for insurance.

5.     Eat an alkaline producing diet—more fruits and vegetables and less animal protein and refined carbohydrate.

6.     Avoid crash dieting.  Never lose weight quickly, as this promotes bone and muscle loss.  If you are on a weight loss program, eat at least 1500 calories a day, burn a few more calories with extra exercise, and lose weight slowly at the rate of 4-5 lbs a month.  Don’t skimp on nutrients while you’re cutting calories.  Strength training will help prevent loss of muscle and bone while losing weight.

7.     Fosamax is often recommended for women with low bone density.  Fosamax and other bone-enhancing medications work best when accompanied by exercise and a bone-supportive diet.  Miriam Nelson is enthusiastic about bone-building medications.  Susan Brown is cautious.  Make this choice with your health care provider if you have osteoporosis.

8.     The following factors increase fracture risk:

© 2004 Elaine Mansfield