Boosting Bone Density: Best Ways to Prevent Fractures as You Age

Do you know how to make your bones stronger and more

fracture resistant?

This is an important issue because thinning bones is something that

affects pretty much all older adults and that includes men as

they age.

So in this video,

I'll tell you what you can do to strengthen your bones

and prevent fractures.

Well, hello there everyone.

I'm Dr.

Leslie Kernison,

board certified geriatrician and founder of the website betterhealthwhileaging.net

and this is the BetterHealth While Aging video podcast where we

discuss common health problems that affect people over the age of

six and the best ways to prevent and manage those problems.

In today's episode,

I want to talk about boosting bone density to prevent fractures

in later life.

As you probably know,

our bones tend to become thinner as we age.

Actually, they almost certainly will become thinner as we age.

And if this gets bad enough,

it's called osteoporosis.

And if we're not careful,

this can lead to fractures,

some of which can be life changing,

such as hip fractures in later life.

Now, this is sometimes thought of as an issue that's for

older women to worry about,

but in fact,

decreased bone density and related fractures definitely affect men as well.

It's just something that happens a little bit later in life

than men than for women.

But if you live long enough as a man,

this is going to become an issue for you as well.

So being aware of bone density and knowing how and when

to take action to improve it is important for all older

adults. And that's what I'm going to talk about today.

Specifically in this episode,

I'm going to explain how bone density changes with aging and

why. I'm going to go over how you can check on

your bone density so you know how urgent it is for

you to address this.

I'm going to talk about the terms osteopenia versus osteoporosis and

then I'm going to go into the most effective ways to

improve your bone density in later life.

And then at the end,

I'm going to talk about my recommendations,

what you can do if you're concerned.

So we'll get started with that.

But before I get into it,

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Okay. Bone density and aging.

So what is the deal with this?

So one thing that is really important to understand,

and most lay people don't know this,

is that bones are actually dynamic.

So they look very solid.

But your bones don't stay the same throughout your whole life.

In fact,

your bone cells are constantly in action.

And at a cellular level,

at a microscopic level,

bones are constantly regenerating.

There is a coupled process of bone resorption.

So where bones get broken down by cells called osteoclasts,

and then bone formation,

when they are rebuilt by cells called osteoblasts.

And it's the balance of those two processes during our life

which determines whether our bones are slowly getting more dense and

stronger or less and less dense,

thinner and weaker.

So in early life,

for children,

as we're growing up generally into our 20s,

the creation outpaces the resorption.

And so over time,

bones are getting denser and denser,

stronger and stronger.

And peak bone mass is generally gonna occur at some point

when people are in their 20s.

It's partly related to,

you know,

when people have puberty and hormones and other things,

but it does continue.

Bones do continue to get denser after people stop growing.

And at some point in one's 20s,

one has the peak bone mass.

How much peak bone mass you can accumulate is important in

that. Later,

as your bones start to slowly,

you know,

we. Over time,

if you start from a stronger foundation,

it takes longer for you to get to a point where

they're weak enough that they're quite easy to break.

So after the 20s,

people's bones aren't increasing in density.

Usually the sort of process of them breaking down and being

reformed is more or less in balance,

unless there are bad lifestyle factors at play.

And I'm going to talk about those in a little bit.

And as people go through midlife,

their bone density is sort of very gradually going down.

But then what happens is,

especially for women,

when women hit menopause,

they have a fairly sudden drop in estrogen.

Estrogen really helps maintain bones.

Women also experience a drop in testosterone.

Testosterone also helps maintain bones.

And for that reason,

women can have,

like, a much steeper decline in bone density in those postmenopausal

years. And then what happens is that later in life,

around the seventies,

both sexes,

men and women,

start to experience gradual related bone loss in the later decades

of life.

This is because,

again, sex Hormones are still going down during that stage,

but also there are other changes related to sort of aging

physiology. I'm not going to go into all the details that

tend to accelerate this process of the bones becoming slowly thinner

as time goes on.

The result being that when people are in their 80s,

both men and women can be experiencing thinner bones,

what is sometimes called osteopenia,

or even bones that have gone so thin that they might

qualify for the diagnosis of osteoporosis.

So how do we check bone density to find out where

a person is at?

It's a near certainty that their bones are going to be

less dense at age 80 than they were at age 50.

But how much less dense have they gotten when you know,

how do we know when it's problematic or really concerning?

So to check bone density,

generally, we're going to use a test called a DEXA scan,

and that is a special type of low dose X ray

that typically evaluates the density of the bone in the lower

spine and in the hips.

And from that study,

the report,

the outcome is a T score for the dexa.

So what a T score is is that it compares your

bone density with that of a healthy young adult of your

sex. And it basically is a report of how many standard

deviations below the bone density of a healthy young adult are

you. So every older person is going to have a T

score that is negative because every older person has a bone

density that is less than a healthy young adult of their

sex, male or female.

But the question is,

how much lower are you?

So if your T score is above minus one.

So if you are within one standard deviation of the bone

density score of the healthy young adult,

your bone density is still considered to be in the normal

range. If your T score is between,

between minus one and minus 2.5.

So if you're between one and two and a half standard

deviations below the bone density of a young adult,

that is considered osteopenia.

And then if your T score is below 2.5.

So if you are more than 2.5

standard deviations worse in bone density,

that is considered osteoporosis.

A Dexco scan also reports something else that is called a

Z score.

So the Z score compares your bone density with that of

somebody who is your age,

also your sex,

male or female,

also your weight and your ethnicity.

So there the comparison is not how are you doing compared

to a normal person,

a normal younger person.

The comparison is how are you doing compared to other people

your age who are similar to you?

And so if you're a lot worse than other people your

age who are similar to you,

then they start to get concerned that there might be something

other than what's kind of considered garden variety osteoporosis,

thinning bones due to the drop in sex hormones and age.

And they start looking for other potential causes of additional bone

loss. So let me just say a few more words about

these terms,

osteoporosis and osteopenia.