Bone Health: Building Strong Bones to Help Prevent Osteoporosis and Fractures
A few days after Christmas last year, my son was playing soccer barefoot with his cousin in the basement when, all of a sudden, I heard a scream. I ran downstairs, saw his increasingly swollen foot that was turning blue in color, and knew immediately he had fractured his 5th metatarsal (a common break from rolling an ankle).
Two months later, after being in a boot and non-weight bearing, riding his knee scooter to school everyday, he was so excited to finally be able to walk again, and play his favorite sport. Despite all of our warnings to take it easy, he got out on the field during recess, kicked a soccer ball with his friend, and felt a sudden pain, this time in the front of his ankle. For the next few days it got a little swollen and he said it hurt a bit to walk, but we were told it was all part of his normal healing. When it didn’t improve after a week, we saw the podiatrist, got an MRI, and found out he had another possible stress fracture, this time of the talar bone (that wasn’t as common but much harder to heal). He was back in a boot for 2 more months, but allowed to walk as long as there wasn’t pain.
At this point, we had to decide whether to keep him non-weight bearing to allow his fracture to fully heal, or encourage early mobilization to prevent further bone weakening and reduce the risk of future fractures. After doing a DEXA bone density scan and seeing the endocrinologist, we knew his bones looked normal, despite his having taken steroids for almost a year during his chemotherapy treatment for his cancer (and steroids can weaken bones). The most likely cause of the second possible fracture was that the bones in his foot had become brittle from long term disuse.
Fractures are common, and can be quite debilitating. Most need to be immobilized and take about 6-8 weeks to heal. During this time, when bones are no longer stimulated by walking or by the normal pull of the foot and leg muscles, they begin to weaken, increasing the risk of another fracture. Rebuilding bone loss is a much slower process, often taking months to years, and sometimes does not go back to normal in older adults. Although early mobilization is a more common recommendation when it can be done safely, there remains some controversy over when and how. It also depends largely on where the fracture is, what type of fracture, and how good the blood supply is in that area.
Keeping our bones strong is a top priority to improve not only our health span (how well we live), but also our lifespan (how long we live). Fractures affect how we interact with the world, and can make getting around and doing daily tasks much harder. As we get older, one of our main concerns is the risk of hip fractures, which are more common in conditions like osteoporosis, and increase mortality significantly. Up to 20-30% of people with a hip fracture over the age of 65 die within one year. This rate is comparable to one who has a heart attack or stroke.
What can we do to prevent fractures and improve bone health in the first place? One of the most important interventions is to increase exercise, both weight bearing and resistance exercises, especially during childhood and adolescence, when our bones are growing the fastest. Weight bearing exercises stimulates bone directly through mechanical loading, while resistance training stimulates bones more indirectly, from the pull of the muscle on the tendons attached to the bones. For weight bearing exercises, the higher the impact, the more bone stimulation is encouraged. In other words, it’s not just how much we move, but how hard and how fast we do the movements.
Although walking and even running are great for overall health, there is not as much effect on bone stimulation as high impact activities like jumping, basketball, volleyball, soccer, and gymnastics. Some studies have shown that doing just 10-20 jumps a day can increase bone mineral density, which is encouraging. One study, called the LIFTMOR trial, showed that postmenopausal women with low bone mass were able to improve their bone mineral density by doing just four specific exercises for 30 minutes, twice a week for eight months (compared to those who did a home-based low-intensity exercise program, whose bone mineral density declined). This study proved those with low bone mass were able to participate in high impact exercises without sustaining injuries or fractures, under the supervision of a trained professional.Again, encouraging.
For four months my son had to stay in a boot, which was torture. No matter how many times I warned him to avoid high impact activities and stop playing basketball, he couldn’t help himself. In the end, maybe it actually helped his bones get stronger. Now, out of the boot for two months, he has been able to prevent further fractures. He started physical therapy to strengthen his hips, legs, and ankles, and makes sure he does his jumping exercises daily. Although the bones will take a few more months to return to their normal state, he is able to be a kid again.
MY TIPS:
Bone Health is influenced by many factors, including how we move, what we eat, how we sleep, and our everyday habits.
Strengthen your bones by doing weight-bearing and resistance exercises for at least 30 minutes, twice a week.(Children need longer, about 60 minutes of exercise daily, with bone strengthening activities at least 3 days a week). If pressed for time, just 10-20 jumps a day can help build bone.
Do weight-bearing exercises to stimulate bone directly through mechanical loading.
Aim for high impact exercises like jumping (jump rope, squat jumps, etc) and sports that involve jumping or rapid changes in direction like basketball, volleyball, soccer, and gymnastics. The harder and faster the impact, the more it stimulates bone to regenerate. (Build up your activity slowly to reduce the risk of injury.)
Moderate impact exercise (jogging and running, hiking, tennis, and dancing) and low impact exercise (walking, elliptical) can still improve bone health, but not at the rate of high impact.
Practice resistance training to stimulate bones more indirectly, from the pull of the muscle on the tendons attached to the bones. These include squats, deadlifts, lunges, free weights, and resistance bands.
Consider working with a trained professional (physical therapist, personal trainer, exercise physiologist, etc) to learn how to exercise safely and prevent injury.
For kids, encourage high impact sports (basketball, volleyball, soccer, gymnastics, etc.). These are some of the best activities for building strong bones during puberty, when bones are growing the fastest.
Gardening is a great way to strengthen the upper body and build stronger bones through gripping, pulling, digging, and carrying.
The LIFTMOR trial showed it was safe to participate in high impact weight bearing and resistance training, even in older adults with low bone mass, as long as done with a trained professional. Just four exercises (deadlift, back squat, overhead press, jumping chin-ups with drop landings) helped increase bone mineral density.
Since bone takes months to years to rebuild after periods of disuse, safely resuming movement as early as possible, under the guidance of a healthcare professional, can help support bone health.
Start working with a physical therapist early after an injury to help maintain strength in a controlled and safe manner.
Consume adequate nutrients daily, preferably through food, and supplement when necessary. Of note, the doses listed are adult recommendations and represent the total daily intake from both food and supplements, (Please work with a healthcare professional to find the right dose for you.)
Calcium: (600mg twice a day). The body absorbs calcium best in doses about 500-600mg at a time.
Vitamin D3: 1000-2000 units daily (or higher if levels are low). The amount of supplementation depends on individual blood levels, with goal levels 30-80 ng/mL, but no higher than 100 (which can weaken bones)
Vitamin K2 (MK-7): 45-180mcg daily (Do not take if on warfarin or other vitamin K antagonist)
Magnesium: 200-400mg daily. Choose magnesium glycinate to minimize digestive side effects.
Nourish the body with enough calories to support hormone health and bones.
Eat enough protein every day to support muscle, collagen, and bone health. Aim for 1.2-1.6 grams/kg ideal body weight.
Consider reducing or avoiding excessive alcohol intake, excessive caffeine consumption, and smoking, as these habits can negatively affect bone mineral density.
Make sure to get plenty of sleep, preferably 7-8 hours a night.
This content is provided for general informational and educational purposes only. It is not intended as, and should not be interpreted as, medical advice, diagnosis, or treatment.
