Did you know that women achieve 90% of their peak bone mass by the time they are 18 years old, while skeletal bones grow in both size and density until the age of 20 years for men? In either case, post 30 years of age, all adults start to lose bone mass, which makes youth the right time to invest in your bone health.
Osteoporosis, which literally means “porous bones,” is a disease that attacks the bones to make them weaker, thinner and more fragile, subsequently making them more likely to break. However, women are more susceptible to osteoporosis as compared to men, with National Osteoporosis Foundation estimating that out of 10 million Americans who are diagnosed with osteoporosis, about eight million or 80% are women. Why do women get osteoporosis and how can they avoid it? Let’s find out!
Statistics conducted by International Osteoporosis Foundation finds that osteoporosis affects about 200 million women worldwide. It is prevalent in 10% of women who are 60 years old and the percentage doubles by the time they reach 80. Global statistics reveal that 1 in 3 women over the age of 50 will experience osteoporotic fractures, but when it comes to men, only 1 in 5 do. So, what’s the reason for this gender gap?
Firstly, women have smaller and thinner bones than men to begin with. This results in lower bone density, and women lose bone mass faster than men as they age. In general, bone density reduces with age, but young women can also have low bone density, often caused by low peak bone mass, and these women are at an increased risk of getting osteoporosis later in life.
Secondly, the reason osteoporosis is more common in older women is because of estrogen. Now estrogen is crucial for bone health; this hormone protects the bones. Estrogen plays an important role in the growth and maturation of bone as well as in the regulation of bone turnover in adult bone, as proven by research. Estrogen prevents osteoporotic bone loss by attenuating bone resorption, and research now has the explanation for this bone-protective function of estrogen. A sex hormone, estrogen levels start to dwindle as women reach menopause, exacerbating bone loss in postmenopausal women.
Thirdly, your diet and exercise also plays a role in bone loss. Most women trying to lose weight will try restrictive diets, which leads to poor nutrition and hence weaker bones. Also, women trying to lose weight are more likely to concentrate only on cardio workout, which results in more wear and tear of bones. In fact, weight bearing exercises are the most beneficial for bone health, and women are less likely to choose weight training over a cardio workout at the gym.
Menopause occurs when sex hormone levels dwindle, causing menstruation to stop. Commonly, this happens between the ages of 48 and 53, though some women may experience early signs of menopause, known as perimenopause, starting at early as 40 years of age. Drop in the levels of estrogen during menopause leads to bone loss , increasing risk for osteoporosis.
However, this risk is dependent on two factors.
We have already discussed how estrogen protects bones from breakdown. And while menopause coupled with aging increases risk for osteoporosis, it’s not that uncommon for younger women these days to get an osteoporosis diagnosis. The reason? Modern lifestyle and high stress jobs have led to wild fluctuations in estrogen during the month and it is this swing in levels that worsens osteoporosis.
Estrogen works with cells responsible for bone forming, known as osteoblasts, to help grow and strengthen bones. A dip in estrogen levels means bone mass is formed slowly, leading to bone loss. In younger women, low estrogen is becoming increasingly common because of high levels of daily psychological stress, according to a study published in Adaptive Human Behavior and Physiology in March 2015.
The answer is – NO.
For years, women who were at increased risk for osteoporosis post menopause were suggested hormone replacement therapy, with ERT and HRT being common. ERT or Estrogen Replacement Therapy differs from HRT or Hormone Replacement Therapy. HRT replaces both estrogen and progesterone levels to mimic natural pre-menopause levels in the body. ERT has been linked to endometrial cancer in women who have not undergone hysterectomy. However further studies found that HRT is not much better; it may increase risk of breast cancer when compared to ERT, when continued for more than 5 years. Research has also linked ERT to increased risk of ovarian cancer, especially in women who continue to use ERT for 10 years or more. Hormone replacement therapy is also linked to cardiovascular disease, though scientists are still unclear on whether estrogen-only therapies also carry the same risk.
As you can see, HRT comes with way too many risk factors to consider it as a safe option to treat or prevent osteoporosis.
Osteoporosis is a tricky disease. It develops gradually over a period of years and can often go undetected and undiagnosed until you suffer a fracture. Age is a big risk factor, and all women over the age of 50 should get Bone Mineral Density (BMD) tests to know more about their bone health. Also, petite and thin women are at increased risk of developing osteoporosis — they have less bone to lose than women with more body weight and larger frames. Research has found that race may also play a role here, with Caucasian and Asian women more likely to develop osteoporosis as compared to black women.
Osteoporosis doesn’t have to be a natural part of aging. The best way to prevent osteoporosis is to work on building strong ones.
To make your bones stronger, you need to get enough calcium every day. The U.S. Recommended Daily Allowance (RDA) for calcium for people aged 31 to 50 years is 1,200 milligrams (mg) a day. People over 50 years of age should get 1,200 to 1,500 mg of calcium each day. You can try to get more calcium through a healthy nutritious diet that contains seafood, bone broth, milk and dairy, dark green leafy vegetables and breads fortified with calcium. Talk with your doctor to decide whether you need calcium supplements, and which ones are best suited to your individual needs.
Vitamin D helps your body absorb the calcium you get from food, and is hence crucial for bone health. Unfortunately, most of us are deficient in Vitamin D, which is naturally produced when your body is exposed to natural sunlight. For this reason, we highly recommend 10-15 minutes of sun exposure early morning when the UV index is lower. If you live in a cold, rainy climate, consider Vitamin D supplements and increasing intake of Vitamin D enriched foods like salmon, eggs and milk products. The recommendations by The Endocrine Society for people who are at risk of a deficiency is – 600 to 1000 IU/day for ages 1 to 18 years; 1500 to 2000 IU/day for ages 19 years and above.
Howver, at Sepalika, we fillow the Functional Medicine aporoach where Vitamin D levels of 60 ng/ml is optimal. When someone is sufferign from a Vitmain D deficiency, a dosage of 60,000 IU per week isrecomemnded, allwoing for regular testing.
There’s not much point in swallowing calcium supplements in the hopes of staving off osteoporosis if your body is deficient in magnesium; especially because magnesium is necessary for the proper utilization of vitamin D and calcium. Magnesium helps increase bone mineral density and the best natural sources of magnesium are legumes, nuts, whole grains, and green leafy vegetables. Consider a 2:1 or 1:1 ratio between calcium and magnesium intake, which means you need to get a minimum of 600-750 mg of magnesium each day through a healthy nutritious diet and supplements combined. We recommend taking magneisum citrate as a better version of this supplement.
Besides these three, we also recommend other supplements to build stronger bones. Phosphorus is another mineral that aids in calcium absorption and balances Vitamin D. The recommended daily value of 700 mg can be obtained from foods such as fish, nuts, beef and pork, but certain conditions such as celiac disease can interfere with its absorption, necessitating the need for supplements. We also recommend 180-200 mcg of Vitamin K2 every day, as it pushes absorbed calcium deposits safely inside of your bones (instead of clogging arteries and tissue, which is not what you want!). In natural form, Vitamin K2 is found in ghee and fermented Japanese soy product called natto. Other trace minerals like boron, copper, zinc and silicon are also important for bone health. We also recommend fish oil for healthy bones to reduce inflammation and promote healing.
A healthy, nutritious diet that is rich in lean cuts of meats, fatty fish, healthy fats and green leafy vegetables makes the foundation of a bone-building diet. Add raw fermented dairy products, as well as magnesium-rich seeds like chia, flaxseed and pumpkin seeds to your diet. Grass-fed beef and grass-fed butter are beneficial for bone health too. However, we also must stress upon removing all toxic, unhealthy foods from your diet. Reduce intake of refined flours, unhealthy fats linked to inflammation and soda drinks. According to Ayurveda, we need to eliminate all toxins from the body to allow for better absorption of minerals from food.
Leading an active lifestyle helps build stronger muscles, reduces bone loss and also improves balance (which in turn, prevents falls that can break bones). Weight bearing exercises will help build stronger bones. Dancing, swimming, jogging, playing tennis, lifting weights, and yoga are great examples. If you are susceptible to osteoporosis, couple your cardio workouts with weight training 2-3 times a week, as studies have linked resistance training with increased bone density.
Cigarettes interfere with normal estrogen levels, increasing risk to osteoporosis. Don’t try to cut down; it’s time to give up smoking completely. And now that we’re trying to eliminate toxins from the body to enhance absorption of minerals, its best to cut back on alcohol as well, don’t you think?! Alcohol can make it harder for your body to absorb calcium, so limit yourself to one alcoholic drink per day, if you must drink at all.
Additionally, always discuss all prescription medication with your doctor, as some of these can increase rate of bone loss. Some medications to treat thyroid dysfunction, seizures and blood pressure can accelerate bone loss, so discuss the same with your doctor.
In the end, it’s important to know that it is possible to beat osteoporosis. A healthy lifestyle that focuses on wholesome nutritious bone-building food coupled with regular exercise and effective stress management goes a long way towards improving your bone health. The younger you are, the better it is to invest in your bone health.
Estrogen and bone metabolism – https://www.ncbi.nlm.nih.gov/pubmed/8865143
Estrogen Prevents Bone Loss via Estrogen Receptor α and Induction of Fas Ligand in Osteoclasts – http://www.cell.com/cell/fulltext/S0092-8674(07)00962-2?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867407009622%3Fshowall%3Dtrue
Elevated Psychological Stress Predicts Reduced Estradiol Concentrations in Young Women – https://link.springer.com/article/10.1007%2Fs40750-014-0004-2
Effect of Hormone Replacement Therapy on Breast Cancer Risk: Estrogen Versus Estrogen Plus Progestin – http://188.8.131.52/content/dam/rand/www/external/labor/aging/rsi/rsi_papers/2006_pike4.pdf
A Meta-analysis of the Effect of Estrogen Replacement Therapy on the Risk of Breast Cancer – http://jamanetwork.com/journals/jama/article-abstract/385646
Hormone replacement therapy and endometrial cancer risk: A meta-analysis – http://www.sciencedirect.com/science/article/pii/002978449400383O
Menopausal Hormone Replacement Therapy and Risk of Ovarian Cancer – http://jamanetwork.com/journals/jama/fullarticle/195119
The Effects of Race and Body Habitus on Bone Mineral Density of the Radius, Hip, and Spine in Premenopausal Women – https://academic.oup.com/jcem/article-abstract/66/6/1247/2651776/The-Effects-of-Race-and-Body-Habitus-on-Bone?redirectedFrom=fulltext
The effects of progressive resistance training on bone density: a review – http://europepmc.org/abstract/MED/9927006