Dealing with osteopenia, ways to increase bone density

[marzNC]

Added a couple blog entries related to building bone. One has a few short videos from a fitness website for seniors showing how to use heavy weight properly. The other is about a website created by a MD/professor to help kids understand how bone cells work and why exercise and good nutrition matters.

This is one of the heavy weight exercises my trainer showed me.

I called my blog Over 50 Fitness for Skiing Adventures. It's basically a personal reference library that's relatively easy to share, as opposed to a journal. The entries related to osteopenia are labeled "bone density."

 

[santacruz skier]

Added a couple blog entries related to building bone. One has a few short videos from a fitness website for seniors showing how to use heavy weight properly. The other is about a website created by a MD/professor to help kids understand how bone cells work and why exercise and good nutrition matters.

This is one of the heavy weight exercises my trainer showed me.

I called my blog Over 50 Fitness for Skiing Adventures. It's basically a personal reference library that's relatively easy to share, as opposed to a journal. The entries related to osteopenia are labeled "bone density."

Wow... Thank you... I will spend some time reading later this weekend. Really thought out and put together well.

 

[marzNC]

Came across a wellness website with an article 10 Ways to Prevent or Reverse Osteoporosis
that touches on several points to consider in terms of nutrition/diet related to calcium absorption. Not sure #10 about what weight is enough makes sense based on what I'm finding elsewhere but the others are worth knowing about. The fact that the body uses calcium from bones to maintain the proper acidity balance is something I came across elsewhere. Human bodies are such complicated systems!

1. Stop the Pop!
Carbonated beverages such as soft drinks, Champagne, and sparkling water leach calcium from your bones. A Harvard study on 16 to 20 year-old women showed that half of them were already showing bone loss as a result of excess soft drink intake. Carbonated beverages also have excess phosphates, which cause even more calcium loss.

2. Cut down on Protein
Excess protein intake causes acidity in the body, which in turn causes calcium to be lost in the urine. Most people need only two to 4 ounces of lean protein, three times a day. The average American diet contains two to three times this much.

3. Keep Your Stomach Acid!
Many people are on acid blocking drugs, such as Nexium, Protonix, Prevacid, Tagamet, and Zantac, for problems such as heartburn and hiatal hernia. Stomach acid is necessary to absorb minerals such as calcium, magnesium, and zinc. Blocking stomach acid significantly increases the risk of osteoporosis.

These drugs were meant to be used for six to eight weeks at a time, not for years at a time! In fact, most heartburn symptoms are not due to excess stomach acid. Two thirds of the patients on acid blocking agents have too little stomach acid, not too much!

4. Cut out Caffeine!
Each cup of coffee that you drink makes you lose 150 mg of calcium in your urine. Chemically decaffeinated coffee is not the answer either though, because it contains harmful chemicals that interfere with the detoxification process. Naturally decaffeinated teas are a better option, but if you must drink caffeinated coffee, at least increase your calcium intake by 150 mg for each cup you drink.

Starting to look over the material that I found last fall related to bone health. In the list above, the comment about excess protein made me wonder. As it turns out, the relationship between dietary protein and calcium is complex. Found a couple of related research articles in nutrition journals. I think that a good balanced diet in probably the best answer for bone health, as it is in general.

Interaction of Dietary Calcium and Protein in Bone Health in Humans, 2003

Protein and calcium: antagonists or synergists?, 2002

 

[santacruz skier]

Starting to look over the material that I found last fall related to bone health. In the list above, the comment about excess protein made me wonder. As it turns out, the relationship between dietary protein and calcium is complex. Found a couple of related research articles in nutrition journals. I think that a good balanced diet in probably the best answer for bone health, as it is in general.

Interaction of Dietary Calcium and Protein in Bone Health in Humans, 2003

Protein and calcium: antagonists or synergists?, 2002

Thanks for the post. Reading material tonight...

 

[Christy]

It doesn't sound like there is evidence that exercise builds strong bones, though exercise can help protect your bones in other ways.

All that can be said is that if exercise builds bone, it does not build much bone. Which isn’t to say that exercise cannot protect bones in other ways. Studies have found that older people who did weight bearing exercise decreased their risk of fractures. But this seems to be more likely explained by the fact that exercise leads to stronger muscles that in turn made falling less likely.

https://www.nytimes.com/2016/04/02/health/exercise-is-not-the-path-to-strong-bones.html?_r=0

 

[marzNC]

It doesn't sound like there is evidence that exercise builds strong bones, though exercise can help protect your bones in other ways.

https://www.nytimes.com/2016/04/02/health/exercise-is-not-the-path-to-strong-bones.html?_r=0

The article is confusing to me. Starts with "Misconception: All you have to do is walk or do modest strength training exercises to build strong bones", then references one small study of men doing resistance training and jumping but says the results were not clinically significant. Then references another small study of women who did a 13-week protocol.

The studies that I found interesting related to exercise for bone building had nothing to do with walking. I listed a few in my blog about over 50 ski fitness. My conclusion when I looked around last fall was that relatively heavy weight was needed, so would agree that "modest strength training" with 8-10 pound weights probably doesn't accomplish much in terms of bone building.

From the first study:

* * *
Results
At baseline, 36 of 38 participants were vitamin D sufficient (25OHD >50 nmol/L); at 12 mo, all participants were 25OHD sufficient. 25OHD did not differ between groups. WB and LS BMD significantly increased after 6 months of RT or JUMP and this increase was maintained at 12 mo; TH BMD increased only in RT. Osteocalcin increased significantly after 12 mo of RT or JUMP; CTx decreased significantly after 6 mo and returned to baseline concentrations at 12 mo in both RT and JUMP. Pain and fatigue ratings after RT or JUMP sessions were very low at 0, 6, and 12 mo.

Conclusion
RT or JUMP, which appeared safe and feasible, increased BMD of the whole body and lumbar spine, while RT also increased hip BMD, in moderately active, osteopenic men.
* * *

From the second study:

* * *
RESULTS:
Trabecular density (TrDn) at the 4% site increased from 279.8±37.1 to 283.1±36.0 mg/cm(3) in the aerobic group, and from 285.1±24.6 to 287.5±22.9 mg/cm(3) in the combined group over the study period (P≤0.001). Regional sector analyses revealed that impact exercises resulted in localized changes to the medial aspect of the tibia. Small increases in total bone area were observed in the diaphysis (38% site) (P<0.05).

CONCLUSIONS:
Subtle, regional increases in trabecular density may be an early measurable manifestation of bone quality changes.
* * *

 

[marzNC]

An article from 2009 in the NY Times has a more balanced view of what was known at the time about the relationship between exercise and bone building. It was clear by then that swimming did little or nothing for bones, but the case was not as obvious for running.

Researchers readily admit that they don’t fully understand why some exercise is good for bones and some just isn’t. As the articles in this month’s Medicine & Science in Sports & Exercise make clear, scientists actually seem to be becoming less certain about how exercise affects bone.

https://well.blogs.nytimes.com/2009/11/11/phys-ed-the-best-exercises-for-healthy-bones/?_r=0

 

[Christy]

That's an interesting article, and like you said also shows how much we don't know about what strengthens bones. They kind of end on a hopeful note, by saying "the current state-of-the-science message about exercise and bone building may be that, silly as it sounds, the best exercise is to simply jump up and down, for as long as the downstairs neighbor will tolerate" but then the article says this has only been tested on mice, and that it really might be helping because it helps your balance (or the mouse's balance) making you/mice less likely to fall. Hmm.

 

[marzNC]

That's an interesting article, and like you said also shows how much we don't know about what strengthens bones. They kind of end on a hopeful note, by saying "the current state-of-the-science message about exercise and bone building may be that, silly as it sounds, the best exercise is to simply jump up and down, for as long as the downstairs neighbor will tolerate" but then the article says this has only been tested on mice, and that it really might be helping because it helps your balance (or the mouse's balance) making you/mice less likely to fall. Hmm.

By 2009, there were studies involving humans that included jumping as part or all of a study design protocol. I would guess that the NY Times article was probably not based on a comprehensive search of the medical literature available at the time. It's a lot easier to find good references as more journals put all their articles online. From what I've read, different populations respond differently to exercise. The best idea is to learn what can be done to increase bone density well before about age 40.

A few references for those interested in more reading.

https://thesportjournal.org/article...nsity-in-adults-a-review-and-recommendations/ - 2010, includes references from 1987 thru 2004

Jump training
Although effective and popular in school based programs for increasing bone density in younger people jump training does not appear to be as effective in middle aged and older women. In a study comparing the effects of 12 months of vertical jumping on spine and proximal femur BMD in a group of pre and post menopausal women, Bassey, Rothwell, Littlewood and Pye (1998) found that 50 jumps six days per week increased BMD in the pre-menopausal group but not in the post menopausal group compared to group specific controls. Interestingly, the lack of change occurred even though the ground reaction forces and rate of force development on landing were higher in the post menopausal group resulting in a greater strain overload than in the pre menopausal group.

https://www.iofbonehealth.org/exercise-recommendations - International Osteoporosis Foundation

The exercise recommendations vary depending on the population: children, pre-menopausal women, post-menopausel women, men. Includes recommendations based on a long-term study with women that was completed in Europe in 2015.

 

[VickiK]

Another recent post on this topic:
https://elsbethvaino.com/2016/04/your-bones-can-change/?mc_cid=f2f4f144b7&mc_eid=e9d2c0b54e

Elsbeth is a personal trainer in Canada and a skier. She's a ski diva, too, I'm pretty sure I've seen her posts around.

 

[Christy]

I would guess that the NY Times article was probably not based on a comprehensive search of the medical literature available at the time.

That is supposed to be what Gina Kolata does, but sometimes, as in that blog post, it's hard to assess as she doesn't always indicate the breadth of her research.

 

[marzNC]

When I was looking around in the fall for info related to osteopenia/osteoporosis and bone building, it was hard to sort through all the info, especially when there was conflicting advice. Was more fun to put the research on hold and focus on skiing for a few months.

After looking over the notes I made in the fall and reviewing the references I found, I added a few more entries related to bone health to my blog. One of the studies of more interest was done in Germany. The Erlangen Fitness and Osteoporosis Prevention Study (EFOPS) followed older women for 16 years, much longer than other studies looking at the impact of exercise on bone mineral density. Together with other studies I've found looking at the effect of certain types of exercise, I feel comfortable with my decisions about how to use exercise and nutrition going forward when it comes staving off osteoporosis.

Over 50 Ski Fitness - bone density entries
Overview of EFOPS study, 1998-2014

 

[santacruz skier]

When I was looking around in the fall for info related to osteopenia/osteoporosis and bone building, it was hard to sort through all the info, especially when there was conflicting advice. Was more fun to put the research on hold and focus on skiing for a few months.

After looking over the notes I made in the fall and reviewing the references I found, I added a few more entries related to bone health to my blog. One of the studies of more interest was done in Germany. The Erlangen Fitness and Osteoporosis Prevention Study (EFOPS) followed older women for 16 years, much longer than other studies looking at the impact of exercise on bone mineral density. Together with other studies I've found looking at the effect of certain types of exercise, I feel comfortable with my decisions about how to use exercise and nutrition going forward when it comes staving off osteoporosis.

Over 50 Ski Fitness - bone density entries
Overview of EFOPS study, 1998-2014

How many bone density scans have you had? I've had about 5 or 6.... scores were low in hip -2.5 but okay in spine. Finally after 10 years agreed to taking Fosamax for limited number of years and no longer have osteoporosis. Did not want to go that route and still don't like it... but my scores have dramatically improved.
Obviously should have been doing weight training, etc a long time ago.
Thanks for your posts...

 

[marzNC]

How many bone density scans have you had? I've had about 5 or 6.... scores were low in hip -2.5 but okay in spine. Finally after 10 years agreed to taking Fosamax for limited number of years and no longer have osteoporosis. Did not want to go that route and still don't like it... but my scores have dramatically improved.
Obviously should have been doing weight training, etc a long time ago.
Thanks for your posts...

Only had the scan done once. What I learned last summer is that my hips are in great shape, but my spine is borderline for a diagnosis of osteopenia. Started researching bone health because I have no desire to take any long term medication. Tend to avoid medication in general. My mother was not that active in a sporty sense, but she was very deliberate about her diet, calcium supplements, and walking for exercise. Also did a little tai chi on her own . . . mostly after age 80. Bottom line is that when she had a hard fall around age 93 or 94, she was sore but no broken bones even though she landed directly on a hip.

Would be nice to think that my daughter will benefit from what I'm learning about the importance of building bone before age 40.

 

[marzNC]

Found a recent study on pre-menopausal women that was specifically looking at the impact of jumping as the primary exercise. Sixty women ages 25-50 were randomized into three groups: a control group, or one of two exercise groups who jumped either 10 or 20 times twice daily for 16 weeks. The women were in 20 cities in the "Mountain West." The jumps were high-impact, meaning as high as possible while throwing hands up, landing with feet together or apart, with a 30-sec rest between jumps. Positive differences in BMD in the exercise groups were found at 8 weeks and after the study was completed.

Effect of two jumping programs on hip bone mineral density in premenopausal women: a randomized controlled trial, American Journal of Health Promotion, 2015, Tucker L.A., Ph.D., et. al., mostly at Department of Exercise Sciences, Brigham Young University, Utah.

 

[santacruz skier]

Found a recent study on pre-menopausal women that was specifically looking at the impact of jumping as the primary exercise. Sixty women ages 25-50 were randomized into three groups: a control group, or one of two exercise groups who jumped either 10 or 20 times twice daily for 16 weeks. The women were in 20 cities in the "Mountain West." The jumps were high-impact, meaning as high as possible while throwing hands up, landing with feet together or apart, with a 30-sec rest between jumps. Positive differences in BMD in the exercise groups were found at 8 weeks and after the study was completed.

Effect of two jumping programs on hip bone mineral density in premenopausal women: a randomized controlled trial, American Journal of Health Promotion, 2015, Tucker L.A., Ph.D., et. al., mostly at Department of Exercise Sciences, Brigham Young University, Utah.

Amazing.

 

[marzNC]

The reaction to the 4/2 NY Times article noted earlier in this thread has prompted a follow up article.

https://www.nytimes.com/2016/04/23/...at-a-misconception-on-exercise-and-bones.html

The NY Times author cites one meta-analysis study report (uses data from randomized clinical trials found in medical literature in 2010) and states that there are few large studies that look at the relationship between low level exercise such as walking and the risk of fractures, presumably focused on broken hips. In the 4/23 NY Times article states that the study conclusions found “'relatively small statistically significant' effect on bone density, 'there was no effect on numbers of fractures.'" The complete Conclusion of the cited study (following link in the article) is that "our results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups. Exercise has the potential to be a safe and effective way to avert bone loss in postmenopausal women." (bold added) As for fractures, the study summary noted that "There was no effect on numbers of fractures (odds ratio (OR) 0.61; 95% CI 0.23 to 1.64). Overall, the quality of the reporting of studies in the meta-analyses was low, in particular in the areas of sequence generation, allocation concealment, blinding and loss to follow-up." Clearly, the researchers understood the limitations of a meta-analysis.

At some point I came across the analysis done as part of the Harvard Nurses Study that included over 61,000 postmenopausal women. (The complete 2002 report in JAMA is available for free.) The way I read the conclusions, doing some walking is related to a lower risk of hip fracture. Since I was looking for exercises that help strengthen the spine, I did not read the full report. Granted, the difference noted may or may not be due to significant changes in bone density. However, I find it easy to locate clinical studies that support weight bearing and resistance exercise as helpful. A well designed small randomized clinical trial can provide useful conclusion based on appropriate statistical analysis. If that weren't the case, no new drugs would ever be approved if only large trials were considered valid. (If you are wondering, I worked as a statistician/programmer in the pharma industry before retiring and turning into a ski nut.)

Walking and Leisure-Time Activity and Risk of Hip Fracture in Postmenopausal Women in JAMA, 2002;288(18):2300-2306. Diane Feskanich, ScD; Walter Willett, MD, DrPH; Graham Colditz, MD, DrPH. Author affiliations: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (Drs Feskanich, Willett, and Colditz) and Departments of Nutrition (Dr Willett) and Epidemiology (Drs Willett and Colditz), Harvard School of Public Health, Boston, Mass.

 

[melchap]

You really need to look into getting more vitamin K2 in MK-4 form. Not K1 or K3, but K2. Vitamin K2 helps your body put calcium where it belongs. In you bones and not in your arteries! You need K2 plus all the other bone minerals, not just calcium.

Vitamin K2 can be obtained in you diet by eating anything grass fed; meat, eggs, milk, cheese or in anything fermented and raw; cheeses, kombucha, raw sauerkraut, and natto.

You also need omega-3 fats to help your body build bones. So if you are eating ANYTHING processed you getting too much omega-6 and hurting your omega-3 to 6 ratio. If it comes in a box, package, bottle, or from a restaurant then you are eating too much omega-6. Even salad dressing! Make your own dressing with omega-3 rich oils.

You body needs calcium, vit D, magnesium, and K2 for strong bones. Check your vit D levels! Supplement with sunshine or Vit D3, not D2. Don't get magnesium from supplements with magnesium stearate. Get magnesium from Epsom salt baths, magnesium chloride or magnesium citrate. Also pay attention to your sodium/potassium ratio.

And of course do weight bearing exercises!

 

[Powgirl]

You should always ask your doctor before taking Vitamin K as it has blot clotting properties.

 

[melchap]

Vitamin K1 is for blood clotting vitamin K2 is not about clotting but helps your body put calcium in the right places.