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”No Skeletons in the Closet” A Guide to Female Bone Health

We love our skin.  We spend hours comparing it with others, nurturing it, feeding it with lotions and potions. When we look for recognition, beauty or health we are looking at skin, neglecting the bones that lie beneath. As women, the natural decline in oestrogen after menopause means we are at higher risk of developing osteoporosis, a condition where bones are thinned and may fracture with minimal trauma. What does this mean for those of us with younger bones and why is it so important to make changes now?

Bones are dynamic powerhouses with a complex system of cells regenerating, remodelling themselves. They thrive on our movement that literally jolts them into action. Astronaut studies are a massive insight into what lack of gravity and motion do to bones, so dancing is far from frivolous to our frame.

Turn the dial back to your teens. There is a surge of mineralisation (bone laid down and strengthened) from age twelve in girls, fourteen in boys, when the body needs more calcium and activity against gravity to jolt the cells to grow bone as strong as possible.  If you have teens in your life, surgically attached to their screens, they need to get up and be active for at least an hour every day during these years or their bones will never meet their full potential. Our sofa ensconced lifestyle as adults is now similar.  We are obsessed with how much exercise we do but scientists are now concerned over our ‘box set loving’ sedentary lifestyle between the bouts of exercise.

Your bone health

What you do every day can literally drain or replenish your 206 bones.  You cannot change your genetics but you can show your bones some nurturing love. We get to our 30s and there will be no new mineralisation of our bones and we have to make the very best of what we have!  That’s it honey, no going back! You eat well, keep fit and think your bones are in good shape?  How about we get them even better?

‘Bone drainers’

Lifestyle

Smoking slows down bone building cells (osteoblasts) almost doubling the risk of osteoporosis! Time recovering from fractures is slower because smoking constricts the blood vessels supplying bone. 

Excessive alcohol reduces the ability of the bone to remodel (plus you might fall over but that’s another story).  

Drinking more than 4 cups of coffee (effects not seen in tea) and caffeinated fizzy drinks may reduce calcium absorption.  The milk taken with coffee will help balance this and we know there are many benefits to a cup of java so everything in moderation. 

Underweight women are at risk. After the menopause a large source of our oestrogen is from fat so being underweight does not do bones any favours. Oestrogen keeps our bones strong. We know about choosing between our derriere and our face but now we have to add bones into the mix!? Being very overweight increases the power of falls and stresses our joints.  

Women who excessively exercise and reduce nutrient intake may find their periods halt and Oestrogen falls prematurely and bones can thin. 

Medicines long term steroids, hormonal breast cancer treatments, some antiepileptic medicines and other meds can put you more at risk. This is not how ever a reason to stop them! Discuss with your doctor methods of bone protection. 

Early menopause  important to discuss bone protection with your doctor and whether HRT or other methods are appropriate for you in protecting your bone against the early decline in oestrogen.  

Inactivity A screen driven lifestyle means we are moving less.  Even after 30 minutes of sitting our bones, circulation, immunity and metabolism may suffer.    This does not occur while sleeping! Future medicine will tell us more- for now move your bones at least hourly.  ‘Standing desks’ in offices will be invaluable as we anchor ourselves electronically into this virtual world.

‘Bone replenishers’

Nutrition

All nutrients are best taken from your plate not a bottle.  If you feel your diet is inadequate it is worth talking to your doctor to see if supplements are needed. Simply taking supplements may be wasting money on something that your body will remove in waste or in fact may do more harm than good if your doctor has not recommended it. 

Calcium

Dairy is a great source of calcium.  Check any non-dairy milks are fortified with calcium.  (Non dairy milks do not have the iodine content of cow’s milk. Low iodine can be detrimental to the developing foetal brain, and iodine is essential for thyroid health in all of us.  So if exclusive non-dairy is your thing ensure you have iodine in your food e.g. (white fish, eggs, nuts, meats and breads).  Check for added sugars in such milks and their salt content.  Excess salt can reduce calcium absorption.  Try adding garlic, spices and herbs to food instead of salt when cooking. Green leafy veg, fish including tinned, almonds, sesame seeds, tahini, chickpeas, other pulses, fortified breads all pack a healthy calcium punch.  Beware spinach, dried fruit, beans, seed and nuts which have oxalates or phytates-chemicals that reduce how much calcium your body can absorb so have plenty of other calcium rich foods along side these beauties.

Vitamin D

Needed to absorb the calcium from our food. We cannot obtain enough from diet alone (eggs, oily fish, fortified cereals/spreads) and 15 minutes in the UK warmer months spent outside (before we apply sunscreen) theoretically manufactures enough in your skin. If you are dark skinned/elderly your needs may be more.  Supplementing in the winter months with the recommended dose after discussing with your doctor may be the way forward and in some cases year round. Care should be taken to adhere to the recommended dose because vitamin D is a fat soluble vitamin and does not just get peed out if you take excess over a long period.

Vitamin C and Protein.

Needed to build collagen (like scaffolding within bones and joints). Vitamin C from vegetables and fruit. Protein from meat, fish, beans, pulses and so on. Thoroughly chew your protein to aid digestion.

Magnesium is a major component of bones and helps the body use calcium but its role is not entirely clear. Wholegrains, fruits, veggies, nuts, dairy and seafood should all give you the essential minerals needed for your bones.

 

Exercise

If you were my best friend this is what I would tell you. Activity has a huge effect on bone health. You will thank me for it.  You will never regret optimising your exercise schedule before or after menopause.  Tailor it to you.  If you are already very fit and active, you need to do a variety of impact exercises – ideally ‘50 impacts a day’ against gravity working in different planes on your body.  This can range from brisk walking (great for the spine) to jumping around in a class.  Strength training is best for hips.  If you are more worried and less fit, try a gentler approach.  Walking less fast, for longer, may be key. 

Yoga has shown benefits on bone density in some studies but more importantly may improve strength and stability to prevent falls.  A brisk walk to yoga class and you are winning! 

Swimming and cycling don’t show direct improvements on bone density (no gravity) but new techniques of looking at bone might suggest other bone benefits- that is more future science.

Let’s not forget dancing random movement and bounce, the effect on your body creates a stronger heart, muscles and bones.  What’s not to love? Dance while the tea is brewing…make like a Mamma Mia extra!

From all of my work one message is always keep your muscles strong.  They will naturally decline with age and it is one way of keeping us super active, healthier and energetic as the years pass. 

How will you know if you have bone thinning?

You sadly might not. Osteoporosis is the ‘silent epidemic’.  You may not realise until you are lying in a hospital bed with a fracture and the doctor tells you they suspect bone thinning from the x-ray.  You might have a simple fall, nothing attention seeking like a ski jump, and suffer a broken wrist or hip.  You may lose height, your posture may change if you have tiny spinal fractures that heal but leave the spine compressed and you in pain.  

If you have a family history, risk factors and are referred by your doctor you may be sent for the gold standard test- a DEXA scan of your hip and spine.  This is only really accurate after the menopause.  Itis simple, painless and importantly not claustrophobic.

The result is a ‘T score’ which will label you with either ‘normal’ bones, osteopenia (less severe bone thinning) or osteoporosis (more severe). The ‘honeycomb’ pattern inside bone is more empty the more bone mineral you have lost. Osteopenia does not mean you have osteoporosis, but if untreated may go on to develop it.  You will be given Vitamin D and Calcium supplements and lifestyle advice.  Osteoporosis means more bone density has been lost. 

Do not despair or be fearful if the diagnosis of osteoporosis is made.  The message from the hugely respected Royal Osteoporosis Society is to keep moving and not be fearful of moving. Fall prevention is the main focus.  Your doctor has an integral role if you have a diagnosis and will prescribe you specific bone medication and discuss lifestyle issues.  Don’t dismiss the need for medicine. The Royal Osteoporosis Society in the UK is a fantastic source of support and information as is the National Osteoporosis Foundation in the USA. 

Dr. Louise Wiseman MBBS BSc (Hons) DRCOG MRCGP 

My writing does not constitute medical advice or replace any consultation with your own doctor who knows you, can examine you and understands your medical and family history. Always seek the opinion of your health care professional if you have a question about your health or changing your lifestyle.

Louise is a former GP, who worked for 15 years in the NHS.  She researched the effect of exercise in preventing osteoporosis in postmenopausal women when she was a young med student.  She is now using her medical and life experience to write a book about women’s health over 40. 

www.drlouisewriting.com

Instagram @drlouisewrites, Twitter @drlouisewriting

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