Most of us don’t think about our bones unless we break one. But our bones are our infrastructure — hidden heroes, holding our bodies together. They work behind the scenes, providing support, protection, and facilitating mobility. They also act as storage for important minerals, not to mention their role in producing blood cells. They’re working round the clock to keep us moving and thriving!

Actually, those heroes are more like superheroes, because like Deadpool and Wolverine they have the ability to regenerate or repair themselves, making them quite resilient. Bone tissue is living and dynamic, constantly undergoing a process called remodeling. This process involves two key types of cells: osteoclasts, which break down and remove old bone tissue, and osteoblasts, which form new bone tissue. So, in essence, your bones are always refreshing themselves!

However, as we age, this balance between bone breakdown and formation can shift. This is part of the natural aging process, but for some people, it can lead to osteoporosis, a condition characterized by fragile, porous bones that are more prone to fractures.

Osteoporosis

Osteoporosis is a disease of bone weakening and increased risk of fracture due to low bone density caused by unbalanced bone remodeling. After age 30, your body can start to remove old bone more quickly than it can make new bone, leading to a decrease in bone density, and therefore a decrease in the strength and quality of your bones as you age. Osteoporosis develops over many years, often without symptoms or signs of discomfort until a bone breaks, especially due to a small amount of trauma.

According to the CDC, more than half of all adults aged 50 and older in the U.S. are either living with osteoporosis or have an increased risk of developing osteoporosis.

The most common fractures caused by osteoporosis occur in the spine in the form of vertebral compression fractures and are almost twice as common as other fractures typically linked to osteoporosis, such as fractures of the hip and wrist.

Risk Factors for Osteoporosis

There are some things that make us more prone to osteoporosis. Risk factors include cigarette smoking, long-term use of medications including steroids (i.e. prednisone) and aromatase inhibitors (for breast cancer patients), low body weight (less than 127 lbs.), rheumatoid arthritis, history of a nontraumatic or low trauma fracture, excessive alcohol consumption (three or more servings a day), and those with chronic disorders such as diabetes, untreated hyperthyroidism, hyperparathyroidism, early menopause, chronic malnutrition or malabsorption, or chronic liver disease.

Bone Density Tests

Bone density tests measure the strength of your bones and can estimate relative fracture risk and indicate where treatment is necessary to reduce the risk of fracture.

Bone density testing is recommended for post-menopausal women and men over the age of 70. But if you have risk factors that are strongly associated with osteoporosis, you may be eligible for earlier testing.

DEXA Scan

The most common type of bone density test is a DEXA scan. It is a specialized kind of x-ray that provides precise measurements of bone density at certain bone sites known to be most affected by bone remodeling, including the spine, hip and wrist. DEXA scans expose patients to minimal radiation and are known to be the most useful and reliable test available to determine bone health. DEXA scans are used to diagnose osteoporosis before you break a bone, estimate your risk of fracture in the future, and monitor the effectiveness of osteoporosis treatment. Measuring the bone density of the hip and spine requires lying on an exam table, but patients who are unable to lie down can sit beside the DEXA machine to obtain a scan of the wrist. It takes no more than 10 minutes and you can often remain in your own clothes as long as they are metal free.

T-score

DEXA scans compare your bone density to the bone density of an average 30-year-old, when peak bone density is typically reached. The T-score is generally reported as a number between one (+1) and negative five (-4). If you score a zero, it means your bone density is comparable to a 30-year-old. The lower the T-score, the farther away from ideal bone density and the greater the risk of fracture. Fracture risk increases by 1.5 to 2 times with each 1-point drop in the T-score.

• Normal bone density – A T-score between +1 and -1. Any score above –1 indicates normal bone density.
• Low bone density (Osteopenia) – A T-score between -1.1 and -2.4. This result indicated that bone density is lower than normal but has not reached a level low enough to be diagnosed with osteoporosis.
• Osteoporosis – A T-score of -2.5 or less.

Keeping Bones Strong – Acing the Test

Fear not, because there’s good news. With just a few lifestyle tweaks, you can keep your bones strong and healthy as you age, significantly reducing your risk of osteoporosis. Here are a few tips to help you on your journey:

1. Weight Bearing Exercise – Weight-bearing and resistance exercises are the best ways to keep your bones strong. Putting stress on your bones with physical activity stimulates the formation of new bone, helping to slow bone loss to keep your bones strong and dense throughout your life.

2. Calcium and Vitamin D – These two nutrients are critical to bone health. You’ll find calcium in dairy products, leafy greens, and fortified foods, while Vitamin D can be found in fatty fish, egg yolks, and yes, even a bit of sunlight!

3. Healthy Lifestyle – Certain habits, like smoking and excessive drinking, can be detrimental to your bones. So, it’s a good idea to limit these habits or eliminate them entirely, if possible.

4. Balanced Diet – A well-rounded diet, rich in fruits, vegetables, and lean proteins, will ensure that you’re getting all the nutrients your bones (and the rest of your body) need.

The Bottom Line:

Your bones are an often-overlooked part of your health. After age 30, your body often starts to remove old bone more quickly than it can be replaced, leading to a decrease in bone density, and risk of fracture. Osteoporosis develops over many years, often without symptoms or signs of discomfort until a bone breaks. There is a simple test for bone density for those most at risk for osteoporosis. Meanwhile there are lots of ways you can keep your bones healthy.

The one thing you can do right now to enhance your bone density is to engage in weight-bearing exercise and resistance training. Physical activity stimulates the formation of new bone, helping to slow bone loss to keep your bones strong and dense. This doesn’t mean you need to hit the gym for hours every day. Working in a few body weight exercises and even climbing stairs can work wonders!