Thinning bones


Tips to prevent and treat osteoporosis

You don’t need me to convince you that exercise is good for you. Or how maintaining a base level of fitness reduces your risk of injury, heart disease and falls. I won’t tell you how regular exercise improves energy levels, quality of sleep and helps fight depression. Instead, I’ll tell you that exercise is the single best conservative step you can take to protect your bones.

And you want strong bones, right?!

It is estimated that 1 in 2 women and 1 in 4 men will suffer an osteoporosis related fracture in their lifetime. For women, that number exceeds the risk of having a heart attack or stroke. We know how to limit our risk of heart attacks and strokes (hint, skip KFC, manage stress and walk more), but most people have no idea how to take care of their bones.

Osteoporosis has been called the “silent disease”. There aren’t multiple screens and clues that the process is happening (ie, high blood pressure, high blood sugar, high cholesterol, and obesity). You don’t feel your bones thinning or get clear warning signs that you’re losing bone density. Instead, the condition happens insidiously over time.

It can happen to anybody. In fact, we all lose bone as we age. But for some, the condition is more likely to happen, it may happen sooner, and when it does happen, it’s more severe.

Osteoporosis and its predecessor, osteopenia, means “porous bone”. It‘s a disease where bones become brittle and frail increasing their risk of breaking. It can be progressive and may not be discovered until you actually break a bone.

Unlike the cardiovascular system, your bones don’t spit out objective proof they are stressed. You have to look at them, through imaging, to see what‘s going on. (More about these tests later.)

If you discover you have low bone density and the activities you once enjoyed are now considered “dangerous”, you may feel motivated to learn more about treatment. Prevention is always better than treatment, but treatment can prevent further deterioration.

And you may ask yourself, “well…. how did I get here?”

How osteoporosis develops

Bone density is maintained throughout our lives by a delicate balance of bone resorption and rebuilding. Bone thinning occurs when the body does not form enough new bone and when too much existing bone is reabsorbed by the body, or both. Bones are living tissue with blood supply and active metabolism. They respond to your overall state of health just like any other organ. If you have a medical condition, genetics, or lifestyle that offsets the resorption-rebuilding balance, you may increase your risk of thinning bones.

The National Osteoporosis Foundation (NOF) has a wealth of information on osteoporosis treatment and prevention. Included on their website are guidelines for when you should get a DEXA (duel energy x-ray absorptiometry) scan as well as your risks of developing osteoporosis.

Below are some of those risks (ie, how you got there).

  • Family history of osteoporosis
  • Smoking
  • Vitamin D deficiency
  • Excessive alcohol or caffeine consumption
  • Weight loss or low body weight; small-boned body frame
  • Early menopause or late onset of menstrual periods
  • Physical inactivity
  • Excessive exercise
  • Poor nutritional habits or a history of an eating disorder
  • Taking a medication (such as prednisone or some anticonvulsants) known to cause bone loss
  • Low estrogen levels
  • Hyperparathyroidism
  • Hyperthyroidism

The good news is that good health has a simple formula: eat well, get moderate exercise and lead a healthy lifestyle.

How to keep your bones strong

Eat a bone-healthy diet. The milk industry has capitalized on catchy slogans promoting milk’s health benefits for years. Milk may have calcium, which is good for bones, but many people don’t tolerate milk and can’t digest it well. There’s also controversy as to whether cow’s milk is good for you. You can get calcium from foods and supplements other than milk.

My favorite sources of calcium are: green vegetables such as kale and spinach, figs, apricots, sardines, fresh squeezed orange juice, and garbanzo beans. (Yay hummus!) Vitamin D is necessary for calcium absorption and found in high quantities in fish. If you are a vegetarian you may need to supplement for the right balance of nutrients.

The NOF recommends 1000 to 12000 mg of calcium a day. This is hard to do! One cup of kale has just 177 mg of calcium. Supplementation is often needed, but too much calcium is detrimental.  Other supplements, like vitamin K2, have been shown to benefit bone health.  K1 is found in leafy greens, many of which also have calcium.  K2 is found in dark meat chicken, eggs and certain cheeses. There is not yet a recommended dosage that I know of for supplementation.  And according to Healthline, true vitamin K deficiency is rare.   Talk to your doctor to see what dose and what form is right for you. If you do it alone, err on the side of less.

Avoid or limit foods that carry a high dietary acid load. These foods include red or processed meats, alcohol, and processed foods to name a few. If your diet is highly acid producing, your body will need calcium to balance PH levels in the blood. To buffer the higher acidity and regain equilibrium, the body leaches calcium from the bones. Having an occasional glass of wine won’t hurt, but I disagree with the American Heart Association that a glass a day is good for you. There are just too many variables to make that statement stick.

Exercise. Strength training and low impact exercises have been proven to build bone density. Studies have shown that resistance exercises, such as lifting weights, can stimulate the bone-building process. Exercise that compresses, or loads your bones increases the formation of new bone cells (osteoblasts) and improves overall bone strength. Bone will adapt to the loads they are placed under — a phenomenon called Wolff’s Law. If there are compressive loads to a bone, the bone will remodel itself over time to become stronger to resist that sort of loading.

The areas of focus for your exercise program should include exercises that strengthen your postural muscles and exercises that address balance and flexibility.

Special care should be taken when bending over and with any activity that involves twisting with weights. There are plenty of exercises that strengthen the core and back without requiring you to bend and twist. (See information below if you’d like more guidance on safe and targeted exercises.)

Lead a healthy lifestyle. You may think living a non-rockstar-type of lifestyle is “healthy” enough. But if you rarely get enough sleep or rest during the day, week or month, your body will suffer. Being constantly tired or wired isn’t good for your bones. Just remember your bones are an organ and rely on a balanced environment for their health. Moderation is key to a healthy life.

Get tested. A DEXA scan is a simple test. You can keep your clothes on and the whole process usually takes 15 minutes. If you feel you are a high risk and are under 65, you may want a screening test or ‘peripheral test’. This test measures bone density in the wrist, finger or heel. From here, your doctor can determine if the more elaborate DEXA scan (that tests your spine and hips) is needed.

Your bone density is measured using T-scores. This compares the density of your bones to that of a 30 year old. A score between -1 and -2.5 indicates osteopenia. Over -2.5 means osteoporosis. Your bone density test also includes a Z-score. This score compares your bone density to others your age and body size. Keep in mind that these tests are not fool-proof and sometimes results can be misleading. This is why it is important to consider your whole health picture when considering treatment options.

Consider the pros and cons of medication. As with most medications, those that slow the thinning of bone are not without controversy. If your doctor recommends that you start taking medication, ask her the following questions.

How long will you be expected to take the medication?

What will they look for in follow up visits to ensure the medications are working?

What side effects may you expect, if any, and how can you best mitigate them?

Oftentimes the benefits far outweigh the risks, but this is something you and your doctor can determine.


If you think you are at risk for osteoporosis, talk to your doctor about your options for testing and treatment. A physical therapist is an exercise specialist and often the best place to start for developing a well-rounded strengthening program that is safe for your body.

As research continues to investigate the relationship between nutrition, inflammation, muscle and bone health, we can better use this knowledge to develop strategies for early identification and treatment of muscle and bone density loss.

“Do something today that your future self will thank you for”.

Would you like guidance on how to strengthen effectively and safely?  What a bone-healthy diet really looks like?  The current research on supplementation and the pros and cons of medication?   Go here to sign up for updates on the launch of my simple, yet comprehensive self-study program (coming soon)!  



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