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For individuals who are getting older, can increasing bone strength help prevent fractures and optimize bone health?
Bone strength is important, as a fractured hip can be serious for older individuals. A study found that for individuals in their 60s who had a hip fracture, 6.5% of women and 9.4% of men died within a year. Among individuals in their 80s, 13.1% of women and 19.6% of men died within a year. (Dimet-Wiley, et al., 2022)
Increasing bone strength can help prevent various issues. A small increase in bone mineral density has been shown to help reduce the risk of fractures, especially hip fractures. A decades-long study found that just a 3% increase in bone strength helps lower the chance of breaking a hip. Researchers enrolled two groups of individuals aged 60 and older, one in 1989 and the second in 1999.
Bone loss is progressive in men and women and increases as the body ages. Osteoporosis is a condition in which bone tissue deteriorates. (Department of Health and Human Services Office of Disease Prevention and Health Promotion. 2020) Bones constantly break down and reform as a normal remodeling process. If the balance of this process is impaired, osteoporosis develops, resulting in more bone breakdown than formation. While men and women experience bone loss, it’s more common in females. (National Institute of Arthritis and Musculoskeletal Diseases. 2022) Menopause is a risk factor because of the decline of estrogen (National Library of Medicine, Medline Plus, 2022). Estrogen reinforces bone strength by protecting against bone breakdown; with estrogen loss, bone breakdown increases. However, anyone of any age or background can experience bone loss due to the following:
While some loss of bone strength is common, several strategies exist to maintain bone health. Exercise, specifically weight-bearing activities, can increase bone strength. When bones and muscles are used to hold a position against gravity, this mechanically stresses the bone, causing it to reform stronger. Movement and physical exercise as medicine and the forces transmitted through the bones generate mechanical signals that tell the cells to increase bone formation relative to breakdown. Exercises focusing on posture, balance, gait, and coordination are recommended for individuals with osteoporosis to strengthen the core, quadriceps, and hip flexors. Different types of exercises can include:
What goes into the body definitely affects bone health. Calcium and vitamin D are key to bone building, but both are needed as vitamin D is needed to absorb the calcium ingested. Calcium can be found in:
Vitamin D can come from:
Studies have found that increasing calcium and vitamin D intake with supplements can help maintain bone health. Talk to a healthcare provider about whether supplements could be beneficial.
Females also naturally produce testosterone, which promotes bone formation. As levels drop with age and negatively impact bone strength, hormone therapy could be recommended. Declining testosterone levels start with women in their 20s and men in their 30s. The typical drop in women is 1% to 3% yearly before menopause and stabilizes somewhat afterward. Female patients at risk of bone loss may be prescribed testosterone in various forms that continuously emit the hormone. The dosage is low, so patients do not experience unwanted hair growth or skin changes. Combined with estrogen, testosterone effectively increases bone growth in female patients. Not everyone is a candidate for hormone therapy, like individuals with a history of breast cancer, heart disease, blood clots, or liver disease. (National Library of Medicine. Medline Plus, 2019)
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Dimet-Wiley, A., Golovko, G., & Watowich, S. J. (2022). One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study. JMIR aging, 5(1), e32683. https://doi.org/10.2196/32683
Tran, T. S., Ho-Le, T. P., Bliuc, D., Center, J. R., Blank, R. D., & Nguyen, T. V. (2023). Prevention of Hip Fractures: Trade-off between Minor Benefits to Individuals and Large Benefits to the Community. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 38(11), 1594–1602. https://doi.org/10.1002/jbmr.4907
Department of Health and Human Services Office of Disease Prevention and Health Promotion. (2020). Osteoporosis Workgroup. Retrieved from https://health.gov/healthypeople/about/workgroups/osteoporosis-workgroup
National Institute of Arthritis and Musculoskeletal Diseases. (2022). Osteoporosis. Retrieved from https://www.niams.nih.gov/health-topics/osteoporosis
National Library of Medicine. MedlinePlus. (2022). What causes bone loss? Retrieved from https://medlineplus.gov/ency/patientinstructions/000506.htm
National Library of Medicine. MedlinePlus. (2019). Hormone replacement therapy. Retrieved from https://medlineplus.gov/hormonereplacementtherapy.html