October 20th is World Osteoporosis Awareness Day (and May is Osteoporosis Awareness and Prevention Month), and this subject is of great interest to me. First because I am a woman and women are much more likely to be diagnosed with osteoporosis and osteopenia than men, or at least earlier than. Second, because a lot of people I know are dealing with or will be dealing with osteoporosis. In fact, 54 million Americans are considered to be of low enough bone mineral density (BMD) to have osteopenia (a decrease in BMD) or osteoporosis (a greater decrease in BMD). Third, because the women in my family are all especially prone to this, and at a relatively young age. So healthy bones are really important to me, and anything I can do to help them remain strong is something I consider worth doing.
When osteoporosis comes up, it is usually linked to nutrition, genetics, and age. And while all of those things matter, the thing that usually doesn't come up is the role of alignment and movement in the creation and maintenance of strong bones. So cuddle up to some calcium, and browse my little osteoporosis quiz!
True or False - Osteoporosis is a whole body disease.
False! Osteoporosis is a very localized phenomenon, and appears in predictable places - wrists, ribs, vertebrae, and the neck/head of the femur (thigh bone). Curious but true, you can have perfectly healthy tissue and osteoporotic tissue on the same bone! So where the porous spots in the bones can indicate is where the body is receiving less load (body weight) and gravity than other places. It's like a map, and that map can point toward aligning the body better!
True or False - Osteoporosis medication builds bone.
False! Did you know that under normal circumstances we get a brand new skeleton every 7 years? There are cells building up and breaking down our bones all the time to keep them at their best. Osteoporosis begins to happen when some spots lose the balance between building up and breaking down. Advances in medication are happening all the time, but we have yet to create a medication that actually produces more bone. The medications we have right now simply keep the body from breaking down the bone tissue that's already there. So while on paper that does help us to maintain a certain number or percentage of BMD, the trouble is that the tissue in question is older tissue that would be broken down under normal circumstances, and is therefore not as healthy, durable, or resilient.
True or False - Weight bearing exercise means using weights.
False! Exercise is good for us in a lot of ways, and weight training is no exception. However lifting weights or using weight machines is not the same as loading your bones. The real secret for building bone is to load and compress it. The bone tissue must receive a deformation to the cells in order to trigger the mechanism that excites the osteoblasts to lay down new bone tissue. When we lift weights or work with resistance we are strengthening the muscles and vicariously the bones where the muscles attach to them. But here's the thing - osteoporosis doesn't occur at those places! Loading our body weight (center of mass) vertically and applying gravity in this vertical arrangement is the absolute gold standard for squishing those bone building mechanoreceptors. So if we're not standing and walking a lot, we don't squish the bones. And even if we do stand and walk a lot, if we're not aligned well (vertically) to gravity and walking with good mechanics (such as landing on a straight leg), we still miss the load and squish. So lift all the heavy things, just remember that aligning your body and walking it around is really the winning combination.
True or False - Positive heeled shoes contributes to osteoporosis
True! And I think this one can be the most difficult to understand, so I'm including a graphic.
As we talked about above, if your body alignment is not vertical, then gravity does not pull on you the same and there are some parts of the bone that would be loaded less than other parts. So just line up the parts, right? Well, not so fast! Most all of us wear shoes with positive heels - that is to say, the heel is higher than the toes. Even a mild heel like what you'd find on a pair of athletic shoes is enough to substantially shift our center of mass forward and create a situation where your body has to sway and buckle in certain places to keep you balanced and upright. What that means is that even if you are more or less upright, it doesn't mean you're aligned in your structure vertically to gravity, which means the loads your bones are receiving are different. So inspect your shoes. How many of them have positive heels? It's entirely possible that they all do.
True or False - Exercise trumps nutrition with osteoporosis
True! While nutrition is definitely an important factor in health in general, and definitely worth examining when treating or preventing osteoporosis, the evidence simply does not suggest that a nutritional deficit is the primary cause. Nutrition alone does not explain why people with osteoporosis have perfectly healthy bone most every place in their body, with a few noteworthy exceptions. A nutritional deficit would likely appear system-wide. So loading up on the calcium is great, but then we need to align, load, and squish those bone cells to encourage them to grow!
We can make it into a chant to cheer the bones along -
ALIGN, LOAD, SQUISH, GROW!
ALIGN, LOAD, SQUISH, GROW!
All that positive reinforcement and encouragement definitely helps.