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Your 3-Point Plan for Stronger Bones

Falls among older adults are on the rise, according to recent research (JAMA Internal Medicine). Analysis of national data on people age 65 and older revealed that the number of seniors with at least one self-reported fall during the past two years rose from about 28 percent to about 36 percent in a 12-year period.

Falls can have devastating consequences for older adults if they result in fractures. Unfortunately fractures are common, since older adults are more likely to suffer from the bone-thinning disease osteoporosis. “Osteoporosis is a state of age-related bone fragility that is a major cause of fractures during a fall,” confirms rheumatologist Yousaf Ali, MD, associate professor of medicine at Mount Sinai. “There is a 20 to 30 percent risk of death in the year following a hip fracture, and 80 percent of people who sustain one lose the ability to perform one activity of daily living.”

Many seniors who suffer a fracture don’t regain their prior independence, and those who do may be plagued by apprehension about future falls. “Even if you don’t sustain a serious injury from a fall, you may well curtail your physical activity afterwards for fear of falling again,” Dr. Ali observes. “This also can decrease your level of function, and worsen osteoporosis.” However, Dr. Ali emphasizes that there are things you can do to preserve your bone strength, and this can help to reduce your risk of fractures as you age. He adds that men too should be vigilant about bone-building. While osteoporosis is commonly seen as a women’s disease, men can men over age 50 will suffer an osteoporotic fracture in their lifetime, according to the National Osteoporosis Foundation (NOF). “The NOF recommends a baseline bone density scan in women over age 65 and men older than age 70 to screen for osteoporosis,” Dr. Ali notes.

Calcium is key Calcium is a major building block for bones, along with vitamin D. Unfortunately, older adults are vulnerable to calcium and vitamin D deficiency. “They may not consume enough dietary calcium to start with, and they also excrete more calcium in their urine,” Dr. Ali explains. A shortfall can be exacerbated by lack of vitamin D, which helps the body absorb calcium from food.

The body synthesizes most of its vitamin D with exposure to sunlight, so if you are housebound, or you live in a region that doesn’t see much sustained sunlight, vitamin D deficiency is common. “Aging also decreases vitamin D receptors in the skin,” Dr. Ali adds, “so older adults produce less vitamin D for the same sun intensity than they did in their younger years.” For these reasons, calcium and vitamin D intake recommendations are higher in seniors—the Institute of Medicine’s recommended daily allowance for calcium in women age 51 and older is 1,200 milligrams (mg) per day (for men, it’s 1,000 mg). You also should consume 800 to 1000 international units (IU) of vitamin D each day.

While a daily calcium and vitamin D supplement can help you meet target intakes, many experts believe it’s preferable to get as much of these nutrients as you can from your diet. “Food is rich in myriad substances that benefit our health because of their various interactions,” confirms Mount Sinai nutrition consultant Fran C. Grossman, RD, MS, CDE, CDN. “This interaction doesn’t happen with supplements.” See our chart for a variety of calcium and vitamin D-rich foods.

Exercise boosts bone strength Weight-bearing exercise can help boost bone strength for several reasons. “Working against gravity means that you are effectively supporting your own body weight, and this forces your muscles to pull on your bones,” says Dr. Ali. “This places your bones under stress, and since bone reacts and adapts to the stress placed on it, this, in turn, stimulates the body’s natural bone remodeling process.”

Weight-bearing exercises include walking, climbing stairs, dancing, and tennis. Resistance training with dumbbells and/or exercise bands increases strength, and also counts as weight bearing. For fall prevention, consider exercise that helps boost your balance, such as tai chi—ask about sessions at your local YMCA or senior center.

Medications can help to slow bone loss There are several FDA-approved medications that can arrest or even reverse bone loss. The most widely prescribed agents are bisphosphonates, and they can help to inhibit the process of natural bone loss that occurs as we age—if less bone is broken down, then bone density is maintained. Due to research linking long-term use of bisphosphonates with a high risk of certain types of fracture, and with loss of bone in the jaw, it is advised that you only take the drugs for a maximum of five years. “You should continue beyond this time span only if your risk of fracture is very high,” Dr. Ali confirms, “for example, if you have a history of fractures, a high fall risk, and/or are very frail.”

Bisphosphonates accumulate in bone, so if you stop taking the medication after five years, the positive effects will continue to persist for a significant time afterwards. “All patients should be instructed in the appropriate way to take these medications, and have baseline dental exams prior to commencing any treatment regimen,” Dr. Ali concludes.

 


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