Sticks and Stones May Break My Bones....

Tips for Bone Health

At Sports Health Northwest, we see individuals with many different types of bone injuries from fall related fractures to overuse or stress fractures to erosive arthritis. There are many etiologies of bone pain. At our sports injury clinic in Portland Oregon, we commonly get asked about ways to optimize bone health, and how to avoid conditions such as osteopenia and osteoporosis. Osteopenia is considered low bone density, and osteoporosis is an even more severe form of low bone density with increased fracture risk. Osteoporosis more commonly affects individuals over age 50, and it is more common among women than men.

Most screening recommendations, advocate for women over 65 to be screened for osteoporosis using a DEXA scan. DEXA stands for dual energy x-ray absorptiometry. A DEXA scan can help to identify individuals with osteoporosis by analyzing the density of bone.

Risk factors for osteoporosis include early menopause, increased alcohol intake, family history of osteoporosis, smoking, and low body weight (<127lb). Other risks include a history of fractures in individuals over age 50, long-term treatment of corticosteroids, and aging.

At Sports Health Northwest, we try to counsel our patients with osteoporosis risk about bone health and the importance of weight-bearing exercise, such as walking and strength training, reducing/ceasing smoking, and moderation of alcohol intake, as ways to help improve bone health and reduce osteoporosis progression. Also, supplements, such as calcium and vitamin D are important for overall bone health for individuals of all ages and especially individuals over 50.

Current guidelines, recommend calcium and vitamin D supplementation with other osteoporosis medications. Dietary guidelines encourage adequate calcium intake of 1000 mg per day for men ages 50 to 70, and 1200 mg per day for women over age 50 and men over age 70.

Recommended vitamin D, intake is at least 800 to 1000 units per day for individuals over age 50. Vitamin D deficiency should be treated to maintain a level of at least 30 ng/mL. In our sports medicine clinic, our sports injury doctor recommends 2000-4000 IU of Vitamin D daily.

Our sports injury specialist also recommends weight-bearing exercises and physical therapy as they have been shown to improve bone mineral density and prevent falls. At Sports Health Northwest, we encourage individuals to stay active, use caution to avoid falls, and adhere to healthy lifestyle modifications, such as decreasing alcohol and tobacco use to improve bone mineral density.

The decision to treat osteoporosis is an important one and determined based on fracture risk assessment. This should be part of a conversation between your primary care physician or women’s health specialist. It should be based on fracture risk factors and the results of a DEXA scan. There are many medication options for treating osteoporosis. Choosing the right medication is an important conversation to have with your primary physician. They will review your overall medical history so that other medical conditions and risk factors can be assessed, and the best treatment options as first line therapies started. Continued follow up and evaluation for additional progression of osteoporosis is recommended to monitor the treatment response.

There are other newer medications, that also can provide significant and rapid improvement of bone mineral density and carry additional risks and costs. These typically warrant an additional conversation with your bone health specialist to determine if these are a reasonable option if other medications aren’t working. Some of these newer agents are called parathyroid hormone analogs, and utilized for people who are very high-risk, or have not responded to other treatments.

If you have been on a medication for osteoporosis for more than five years, it would be important to talk to your physician about considering a drug holiday as recent studies show that the duration of benefit can extend after discontinuing therapy beyond five years of treatment.

In summary, bone health is very important as we age for overall quality of life. Fractures associated with osteoporosis can contribute to chronic pain and certain fractures like hip fractures can be life-changing and increase risk of additional illness and even death. It is important to work with your physician to optimize your bone health. Staying active, exercising regularly and utilizing appropriate supplementation to help preserve bone health are important for adults of all ages. At Sports Health Northwest, we want to help you optimize your bone health through, regular exercise, appropriate supplementation, and lifestyle modifications, moderating alcohol intake, treating hip pain and back injuries effectively. We're happy to help with questions you may have about exercise and bone health. Contact us today for expert guidance and support.

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