Resources: Tips for Healthy Aging at Hebrew SeniorLife

How to Improve Bone Health

Worldwide, musculoskeletal conditions such as osteoporosis, osteoarthritis, rheumatoid arthritis, back pain, spinal disorders, and fractures are the most common causes of severe long-term pain and physical disability. The following statistics illustrate this claim:

  • The most common fractures among older adults are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Hip fracture is the most significant age-related health threat to adults older than 70 and the primary cause for hospitalization. Up to 25 percent of community-dwelling seniors who sustain hip fractures remain institutionalized for at least a year.
  • Hip fracture surgery, and the immobility that follows, promote other problems that contribute to physical decline. In the hospital, older patients are particularly susceptible to pneumonia and other infections, bowel and urinary disorders, pressure ulcer, and depression. A post-operative condition called delirium, marked by severe confusion and disconnection from surroundings and reality, occurs at an alarming rate – 45 to 60 percent of the time. Unfortunately, delirium all too often leads to poor recovery and cognitive decline.
  • Every year, nearly 1.5 million fractures are attributed to osteoporosis.
  • Ninety percent of hip fractures are caused by a simple fall from standing height or less.

What causes bones to weaken and fracture more easily with age is still not completely understood, but researchers are steadily making progress in their quest to know why this is true. Scientists in the Musculoskeletal Research Center in Hebrew SeniorLife’s Institute for Aging research are among those who have devoted their careers to identifying all health risks associated with poor bone health (not just fractures) and discovering the underlying causes of bone disease, as well as prevention options and treatments. The Institute’s faculty has particular expertise with drug and non-drug therapies to prevent osteoporosis; falls and fractures; the relationship between genetic factors and lifestyle choices, including diet and exercise; and the relationship between osteoporosis and other diseases, such as osteoarthritis and cardiovascular conditions.

As serious as fractures are in and of themselves, they suggest additional health risks. According to Lisa Samelson, Ph.D., assistant scientist in the Institute for Aging Research’s Musculoskeletal Research Center, fracture is arguably the most underappreciated condition from a clinical perspective. When bones fracture, even among young adults, it may signal that all is not well with overall bone health, which in turn may indicate additional health risks are operating. Dr. Samelson has studied the link between the skeleton and the heart. When people age they tend to lose strength in their bones and become more vulnerable to heart disease, stroke, and other vascular-related events. Institute research has shown that people who lost the most bone density over time, also developed the greatest amount of plaque in their aorta. Dr. Samelson’s study of the relationship between bone and heart health indicates a link between losing bone and increasing heart disease risk, which goes beyond shared risk factors such as smoking. Just as clinicians had to learn that high blood pressure and high cholesterol need to be managed to reduce the risk of heart attacks and strokes, we need to look at low bone density and fractures in the same way.

While Institute findings have opened up promising new areas for continued research, others suggest various steps individuals can take now to improve their bone health.

What You Can Do Now

  • According to one Institute study, seniors who consume a higher level of dietary protein are less likely to suffer hip fractures than seniors whose daily dietary protein intake is less. Senior study author Marian T. Hannan, D.Sc., M.P.H. recommends that older women consume at least 46 grams of protein per day and that older men consume at least 56 grams of protein daily. This can come from both animal sources (meat, poultry, fish, eggs, milk, cheese, and yogurt) and plants (legumes, grains, nuts, seeds, and vegetables).
  • Vitamin D deficiency has been associated with low bone mineral density. Institute Director of Medical Research, Douglas P. Kiel, M.D., M.P.H. recommends including 2,000 international units (IU) of Vitamin D in your diet each day.
  • Exercise regularly, including weight training, to minimize bone loss and strengthen muscles. A recent Institute study showed that Tai Chi for nine months improved bone mineral density and tended to slow down the turnover of bone.
  • Lifestyle choices make a difference. Eliminate smoking and excessive alcohol consumption.
  • Talk to your doctor about scheduling a bone density screening to help assess your risk of fracture.

Looking to the Future
One of the most exciting developments in osteoporosis research is the identification of genes that influence the skeleton. Recent advances in molecular genetics and genetic epidemiology have allowed scientists to identify chromosomal regions that affect a range of age-related diseases including osteoporosis.

A 2012 study in which Institute researchers took part, identified 32 new genetic variants linked to the level of bone mineral density in addition to 24 already identified. Bone mineral density is the most accurate predictor of fracture risk. The research adds to a better understanding of the biology of skeletal health and fracture susceptibility.

The osteoporosis team continues to make important contributions to aging research, not just for finding ways to prevent or treat osteoporosis and fracture down the line, but also increasing awareness that fractures can be symptomatic of other of underlying conditions.

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