Dr Luke Perraton, physiotherapist and physiotherapy educator/researcher
My previous article called Incredible facts about bones and how they develop was a summary of some of the amazing facts about bones I have learned over my years working as a physiotherapist and physiotherapy educator. I talked about how bones develop, their many roles in musculoskeletal and metabolic health and how they respond to normal loading forces.
In this follow up article I am going to talk about how to keep your bones healthy, particularly as you get older.
Bones are living tissue that are constantly adapting to the forces placed through them from gravity and from your own muscles. When we move, forces are transferred through our bones to keep us upright and produce movement. Over time, these forces cause bone to remodel and become stronger in the places where they need to be strong. Strong bones allow you to be physically active and perform at a high level with a lower risk of fractures (note a fractured bone is the same as a broken bone – they’re the same thing!)
You may have heard about bone density? More bone density is a good thing, it means that your bones have responded to the loads placed through them by becoming denser and stronger. You can improve and maintain your bone density by being physically active. However, some physical activities are better than others for improving bone density. Activities involving impact and resistance such as running, jumping, landing and resistance training are particularly effective for stimulating bone to remodel and become stronger.
Activities involving impact and resistance such as running, jumping, landing and resistance training are particularly effective for stimulating bone to remodel and become stronger.
Good bone density is also dependent on good diet, healthy digestive, nervous and hormonal systems and adequate vitamin D levels.
The opposite is also true. Lower bone density is a risk factor for breaking bones and can also be an indicator of other health problems. Lower bone density occurs normally with ageing but not nearly to the extent that we see in modern societies. Poor diets, poor sleep, reduced physical activity levels, smoking, some medications and other illnesses that affect the hormonal and digestive systems can accelerate loss of bone as we age. Low bone density is called osteopenia. Severe osteopenia is called osteoporosis. There are excellent web-based resources where you can read more about the causes, contributing factors and management of these conditions – for example, Healthy Bones Australia.
Bone density is measured using a DEXA (dual-energy x-ray absorptiometry) scan. A DEXA scan is a low-energy x-ray scan that measures the amount of calcium and other minerals in the bones of your hips and spine. A DEXA scan gives you an indication of the density and therefore strength of your bones. Higher bone density, particularly when you are young is important for having strong bones when you are older. Strong bones are less likely to break if you have an accident or fall over.
So how do you keep your bones healthy and strong and avoid fractures? Like most things, you are better off starting when you are young. Good bone density in childhood and adolescence gives you a buffer across your lifespan. You may inevitably lose some bone destiny in periods of your life through illness, use of certain medications, dietary changes or periods of inactivity. However, if you start your life with high bone density you will have more bone stock to work with when you are older.
It’s never too late to start. People of all ages can improve their bone health through regular weight-bearing exercise, particularly exercise that involves impact and resistance such as team sports, dancing, martial arts, running, weight lifting and group exercise classes. Nutrition is another really important component of bone health and a dietician can make recommendations for the best types and amounts of foods to include in your diet to help keep your bones healthy. Your family doctor is the best place to start to have your bone health assessed. Doctors can refer you for investigations like DEXA scans. A good doctor will recommend lifestyle modifications, refer you to other health professionals as required and, if necessary, help you manage low bone density with medications.
So far in this series of blogs we have covered incredible facts about bones and how to keep your bones healthy. Stay tuned for my next blog article where I am going to talk about when bones break – why bones break, the criteria health professionals use to decide whether you need an X-ray and how common fractures are managed.
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Luke is a physiotherapy educator and researcher from Monash University, Australia. He teaches in the first year of the Bachelor of Physiotherapy course in the Department of Physiotherapy and is the co-director of the Monash Musculoskeletal Research unit @MonashMRU. Luke is the co-founder of Perraton.Physio.