Longevity Bloomington Newsletter # 26 - Osteoporosis

How to improve your bone health plus high protein + calcium smoothie recipes

Apr 14, 2024

What is osteoporosis?

Osteoporosis is a condition in which you have low bone density. It occurs when bone breakdown exceeds bone formation. This causes your bones to become weaker and increases your risk for a fracture. A less severe form of low bone density is called osteopenia. Osteopenia can lead to osteoporosis if left untreated for many years.

How common is osteoporosis?

More than 50 million Americans have osteoporosis. It is much more common in females. In fact, studies estimate that half of all females and 1 in 4 males over 50 have osteoporosis. Experts estimate that an additional 40 million individuals have osteopenia.

How is osteoporosis diagnosed?

Low bone mass is best diagnosed using a DEXA scan. A DEXA scan uses very low-level X-rays to determine your bone density. It is a painless procedure that only takes a few minutes. Screening for osteoporosis with a DEXA scan is recommended for all females 65 or older and males 70 or older. It is also recommended for females 50-64 with a family history of low bone mass or those who are postmenopausal.

What are the symptoms of osteoporosis?

There are no obvious symptoms of osteoporosis. Unless you suffer a fracture, weaker bones will not cause pain. This is why it is important to get screened for osteoporosis via a DEXA scan if you meet the criteria above.

What can I do to improve my bone density?

In this section, we will focus on changes you can make to your lifestyle to improve your bone density. If you do not yet have low bone mass, making changes to your lifestyle now may allow you to avoid becoming osteoporotic in the future. If you currently have low bone mass, making changes to your lifestyle can strengthen your bones and prevent things from getting worse.

There are effective pharmacological options to improve bone density and reduce your risk of fracture. Discuss these options with your physician if you already have osteopenia/osteoporosis. The rest of this section will focus on non-pharmacological options to improve bone density.

In order to improve your bone density, we must first discuss a bit about how bones behave. It is important to understand that your bones are living tissues that are constantly being built up or broken down depending on how they are used. Think of your bones as a never-ending remodeling project. Just like muscles, bones get stronger when given the right challenge. The opposite is also true: if you do not stress your bones enough, they will become weak over time. Your bones will adapt to the stimulus placed upon them.

What kind of exercise is best for bone density?

After receiving a low bone mass diagnosis, most patients understandably assume they should participate in exercise that is “gentle” on their bones. They view themselves as fragile and avoid participating in “impact” activities out of fear of a fracture. For example, many patients begin water aerobics. This is the exact opposite of what you should be doing to improve your bone mass.

Not all forms of exercise will provide the same benefit for bone strength. For a particular exercise to cause your bones to get stronger, the mechanical load applied to the bones must exceed the load encountered during daily activities. This is why every major clinical practice guideline recommends weight-bearing exercise to improve bone density. Exercises that do not put much force through the bones will not provide the same benefit as exercises that put higher force through the bones. Broadly speaking, the best types of exercise for osteoporosis are resistance training and balance exercises.

Resistance training

Resistance training may be the most important lifestyle change people can make to improve their bone health. When an individual is lifting weights, the muscles and tendons apply tension (force) to the bones. This increase in tension stimulates the bone cells to remodel and produce more bone tissue. As a result, the bones become stronger and more dense.

Individuals should perform resistance training at least two days per week for all major muscle groups. Importantly, the exercise needs to be intense enough and progress over time to be effective for strengthening bones. From a 2018 review on the effects of resistance training on bone density:

“The greatest skeletal benefits from resistance training have been achieved when the resistance was progressively increased over time, the magnitude of mechanical load was high (around 80% to 85% one RM), exercise was performed at least twice a week, and large muscles crossing the hip and spine were targeted”

If you are just getting started with lifting weights or you have been inactive for a long time, start light. BUT you must gradually increase the amount of resistance over time if you want to improve your strength and bone density. Lifting the same 5-pound dumbbell for the next 10 years will not improve your bone mass. Remember, without challenge, there is no change.

Balance exercises

In addition to resistance training, balance exercises are very important for those with osteoporosis. Most balance exercises will not improve your bone density but they will reduce your risk of falling. Falls are the precipitating cause of most fractures and 95% of hip fractures are due to a fall.

“Balance exercise” is any activity that improves your body’s ability to maintain its center of mass over its base of support. If you have “good balance”, you have the ability to remain in an upright and stable position and distribute your weight in a way that lets you stand or move without falling. Good balance is also demonstrating the ability to recover your balance if you trip or stumble. In other words, balance is the ability to not fall over.

Two broad categories of exercise are most effective in improving balance: resistance training and balance exercises. A 2017 review in the British Journal of Sports Medicine reviewed the current evidence on the effectiveness of exercise to prevent falls. From the author:

“There is strong evidence that appropriately designed intervention programmes can prevent falls.
This systematic review with meta-analysis provides strong evidence that exercise as a single intervention prevents falls in people living in the community. The meta-regression suggests programmes that involve a high challenge to balance and include more than 3 hours/week of exercise have greater fall prevention effects.”

To summarize, exercise is effective in reducing falls. You should be performing both lower extremity strengthening exercises and balance exercises. The balance exercises need to be challenging to be effective and these exercises need to be performed at least three hours per week.

What should I eat to improve my bone health?

In addition to exercise, nutrition plays a pivotal role in bone health. Adequate intake of essential nutrients helps to maintain bone density, support bone formation, and reduce the risk of fractures. Here are some key nutrients that play a crucial role in preventing and managing osteoporosis:

Vitamin D

Vitamin D is essential for calcium absorption and bone mineralization. Sun exposure is a natural source of vitamin D, but as we age, our skin becomes less efficient at synthesizing it. Therefore, adults 50+ may need to rely more on dietary sources such as fatty fish, fortified foods, and supplements to meet their vitamin D requirements.

Most scientific organizations recommend an intake of at least 1,000 IU of vitamin D per day for adults aged 50 years and older.

source: https://www.metropolisindia.com/blog/preventive-healthcare/vitamin-d3-rich-foods-for-a-healthy-diet

Calcium

Adequate calcium intake is also a fundamental aspect of improving bone health. Calcium is the building block of bones, providing strength and structure. Most Americans are not getting enough calcium in their diet. The average daily calcium intake among American adults is about half of what is recommended. For adults aged 50 years and older, the recommended calcium intake is 1200 mg/day. Increasing calcium intake beyond the recommended levels does not add benefit.

Getting enough calcium through your diet (or supplementation if necessary) has been shown to increase bone density and reduce your risk of fracture. A 2016 research review by the National Osteoporosis Foundation showed that calcium plus vitamin D supplementation resulted in a 15 % reduced risk of total fractures and a 30 % reduced risk of hip fractures.

Dietary sources of calcium include dairy products, leafy green vegetables, fortified foods, and certain types of fish such as sardines and salmon. If you have trouble getting enough calcium through your diet, supplementation is also an option.

Protein

Protein is vital for maintaining bone mass and strength. A 2018 consensus paper from the Osteoporosis International Journal concluded:

“dietary protein is rather beneficial in reducing bone loss and fracture risk, especially at the hip, provided calcium intakes are adequate. Insufficient dietary protein intake may be a much more severe problem than protein excess.”

As we have discussed in previous newsletters, adults 50+ do not process protein as efficiently as younger adults and therefore actually need more protein than their younger counterparts. As a starting point, try to consume half of your body weight in grams of protein. For example, if you weigh 150 pounds, aim to consume 75 grams of protein per day.

High Protein Smoothie Recipes (with calcium!)

If you have trouble getting enough nutrients through your normal diet, smoothies can be a quick and convenient way to boost your diet. Whether you're rushing out the door in the morning or need a fast and healthy snack during the day, a smoothie can be whipped up in minutes and enjoyed on the go.

Here are a few smoothie recipes that are packed with protein and calcium to help with improving your bone (and muscle) health.

1. Creamy Spinach and Banana Calcium Smoothie

Ingredients:

1 cup unsweetened almond milk (fortified with calcium)
1 ripe banana
1 cup fresh spinach leaves
1/2 cup plain Greek yogurt (low-fat or non-fat)
1 tablespoon almond butter
1 tablespoon chia seeds
1 tablespoon honey or maple syrup (optional for sweetness)
Ice cubes (optional)

Instructions:

In a blender, combine the almond milk, ripe banana, fresh spinach leaves, Greek yogurt, almond butter, chia seeds, and honey or maple syrup (if using).
Blend on high speed until all ingredients are well combined and the smoothie is creamy and smooth.
Taste the smoothie and adjust sweetness or add more liquid if needed.
Pour the smoothie into a glass and serve immediately, optionally garnishing with a sprinkle of chia seeds on top.

2. Almond Berry Protein Power Smoothie

Ingredients:

1 cup almond milk (fortified with calcium)
1/2 cup plain Greek yogurt (low-fat or non-fat)
1/2 cup frozen mixed berries (strawberries, blueberries, raspberries)
1 tablespoon almond butter
1 tablespoon hemp seeds
1 tablespoon honey or maple syrup (optional for sweetness)
Ice cubes (optional)

Instructions:

In a blender, combine the almond milk, Greek yogurt, frozen mixed berries, almond butter, hemp seeds, and honey or maple syrup (if using).
Blend on high speed until all ingredients are well combined and the smoothie is creamy and smooth.
Taste the smoothie and adjust sweetness or add more liquid if needed.
Pour the smoothie into a glass and serve immediately, optionally garnishing with a few extra berries on top.

Member Spotlight - Judy Childers

1. How long have you been a member of Longevity?
I have been a member for a little over 2 years

2. What is your favorite exercise at Longevity? Least favorite?
My favorite is the bench press. My least favorite is box pushes.

3. Where are you from originally? Where did you go to school?
I'm from Oolitic and lived there until marriage. IUPUI was my College choice.

4. What brought you to Bloomington if you are not from the area originally?
Oolitic is just 25 miles south, but I moved to Bloomington when I got married to be closer to my husband's job.

5. Tell us about your family. Any information about your spouse, kids, or grandkids that you would like to share!
I have been married for 53 years and we have 2 daughters, a son, and five grandchildren.

6. What do you do for work? If retired, what did you do for work?

I am a registered nurse who began in critical care but spent most of my career in Pediatrics. I retired in 2015 and prepared to fade into the sunset. Five years later when COVID came along and triggered a nursing shortage, I wanted to help and wound up administering thousands of vaccines at local clinics. I am still working part-time as my schedule permits.

7. If you had to eat one meal every day for the rest of your life, what would it be?
My favorite food is any type of seafood.

8. What is your favorite hobby?
I like to travel, read, and spend time with my family.

9. What’s something about you that not many people know?

As I noted, I am a nurse but did not begin college or start a career until my children were almost raised. In fact, my son and I were in college at the same time.

10. What do you like to do when you’re not working out at Longevity?

I try to walk at Twin Lakes a couple of times a week and enjoy time with friends and family including the MANY MANY activities that my grandkids are involved with.

11. What’s the next place on your travel bucket list?

Since my husband retired seven years ago, we have had the opportunity to check off a lot of places. Africa is a destination I think I would enjoy, but I would settle for a return to Italy. :)

12. Favorite restaurant in Bloomington?
I enjoy the Uptown restaurant but have to fight my husband to go there.

13. Favorite place you have ever been?
Italy Is my favorite, although Alaska and Hawaii were also great.

14. Anything else you'd like to talk about?

I am not a paid spokesperson and I realize that me saying longevity is great WITHIN A LONGEVITY NEWSLETTER may seem like over-the-top flattery, but the fact is - longevity has been beyond great for me. By the time I reached 70, my physical condition was on a down hill slide picking up speed. I was becoming weaker, had less stamina, and felt fragile. Longevity truly has turned my life around and I feel stronger and healthier than I did 20 years ago.