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Bone Health: Promoting Spirit in the Elderly

"Our bones are dynamic!"
By: Marc Evans Abat, MD, FPCP, FPCGMBone Health: Promoting Spirit in the Elderly

What is the stereotypical image of an older person? Whether people admit it or not, there is a tendency for older persons to be pictured as frail, rickety individuals, who are often stooped over and walking with the aid of canes or other mobility aids.  It is nearly impossible to even imagine older folks doing feats of athleticism or even any activity that requires a significant amount of elbow grease.

So what goes on in your bones as you age? 

Our bones are dynamic! There is constant bone remodeling:  we break down some of our bone but we continually make new bone.  Bone strength is maintained or increased by tilting the balance towards bone formation.  For example, martial arts practitioners are able to strengthen their bones by constantly inducing stress and small fractures in their bones, which then provide the impetus to make stronger bone. However, when you grow older, various factors may sway the balance of bone health into either direction:

  • Diet: Bone strength relies on stocking up on your calcium stores, especially when you are younger.  People who are not used to drinking milk, for example, are at risk for not developing their calcium stores.
  • Vitamin D levels: Those who are not adequately exposed to sunlight also run the risk of having low vitamin D levels (the production of which is initiated by sun exposure).
  • Body weight: Those who are thin are at risk of having weaker bones, especially as they age.  This is most likely related to having less bone mass in the first place.
  • Smoking and drinking: Both situations appear to be associated with weaker bones, mostly likely from poor calcium utilization.
  • Medications: There are certain medications that may affect bone health.  Glucocorticoids like prednisone (given to those with immunologic diseases like rheumatoid arthritis or lupus) make weaken bones by preventing bone formation and increasing bone loss. 
  • Physical activity:  Weight-bearing exercises provide stimulus in promoting bone formation.
  • Sex: Women, in general, have relatively less bone mass from the start, compared to men.  Menopause further causes bone weakening through the loss of estrogen, an important hormone maintaining bone health.  For men, loss of testosterone (the male sex hormone) in situations like medical or surgical castration, may lead to bone loss.
  • Ethnicity:  Caucasian and Asian women appear to be at risk for having poor bone health. 
  • Diseases:  Certain diseases increase the risk for bone weakening, either through the medications used to treat them (as mentioned above), or by directly affection calcium and vitamin D balance or decreasing bone formation. 

Why is it important to maintain bone health? 

It is important to know what happens when bones get too weak.  This condition is called osteoporosis, wherein there is more bone loss and less of bone formation, leading to a decrease in bone density and strength.  Osteoporosis will then predispose an older person to fractures.  These fractures can happen even with low impact falls or trauma (wherein the forces are not usually enough to cause injuries in older persons with normal bone strength). 

Who should have their bone density and strength checked? 

The US Preventive Services Task Force recommends women to check their bone density at age 65 years and older, especially if you have risk factors for possible bone weakness.  Women younger than 65 years old should have their bone density checked if their fracture risk is similar to that of a 65-year-old woman or older without additional risk factors.

So what does one have to do to maintain bone health?

 Basically we should address all of the previously mentioned factors that may weaken bones.

  1. It is important to build up your calcium stocks in your bones even while you’re younger.
  2. Of course you also have to ensure that you have adequate vitamin D levels.  The following table also shows the recommended intake of vitamin D.  Good sources of vitamin D include egg yolks, saltwater fish, liver, and milk with vitamin D.
  3. A well-balanced diet in general is also important since there are other nutrients that are important in bone formation.
  4. Bone formation is further enhanced with exercise.  The best exercises to improve bone strength include weight bearing.
  5. Avoid smoking!  If you smoke, stop by all means.   Moderate your alcohol intake.
  6. As was mentioned earlier also, fall prevention is important, even in older people with normal bone strength.  This is to prevent injury in any form (either to bones or other internal organs). 

And there you have it!  With this information, the older person’s bones may not as easily be broken by “sticks and stones”.

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