Women are the central axis around which the social framework of our society revolves. Bone health is critically important in maintaining the quality of life and yet many women tend to ignore their own healthcare while tending to the multiple roles in balancing their professional and household responsibilities.
In women, bone health deteriorates rapidly after menopause. According to worldwide estimates, 1 in 3 post menopausal women suffers from osteoporosis. In India, approximately 30 million women suffer from osteoporosis of which, 50% are post menopausal.
Osteoporosis literally means ‘porous bones’. Hence , in this disease , the bone mass gradually decreases and this, in turn, decreases the mechanical strength of the bone. As a result, the risk of fractures, even with minor trauma, rises markedly. After the age of 50 years, a woman has 32% risk of fracture of vertebral column, 16% risk of fracture of the wrist and 15% of hip fracture.
The development of osteoporosis depends upon the peak bone mass achieved in youth and the rate of bone loss in middle and old age. Multiple factors play a role in the development of osteoporosis and they can broadly be divided into Genetic and non Genetic factors.
Causes of Low Bone Density in Women
Genetic factors affecting bone health
- Gender – There is no difference in the Bone Mineral Density ( BMD ) in girls and boys till the age of puberty. After puberty the rate of increase of bone mass differs and as such, by the age of 25 years, the peak bone mass attained is higher in men than in women. Thereafter , it remains stable till the age of 50years in men and until menopause in women. Following this, the bone loss occurs at a much slower rate in men whereas in women, the rate of bone loss is quite high for the first 5-7 years after menopause. Hence, the chances of bone and joint problems and fractures is higher in women after menopause.
- Race – The peak bone mass achieved is lower in lndians as compared to Americans/ Europeans due to certain genetic differences. Thus, the fractures related to osteoporosis occur at a younger age ( about 10-20 years earlier ) in Indiana.
- Family history – A family history of someone having suffered fractures in old age is also a risk factor.
Non Genetic factors affecting bone health
Although the genetic factors play a vital role in determining the bone mass, lifestyle factors also have a major impact on the strength of the bones and muscles. In fact, lifestyle factors are responsible for 10- 50% of bone mass and structure. A mere 10% increase in bone mass could reduce fracture risk by as much as 50%. Various non genetic factors affecting the bone health include:
- Age –Osteoporosis and bone fragility fractures are more common after the age of 50 years or after menopause.
- Hormone status- Estrogen deficiency is known to be associated with bone loss and various medications which decrease estrogen levels in the body also predispose to osteoporosis.
- Sedantary lifestyle – Physical activity contributes to improving bone health by improving blood circulation, strengthening muscles and building strong bones . Regular exercise also prevents bone loss and improves body balance and agility thus decreasing the chances of fall and subsequent fractures.
- Diseases- Various diseases such as hyperthyroidism, anorexia, diabetes etc predispose to osteoporosis.
- Smoking and excessive alcohol intake- These greatly increase the chances of osteoporosis in an individual. Alcohol, especially if consumed in higher amounts( more than 3 drinks in a day ) is detrimental for bone health.
So How can women take care of their bones and prevent fractures ?
We have seen that both genes and lifestyle factors contribute to bone health. While there is nothing that one can do about the inherited genes, paying attention to lifestyle factors can have far reaching effects. You can focus on improving your diet and exercise and enjoy a lifetime of strong bones and joints.
How to Increase Bone Density
1. Dietary factors –
A well balanced diet is extremely important for preserving bone mass and strength. A diet rich in calcium and vitamin D , alongwith other micronutrients eg . Copper, manganese, zinc, phosphorous, magnesium , Vitamin K is important.
The daily requirement of calcium in adult female is 1000 my / day, which increases to 1200 mg/ day during pregnancy and about 1300 my/day in postmenopausal women.
Foods rich in calcium include milk, curd, cheese, yoghurt, almonds, pistachio, groundnuts, black gram dal, cauliflower, fenugreek, beetroot, oranges, rice, soybeans, meat, fish, egg etc.
When one does not get sufficient calcium from dietary sources, calcium supplements can be taken.
Vitamin D :
Vitamin D is important because it helps in absorption and utilisation of calcium in the body. The main source of Vitamin D is sunlight and it may be deficient in people living at high altitudes or those who have very dark skin, are obese or spend very little time in the sun. Recommended intake of vitamin D in adult women is about 200 IU/day , which increases to about 400 IU/day in post menopausal women and to 600IU/day in women above the age of 60 years.
Foods rich in vitamin D include – For liver oil, fortified margarine, certain fish like Salmon, Mackerel etc and eggs. Apart from these, a Vitamin D supplement should be taken as prescribed by your doctor.
2. Exercise and bone health –
Exercise improves bone health by building and maintaining strong bones, preventing bone loss , improving blood circulation, muscle tone and overall health of an individual.
An important point to remember is that the effect of physical activity and exercise on bone health is maintained only as long as one continues with the exercise and the benefits are soon lost if physical activity is decreased. Hence it is crucial to maintain an active lifestyle throughout. Having said that, excessive exercise can also be detrimental and should be avoided. It is recommended that moderate exercise for120-150 minutes per week is optimal for maintaining cardiac and bone health. This includes the following types of exercise:
- Weight bearing exercises for eg climbing the stairs, jogging, dancing,walking, aerobics, Tennis, Basketball etc.
- Resistance training or weight training- weight lifting, using elastic bands while exercising, standing and rising on your toes etc
- Balancing and postural exercises- Tai chi, Yoga, Pilates, sit ups etc
- Others- Include cycling, swimming, stretching etc.
3. Prevention of falls and fragility fractures-
Taking measures to prevent falls or injuries goes a long way in reducing your chances of getting a fracture . These include various measures such as:
- Keep houses and offices well lit , especially the corridors and staircases.
- Avoid loose wires and rugs on the floors
- Avoid very slippery/polished floors and use adequate footwear
- Install grab bars in bathrooms and use anti skid mats/tapes
- Go for regular medical check ups in order to assess bone health and identify early problems
- Gait training and muscle tone improvement helps in improving balance and prevent falls and injuries.
4. Other precautions
Many other lifestyle changes can have a huge impact on improving bone health. These include :
- Quit smoking
- Minimise alcohol intake
- Maintain optimal body weight
- Dosages of medications such as steroids etc needs to be adjusted periodically if it is affecting the bones.
Above all, a healthy lifestyle and dietary habits go a long way in maintaining your overall health and bone strength.
Watch Dr. Smita Vats Talk about Women Bone Health – Causes of Low Bone Density in Women and How to Increase Bone Desity
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