Bones are complex and important parts of us—carrying us around and protecting our vital organs as well providing a store of calcium. The premenopausal years are a time of gain to peak bone in the spine and to preserve maximum bone through until normal bone loss begins in perimenopause and menopause. Building and maintaining our bones is not just about getting enough calcium—it is a "whole meal deal." Following these ABC's will help you prevent later fractures and osteoporosis.
"A" is for "Active"
Bones become stronger because of forceson them from gravity and from muscles. Being active doesn't mean you have to be an athlete. It means regularly choosing to climb the stairs and to walk; it also means doing active things for fun, like skating or tennis or hiking. Aim for at least a half an hour of physical activity every day.
"B" is for "Brawny"
Brawny doesn't mean muscle-bound or showing six-pack abs. It means being strong and of normal weight (body mass index [BMI] of 18.5-24.9). Muscle work builds stronger bones. If you are trying and can't build muscle it is usually because you are not eating enough—our body burns muscle when it needs calories. With dieting or weight loss we lose both muscle and bone. Our goal is to neither to lose/need to lose or need to gain but rather to maintain a healthy, strong weight.
Calcium is an essential nutrient for bones—you need 1,000 mg a day. One dairy or fortified serving, ¾ cup yogurt or a 1X1 inch hunk of cheese has 300 mg of calcium. Ideally take one dairy food with each meal—if you can't, then take calcium pills. We can absorb only 3-500 mg at a time therefore we need calcium throughout the day. Overnight, without food calcium being absorbed, blood levels decrease so the body must take bone calcium. Thus the most effective time for calcium supplements is at bedtime. Extra calcium (up to 2,500 mg/d is safe) may help prevent bone loss if you are temporarily very stressed, your cycles are absent or irregular, you are losing weight, sick or can't exercise.
Vitamin D, that is really a hormone made in our skin by sunshine, is present in only a few foods. Vitamin D helps our body absorb and use calcium. You need 600 international units (IU) every day; therefore those not regularly eating cod livers (!) will need to take a Vitamin D supplement. A usual multiple vitamin includes 400 IU of Vitamin D—that is insufficient, especially in winter. If you do not take a daily vitamin, take a 1,000 IU Vitamin D pill instead. Vitamin D is safe up to 4,000 IU a day. Those at risk for bone loss such as with absent, irregular or non-ovulatory menstrual cycles would be wise to take 2000 IU a day. It can be taken all at once since it is stored in fat.
"E" is for "Easy-Going"
A quiet, confident approach to life helps bones! Amazing isn't it? We now know that stress or depression (with higher levels of cortisol) and anxiety (with higher levels of norepinephrine) cause bone loss and eventual fracture. To be happy, we need three A's: to feel accepted a sense of achievement and that we are loved (affection). Everyone has some stressors, feels alone and sad but putting things into perspective and using relaxation/ yoga/activity will help achieve emotional balance.
"F" is for "Bone Formation"
Regular, normal length (21-35 d) menstrual cycles mean we are making enough estrogen. But we also need to ovulate and make progesterone to build new bone, to prevent bone loss and to be able to become pregnant. Women with normal cycles who don't make proges-terone are losing almost 1% of spine bone each year. Ovulation disturbances usually relate to stress, abuse, weight loss or even worrying about becoming fat. You can take progesterone in its natural form cyclically (/resources/cyclic-progesterone-therapy) to build bone.
"G" and "H" are for "Good Habits"
Good habits start with eating regularly (healthy foods) and getting 7-9 hours of restful sleep most nights. It means avoiding cigarettes (that increase bone loss and prevent rebuilding bone) and binge drinking or averaging more than one alcohol drink a day. Also avoid colas (high phosphates that cause urine calcium loss) and stick to less than three caffeine-rich servings a day.
In summary, preventing broken bones in menopause or when you are old begins now with rather simple and healthy things you can do for yourself. It's up to you!
Jerilynn C. Prior MD, FRCPC 2014/1 (adapted from her Health Writes BC publication from 1995)
Revised September 2017 JC Prior
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