Treating Low Bone Mass — Three-Pronged Approach Focuses on Diet, Exercise, and Medication
By Densie Webb, PhD, RD
Thirty-eight-year-old Gwyneth Paltrow is best recognized for her acting and singing careers, but she became known for her bones last year when she joined the ranks of the 34 million women diagnosed with osteopenia, a condition in which bone mass is lower than normal but not low enough to be classified as osteoporosis.
According to the National Institutes of Health, everyone begins losing bone after about the age of 30, the point at which bone mass peaks. For women, that bone loss accelerates after menopause. Paltrow’s loss, however, is more dramatic than most women her age.
Rather than being a disease in itself, osteopenia is considered a possible risk marker for osteoporosis and debilitating bone fractures. However, according to Lora Giangregorio, PhD, an assistant professor of kinesiology at the University of Waterloo in Ontario, Canada, the focus is now shifting away from using the term “osteopenia” as a diagnosis or as a cutoff point for prescribing medications. Rather, recommendations for bone health are made for anyone with less-than-optimal bone mass.
Low bone mass has no symptoms. It is usually diagnosed with a bone mineral density test known as dual-energy x-ray absorptiometry, which can identify bone loss of as little as 2% in one year. Earlier this year, the U.S. Preventive Services Task Force issued new recommendations for bone mass screening.1 The agency recommended screening for all women older than 65 and for younger women who have a risk profile similar to that of a 65-year-old woman. The report avoided the use of the term osteopenia and instead referred only to low bone density revealed through screening. No recommendation was made for men because of a lack of evidence for screening’s effectiveness. However, the National Osteoporosis Foundation recommends screening for all men aged 70 and older.
• Get enough calcium. The Recommended Dietary Allowance (RDA) for adults younger than 51 is 1,000 mg/day. For adults aged 51 and older, the RDA is 1,000 to 1,200 mg/day. People need to take a supplement if their dietary calcium level is inadequate.2 No specific recommendations have been made for low bone mass.
• Get ample vitamin D. The RDA for adults is 600 IU/day. This recommendation assumes minimal sun exposure. If dietary intake is low, a supplement is recommended. No specific recommendations are made for low bone mass.
• Limit intake of salt, caffeine, and soft drinks, as they can weaken bones when consumed in excess.
• Avoid consuming too much alcohol. Drinking more than two or three alcoholic drinks per day can harm bones.
However, according to Mary Jane Detroyer, MS, RD, CDN, a New York-based dietitian and exercise physiologist, “To build bone, you have to participate in weight-bearing exercise. Research clearly supports that.”
Weight-bearing exercises such as walking, hiking, and dancing are all good choices for the lower body, and adding exercise with light weights or elastic bands or straps can help the bones in the upper body. Less traditional forms of exercise, such as yoga, tai chi, and Pilates, may not only help increase bone density but also significantly improve balance by increasing core strength. Research has shown that better balance and improved gait translate into fewer fall-related fractures, regardless of the degree of bone loss.4
Detroyer, who regularly counsels patients on how to improve their diet and incorporate more physical activity into their lives, offers the following suggestions for bone building:
• Incorporate balance work such as yoga at the beginning of a workout to help prevent falls.
• Women should use weight-lifting machines in the gym, beginning with lower weights (the amount a woman can push or pull for 15 repetitions, with the last one being a challenge) and gradually increasing both weight and repetitions over time.
• In the absence of joint or muscular problems, Detroyer recommends jumping activities such as jumping rope, jumping up on a bench, and simply jumping up and down on the floor. The impact helps build bone.
• To help the spine, include exercise that strengthens the back muscles, such as back extensions, bridges, and planks.
• To avoid injury, people should work with an exercise physiologist or a personal trainer with a degree and certification to work with a specialized population.
If, however, there is no obvious underlying condition, the three-pronged approach of diet, exercise, and medications is the key to preventing further bone loss and even increasing bone mass.
— Densie Webb, PhD, RD, is a freelance writer, editor, and industry consultant based in Austin, Tex.
2. Institute of Medicine Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academies Press; 2010.
3. Chubak J, Ulrich CM, Tworoger SS, et al. Effect of exercise on bone mineral density and lean mass in postmenopausal women. Med Sci Sports Exerc. 2006;38(7):1236-1244.
4. Papaioannou A, Morin S, Cheung AM, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ. 2010;182(17):1864-1873.