Do you have a bone health plan? A strategy to optimise your bone strength from now well into the future...for healthy, active, independent Future You? Bone health is protective for healthspan. Have you ever thought of it that way? We may be living longer but we are not living well longer. Strong bones are foundational for mobility, for independence, for a confident 'I can do' mindset.
For future you.
Taking a long view when it comes to your bone health just makes sense.
What are you doing now, in 12 months, 3 years, 5 years, 10 years...for strong healthy bones?
Hello and welcome to the Bone Health Series - edition 7, the final edition. To find previous editions simply scroll The Blog.
With 67% of the Australian population aged 50 years and older having osteoporosis or osteopenia (Healthy Bones Australia) bone health needs to be on our health radar. Why? Because poor bone health puts us at greater risk of a fragility fracture, a bone break from low force. It's estimated that 1 in 4 people who have a hip fracture die within the first 12 months and the likelihood of repeat fracturing, is very high. As humans, we all begin to lose bone mass from our 30's at about 1% a year. As women, we have a steep drop off, losing between 10-20% of our bone mass during our menopause transition with accelerated loss again after 70. So if you enter your menopause transition with sub-optimal bone health, it's much harder to maintain good bone strength in your future years.
Bone health is something we don't often focus on until we've had a fracture and the window of opportunity to pro-actively manage our bone health well, is almost closed. We also have a health system that doesn't make it a priority to measure our bone heath status until we are 70 years of age (unless we have had a low impact fracture after the age of 50 or if we have health condition that puts us at greater risk of sub-optimal bone health). That is way too late. It's setting us up for limited options to improve our bone health without taking medication.
There is so much we can do to optimise our bone heath before that tipping point. That's what this in-depth series is all about. To help you appreciate the many ways you can and have the power to help your bones...for future you.
In this final edition in the series, the focus is on bringing all those pieces of the puzzle together and formulate a Bone Health Plan. To help you to craft conversations with your health team to get your bones in tip-top shape now and into the future.
Bone Health Is A Team Sport with you as the team manger, as you play your health advocate role. Your health team could include:
- GP - for general bone health advice and fellow custodian of your bone health plan
- Endocrinologist - with specialised hormone knowledge, for more indepth management and to support your GP
- Naturopath - for complimentary overall health and dietary support
- Dietitian
- Physio/Exercise Physiologist - for specific bone exercise support - correct moves in the correct way
- Bone Scan Technician - for your regular bone scans to measure bone health status; REMS or DEXA or both
In addition to these team members you may also have other specialists or health professionals who look after other aspects of your health. You will need to ensure they are kept in the loop too because many aspects of our health will impact our bones.
Weave your bone health into your overall health management. Keep it on your radar. Make it a priority for future you. Yes, you may have to pay for scans out of pocket once a year or so but like all things in life, it's about priorities. I'm asking you to make your bone health a high priority.
My Story: If I wasn't my own health advocate, my bone health would have suffered more than it already has. From the age of 40 (I'm now almost 58), my birthday gift to me is having general blood tests taken. A pattern emerged with rising ionised calcium that lead to investigating my parathyroid function. I have my GP to thank for that.
Hyperparathyroidism is a cause of osteoporosis. A benign tumor on one of my parathyroid glands was the culprit. Once that was removed, my bones were no longer losing calcium as quickly. Things stabilised.
Now it was up to me to keep it that way and ideally, see if I could improve my bone health with that resolved. Because of my age then (I was 51) and I was just in the osteoporosis range, I did not want to take the medication. The advice from my then endocrinologist was that 'once I started on the medication, I'd be on them for life'. At 51, that was not an option for me.
Exercise became the essential foundation for my bone health treatment plan. My team then grew to include a physiotherapist who helped me with bone loading exercise routines. I now do 2 gym sessions a week with her for strength training and bone loading. I never stopped my pilates (reformer pilates with resistance) which also includes movements specifically for my bone health and balance (to help prevent falls).
Protein, Calcium, Vitamin D and K are intentionally on high rotation in my diet now too. Eating more protein than I ever have to help build muscles, which in turn support my bones, as well as more calcium rich foods to keep replacing what I have lost. Diet first with very minimal supplementation which includes Vitamin D and K for encouraging calcium absorption in my bones, minimising calcium depositing it into my blood vessels. I also supplement with Fortibone (a form of collagen specifically for bone health) prescribed by my naturopath.
To reduce my menopause symptoms, I gave up regular alcohol consumption and have taken up meditating and yoga to reduce the impacts of stress. Reducing alcohol and stress are other key lifestyle changes to make for your overall health, including your bone health.
Regular Bone Scanning - Discovering REMS bone scans.
Things have continued to stabilise. AND I discovered that my Bone Quality was really, really good. My Fragility Scores were a helpful guide too - they were encouraging. After a DEXA scan (in year 4) was dismissed because of wildly inaccurate results, I did my own research and found REMS bone scanning.
Now, I'm a REMS convert (and have educated my health team members about it too). I'm also taking myself off for annual REMS scanning (instead of DEXA scans every 2 years - DEXA does not detect small changes in bone health under about 18 months, that's why they are usually every 2 years. REMS picks up changes in 6 months) curious to see if what I am doing with diet and exercise is helping.
Hope is an incredibly powerful motivator. That is what having the results of my REMS scan gave me. Hope that what I was doing was helping my bone health. The motivation to keep it up - for future me.
Health Team Change: I recently changed my Endocrinologist. Because of the research I had done on bone health and menopause I was aware of what the current recommendations were for treatment. Hormone Therapy is one of those recommendations as outlined in the recently published the 2023 Practitioner's Toolkit for Menopause Management.
We never had the conversation about HT and bone health. That's what floored (and upset) me the most. I decided to move on.
I now have an Endocrinologist who specialises in women's health and bone health. After discussing treatment options and assessing my overall health status, I have just commenced HT with the aim of increasing my bone health baseline so that in later years, it's reducing off a higher base.
We're also doing additional blood testing for bone markers as a guide for how much bone is being lost and built. I feel like I now have someone on my team who is more up to date with treatment options for me and has the experience and confidence to administer them. She's also aware of REMS scanning and is open to me using it as a measurement tool.
Don't be afraid to speak up. Read up, advocate for yourself and have the conversations. Add the right members to your bone health team and don't be afraid to change them out to if you don't feel you're getting the best help possible. These are YOUR bones and FUTURE YOU depends on you, now.
Measure Your Bone Health Status!
If you're not already onto it, start now. Because here's the thing. The health system does not support bone health treatment for the majority of us (both women and men) until it's too late. Too late to have proactively managed it with exercise and diet.
And poor bone health is a silent condition. We don't feel pain from sub-optimal bone health.
The most reliable way currently to know, is to measure with a REMS or DEXA scan.
Why wait until you fracture to find out? If you haven't had a recent bone scan, click off now and book in for your bone scan now! Make an appointment to visit your GP for a DEXA scan referral and book at a radiology practice you can return to again and again that has a DEXA machine. Alternatively book in for a REMS bone scan. You don't need a referral for that.
Bone Plan Checklist
Is about what to consider when taking a long term view of your bone health. Not prescriptive, do this, do that. Rather, talking points, to guide conversations with each member of your Bone Health Team.
Outcome: greater confidence in managing bone health because of an increased understanding and clarity of what the next steps might be.
Things to consider and include in conversations with your health team when making your Bone Health Plan:
1. Know Your Bone Health Status - Measure it. Is it optimal?
- DEXA or REMS scan
- Fragility Score (REMS scan) & Fracture Risk
- If it's sub-optimal WHY is it sub-optimal? This is a critically important question to ask your health team (GP or specialist).
2. Your Menopause Status - are you peri-menopausal? Post menopausal? How many years since your last period?
3. Your Risk Factors - it's important to discuss with your health team if any of your health conditions including the medications you are taking or treatments you've been on/are on, impact your bone health and how. In my case it was hyperparathyroidism.
4. Exercise - what's your weekly exercise regime?
- Are you including correct bone loading exercises in your weekly exercise habits? Strength and Resistance work?
Knowing what specific exercises to do and HOW to do them correctly is important (particularly when lifting weights). Not only to maximise your efforts but to reduce injury. Bone loading exercises have the added benefit of building muscle strength too.
- Are you working on improving your balance regularly? How can you best do that?
5. Diet & Supplementation - are you consciously including
- adequate protein - how much should you be eating and sources
- nutrients for bone health such as calcium, vitamin D and K - again, how much do you need and sources
- other nutrients for your specific health needs that will aid bone health too
- If you are not getting enough in your diet, what supplementation may be helpful? What amounts are required?
6. Medications (including Hormone Therapy)
- What's your attitude to taking bone medication (including hormone therapy). Do you have concerns? If so, what are they? Talking this out with your health team member is crucial because it will set the future direction of your bone health treatment.
- How long can I be on this particular medication for?
- What are the risks of taking it? What are the benefits? How specifically does it work to help?
- What happens if I stop taking it? The impacts on overall health not just bones.
- What is the medication plan for - 0-1 year, 1-3 years, 5 years and 10 years+? Map it out with your health team and have it in their file notes as well as yours.
- Are you prepared to take it as directed? Consistently?
- Will this impact other medications you're on - how? What are the risks?
7. Ongoing Measuring To Know
This is an ongoing effort. Keep track of when you have your bone scans and your results. Push to have regular scanning to know. Maybe you need regular blood work to know. Keep measuring to assess on your radar and in your calendar.
Discuss with your health team the appropriate intervals for measurement testing.
Final Thoughts
This is the final edition of a BIG bone health series. You can scroll back in the Blog and see the other editions. I hope you find it helpful.
Email me with the subject 'bone health' and let me know here what's been helpful and if anything wasn't covered you'd like to know more about.
Even if you don't currently have a diagnosis of osteoporosis, do you know what your bone health status is? If not, please find out asap. The earlier you know, the earlier you can start managing it pro-actively with the right exercise and diet. Get your team in place.
To strengthen your bones for future you - your independence. Living longer, well.
Because bone health is an indicator of health span. Keep it on your radar. Make it a priority.
Remember the contents of this post are meant for education purposes only. This newsletter is here to spark thoughts and conversations not to give advice. Conversation not consultation. I'm not a doctor or a qualified health professional offering advice. That's on you to glean from your health team and determine what's best for you.
Take care, and be kind to you. Because girl...you are just getting started.
Anita xx
p.s. Scroll to look out for other blog posts in my Bone Health Series. They're near by so it won't take long to find them :)
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