I found a paper recently that contained some insights that might be worth thinking about." Studies of Osteoporosis (OP) and drug treatments have challenged the concept that denser bone means stronger bone. Bone strength, or resistance to fracture, is not easily measured by routine DXA as it is a function of both density and quality".
(Cleveland Clinic, Angelo Licata 2009).
Many thanks for that - it was VERY interesting.
Just out of interest, what amount of Vit D supplements do people take?
The main findings of the above paper are as follows:
* Bone quality is best described as a number of factors that make a bone resist fracture eg. microarchitecture, any microscopic damage, bone turnover etc.
*So - Denser bone is not always stronger bone.
* Young bone is stronger than old bone even with similiar bone density - fracture rates can be dramatically different between people with the same t-score - depending on a person's age.
*Changes in bone mineral density (BMD) account for only part of the dcrease in fracture risk. Studies showed that drugs approved for treating OP prevented fractures better than we would expect from their effects on BD.
*Bones become stronger before they become denser.
*Small increase in BD can show llarge decrease in fracture risk.
*Lack of change in BD does not necessarily mean lack of response to treatment.
Commonly used treatments and their effects on BD and fracture risk:
VITAMIN D - Showed 0.4% increase in spinal density, with 37% decrease in new fractures.
CALCIUM - Showed 1.7% increase in spinal density, with 23% decrease in new fractures.
EVISTA - showed 2.5% increase in spinal density, with 40% decrease in new fractures.
ACTONEL - showed 4.5% increase in spinal density, with 36% decrease in new fractures.
FOSAMAX- showed 6.1% increase in spinal density, with 48% decrease in new fractures.
FORTEO - showed 9.7% increase in bone density, with 65% decrease in new fractures.
Finally, a blood test measuring bone turnover is a good way to assess a patient's response to medications and their efficacy.
Any thoughts? I thought this was really interesting. J
Hi Chris, don't know. Not specified. I'll have a look at the references at the end of the paper. . . .. J
When you compare the lack of risk with something like Vit 3 and the results it produces, with meds that have serious side effects, it does make you need to weigh up the risk you're at, and then do what you feel is best for you, doesn't it. Just reading up on Actonel, for instance, that has serious side effects, but doesn't seem to reduce risk of fractures less than Vit D! This really is SO interesting, and thank you so much for posting about it!
Hi Chris, the Vitamin D figures confused me as I had thought there was no evidence that "natural methods (vitamin,Diet) had been shown to increase BD and had to be used in conjunction with meds. for someone with OP, but COULD be used for bone protection for someone on the osteopenia range. . .PS don't be thanking me for posting this. This Dr. Licata could be a complete maverick . . .. J
Ah thank you Juno, both re the Vit D and I am thanking you for posting it because it's all relevant isn't it:-))) It all gives food for thought, and actually confirms some thoughts too! I did just look on the NOF site about Vit D and they recommended 800-1,000 iu daily but said need can vary due to various factors and up to 4,000 was considered safe.
This is, really interesting. I havent had a chance to fully study these findings, but I am feeling quite positive. Never come across a blood test to measure bone turnover, but it decreses as we age, at different rates in each of us. I hope that because of all the exercise I have done in the past, my strength is better than my density, but will certainly be finding out more. Thanks Juno for sharing these findings. Nothing is ever cut and dried which is why OP is a great subject for discussion.
It seems there is so muuch more to preventing fractures than bone density - I just found this on the ncbi nim nih gov site: Reasons for an increased risk of fracture associated with vitamin D deficiency are numerous. Inability to absorb adequate amounts of calcium for optimal bone health, as well as an increased susceptibility of falling, impaired muscle strength, and increased rates of bone loss can increase the risk of fracture (Lips 2001). It has been reported that lower levels of vitamin D are independently associated with an increased risk of falling in the elderly. In fact, supplementation with vitamin D has been shown to improve musculoskeletal function and reduce the risk of falling in elderly women (Bischoff et al 2003). Human muscle contains vitamin D receptors that may lead to increasing muscle strength and improving stability (Snijder et al 2006). The combination of 700 units/day of vitamin D and 500 mg of calcium (obtained through supplementation in addition to diet) was shown to reduce falls by as much as 65% over three years in less active women over the age of 65 (Bischoff-Ferrari et al 2006). So lack of Vit D can cause instability thus increasing risk of fractures.
Hi Chris, I think it's important that calcium, where possible, should come from diet - and only add a calcium tab (or half ) if you haven't got your !,200mg. from food that day. If daily calcium from food exceeds the 1,200 mg. , it isn't a problem but exceeding the dose with tabs. is not recommended at all and can cause other problems. Again, one can overdo the Vit D - so again more is not necessarily better . . . J
This is something that although I don't think I'm taking too much, does concern me Juno. I did start eating three slices of Gouda a day but was then gaining weight, so reduced it and just take 630mg calcium citrate, and 100mcg of K2, 650 magnesium and 1,000 iu Vit D3, and we have a treadmill coming this week too - I'm understanding the importance of weight bearing exercise. It IS very confusing though because I just downloaded something from 'natural health advisory' that said the calcium in dairy doesn't help! I know too much calcium can block arteries, and too much K2 can clot blood and so on, but the studies all show levels WAY higher than those I'm taking, so I'm hoping I'm not overdosing on any of them???? I'd value your opinion though.
Hi, I found this a very helpful site. If you Google- " Calcium: what you should know - WebMD" it answers a few questions. There's no reason you should put on weight trying to get an adequate amount of calcium as you can always go low-fat for any of the dairy products. Get fortified milk (higher calcium than regular milk and is also low fat), fortified cereals for breakfast, yoghurt, and cottage cheese - if you really want to keep the pounds off . . . It all adds up pretty quickly. Even a slice of white bread has apx. 50mg of calcium (check the package) For Vit D, I use baby drops in a tiny amount of orange juice. . . . Then, if I haven't made up the 1,200mg, I add in one calcium tab. or a half. (mine are 500mg per tab.) Finally, if I just couldn't be bothered totting it all up or if I'm eating out etc. ,I just take the two Calcium tabs. which also contain Vit D and that does the fob for the day . . . . . Don't know anything about K2 - thought that was a mountain in the Himalayas !!. J
Thanks Juno:-)
Vitamin D plays an important role in protecting our bones and our body requires it to absorb calcium.
A recent article in a well known UK daily paper has stated "A balanced diet rich in a wide range of vegetables and fruit will, according to the experts, provide all the vitamins and minerals the body needs to function. Popping supplements used to be thought a waste of time, however a well known scientist has now advocated that as we spend far more time indoors than our parents did, plus we have been led to believe that the sun exposure causes skin cancer, many people fail to realise that sunlight is our primary source of Vitamin D3".
Whilst the alternative source of Vitamin D3 will always be via our diet: oily fish, fortified margarines, breakfast cereals, red meat, egg yolk, cheese and powdered milk for example, the usual advice is to obtain 10 to 15 minutes sun exposure to arms, hands or back. Longer exposures does not provide additional benefit. SPF8 sunscreen reduces Vitamin D production in the skin by 95%, while SPF15 reduces it by 99%.
We can only make Vitamin D3 when the UV index is greater than 3, which in the UK is only achieved on some days in spring and summer.
In the UK the recommended daily amount used to be 200iu per day however it has now been suggested that we should take 2,000iu of Vitamin D3 a day. Our northern climate here in the UK means that millions of us are now deficient, as dietary sources are not enough to keep levels in a healthy range.
If I cannot get out in the sun for around ten to 15 minutes a day I take a supplement of liquid Vitamin D providing me with 2,500iu per day. This is in addition to calcium with magnesium supplement.
I understand that it is impossible to overdose on Vitamin D3 (although the safe limits are believed to be 4,000iu per day), vitamin D3 is complex and excess amounts can be stored in fat and other tissues, it is difficult to determine how long a daily dose of vitamin D3 would stay in the body, but I've been told that large doses can stay in the body for two months - please correct me if I'm wrong!
P.S. I've just read an article that states walking does not increase bone density (Google "does walking increase bone density"
whilst Pilates (in particular Clinical Pilates) definitely help to increase bone density for those of us with osteopenia or osteoporosis. I walk a lot, go to the gym, attend Pilates classes once a week, take additional calcium with magnesium and vitamin D3 AND have six monthly injections of Prolia - due a DXA scan (previous t score -5.2) end of this month - results eagerily awaited!!
Now I'm confused Mary:-) I did just google 'does walking increase bone density' and got the impression that it does from all the first articles it brought up, so anyone else got any opinions on this? That is exactly what I'd read about Vit D3 - that 4,000 iu is about the top whack to take but anything between 1,000 and 4,000 is good. I hope your results are good, do keep us updated:-)
I think you are right to be confused!
I have always walked and since diagnosed with osteporosis walked even more in the belief that walking can only increase bone density but a web article starting with osteopoenia3 claims " Bone density exercise research gives us mixed signals about the usefulness of walking. Some studies show that walking improves bone density; other studies show it offers little or no improvement. Osteoblasts respond to increased stress on bones. It could be that for those who have not been exercising regularly, walking is good for increasing bone density. It offers increased stress on their bones. BUT for those who have been walking regularly, it may not such a good bone building exercise since they are not adding stress on their bones. To add new stress they need to add something to their walks"
Another article states "Most of the impact of your step is absorbed through the foot, ankle, knee and hip. As a result, walking is good for building and preserving bone in the lower body. Walking does not provide enough stimulus for the spine or upper body.What could possibly explain the differences in the research results?
Well, maybe we need return to what we know about Osteoblast activity. (Remember your Osteoblasts are the bone cells that build new bone.) "
Yet another article I read has stated that walking improves the bone density in hip and spine.
Mixed messages here!
I think I'l just carry on doing what I believe is right for me and not do any more research!!
Right, yes, NOW I understand it. You need to put more stress on bones than they've previously had. I've not walked much at all because of severe arthritis in knees and back problems (not osteoporosis) but have decided I'm pandering to those too much so AM going to walk more, so for me it will probably be beneficial and I'm thinking a little mild weight exercise, such as holding a can of food in each hand when exercising, should maybe help the spine keep strong too. At the end of the day you can only do what you can do, and since I'm never going to be jogging or anything like that, then more walking is going to be an improvement for me. I am cycling more but realise that isn't weight bearing at all, so that improves muscle strength in legs, which all helps balance, and also cardio, and general fitness makes us feel like more exercise, so more walking and so on. That's my theory:-))))
I couldn't resist googling this a bit more and I thought this article was useful: Still, it's never too late to start a bone-healthy exercise program, even if you already have osteoporosis or are at high risk of developing osteoporosis.
Although people with osteoporosis may believe that exercise increases the risk of injury from broken bones, the truth is quite the opposite. A regular, properly designed exercise program may actually help prevent the falls and fall-related fractures that so often result in disability and premature death. That's because exercise strengthens bones and muscles, and improves balance, coordination, and flexibility, which is especially important for older adults and people who have been diagnosed with osteoporosis.
According to the National Osteoporosis Foundation, the best exercises for building and maintaining bone density are:
Weight-bearing exercise, such as walking, that makes you work against gravity while staying upright
Muscle-strengthening exercise, such as weight lifting, that makes you work against gravity in a standing, sitting, or prone position
Nonimpact activities such as balance, functional, and posture exercises also may benefit people with osteoporosis. Although these exercises don't build or maintain bone density, they may increase muscle strength and decrease the risk of falls and fractures.
Medical Evaluation Is Key
If you have osteoporosis or are at risk of osteoporosis, most experts believe that supervised weight-bearing exercise and strength trainingexercise is safe and effective. Studies of postmenopausal women report that aerobic, weight-bearing, and strength training exercise can increase bone mineral density in the spine, and that a simple walking program can increase bone mineral density in the spine and hip.
Before beginning any exercise program, it's important to undergo a thorough medical examination to determine which activities are safe for you.
There is no single exercise regimen that's best for everyone with osteoporosis. Each regimen should be specifically tailored to the individual patient based on a medical evaluation of:
Fracture risk
Muscle strength
Range of motion
Level of physical activity
Fitness
Gait
Balance
It IS difficult knowing what's best re meds and exercise and everything else because there is so much to research, but at least all this information does give us options on what we feel is the best way forward for us all.
Good for you, walking and cycling. Cycling (unless you're on a three wheeler!!) must surely be all about balance so that's good.
Sometimes I forget I have osteoporosis in my spine and try not to let it rule my activities. if we all keep a positive mind, eat well and exercise within our capabilities we will all live our life to the full!!
You're right Mary. Although I don't actually have osteoporosis (the GP told me I did and had me on Alendronic Acid before we were able to get hold of bone density test results), I don't want bones to deteriorate, but I did do so much less exercise than I might have done for years because of the knee arthritis, trying to hold off knee replacements, until I realised that it was no good favouring that bit at the detriment of other parts of my body! It's an exercise bike, but I've no doubt it's helping balance too, but then Tai Chi does that well also. I think what you said about living life to the full by making choices helps us feel in control and be positive too. There is a lot recently about exercise reducing the chance of brain deterioration too!