Healthy aging with strong bones

Dr MK Mam
Bone and Joint day is celebrated all over India by the Indian Orthopaedic Association (IOA) and all its state chapters on 4th of August every year since 2012.
This year the theme of observing the day is “Healthy aging with stronger bones”. It is true that our bones lose their mass or density- become weaker as age advances. Weak bones i.e. osteoporosis is a major and a serious health problem as fractures of spine, hips and wrist bones occur just with a minor trauma. It results in lot of disability ,affects quality of life and performance of the person. There is lot of morbidity and mortality associated with these fractures. Chances of having all these problems in an elderly can be reduced if the bones are reasonably strong. As such it is important that we take due care of our bones and it should start when we are kids. It has to continue all along our life, especially in later years of life. We can do a lot to keep the bones and muscles strong even in later years of life, yes it can be done.

Today is Bone and Joint day

Physical activity is very essential for loading the bones and making them strong. Bones become stronger when loading increases on it. Weight bearing exercises i.e. when bones and muscles work against gravity and resistance, certainly make the bones and muscles stronger. Routine physical activity especially weight-bearing exercise prevents bone loss associated with aging and menopause in women. It has also been found that fracture rates are lower among people who perform more of weight-bearing activities as compared to sedentary people. Insufficient or lack of physical activity certainly leads to weakness of bones- osteoporosis, falls, fractures and all other medical problems. Exercise has to be regular and of sufficient duration and intensity.
In an elderly, weight bearing exercises have to be of moderate intensity. Around 150 minutes per week of moderate physical exercise done in different spells should be fine for an elderly person. Simple walking, dancing, going down and up the stairs, riding a bike on a level ground, gardening , pushing a lawn mower , playing outdoor game- like tennis are some of the weight-bearing exercises which an elderly can do depending upon one’s capacity and health status. Yes, loading is good for bones, however may not be good for joints especially in an elderly as some arthritic changes may be there . So we have to keep a balance and do what our body allows. Walking in fact is safe and can be enjoyed by almost anyone including an elderly. Walking improves bone mineral density in lower limbs, strengthens muscles and joints and is also good for good for heart , lungs and overall health of a person. We should avoid sitting for longer periods. As a principle we should move more and sit less. We need to be active as much as we can and as long as we can.
Yoga certainly has a positive effect on the physical and mental wellbeing of a person. It strengthen muscles and bones. It also improves flexibility of the joints and balance . An elderly can do yoga at his own pace. Studies show that yoga done every day can prevent osteoporosis and in some cases can also slow down its progression. Nutrition with adequate supply of different bone healthy factors is important for the growth and development of the bones. We need to have a balanced diet and keep our weight under control. Intake of a bone healthy diet is essential in elderly to maintain a sound bone health. Malnutrition is one of the common problems with elderly. It could be because appetite in general decreases and then absorption of the nutrients in the gut also is affected with aging. All this means less of essential nutrients, with the result the strength of bones and muscles is affected. So we have to stress on taking a bone healthy diet especially in an elderly.
Calcium is an essential mineral for growth and development of the bones, so a diet rich in calcium has to be taken. Men aged 50-70 years should consume 1000 mg per day of calcium and the women age 51 and older and men age 71 and older should consume 1200 mg per day. Intakes in excess of 1200 to 1500 mg per day may not have much of benefit, it may increase the risk of developing kidney stones and cardiovascular problems. Calcium intake is usually inadequate in elderly and then its absorption also decreases, so it has to be taken care of. Milk and dairy products like yogurt, cheese etc. are rich in calcium and high in calcium absorption, thus are useful foods for prevention of osteoporosis and maintaining the bone health. In addition green leafy vegetables like broccoli, turnip greens, mustard greens, dried figs and nuts like almonds also provide calcium.
Vitamin D is important for calcium absorption and mineralization of bone. Vitamin D deficiency is characterized by inadequate mineralization of bone. An intake of 800 to 1000 international units of vitamin D per day is recommended. Exposure to sun light does provide vitamin D by way of skin. Most of us including elderly are not able to make use of this free source of vitamin D as most of the time we stay indoors and when outdoors elders mostly cover up most of the body -skin by wearing clothes. Formation of vitamin D in skin and then its activation in the kidneys also drops down with aging. As such there is a widespread deficiency of vitamin D in elderly and there is a need to take the supplements.
In addition we also need to have enough of proteins, phosphorus, magnesium, vitamin K, vitamin A and B12 as they are helpful in maintaining optimal bone health. A moderately increased intake of proteins in elderly is beneficial for bone health as long as kidney function is fine. It also prevents muscle wasting and as such increases muscle mass and strength, thus decreasing the chances of fall and fractures in the elders. Smoking and use of tobacco products affect lungs and heart is a fact, that is well known to many. However, most of the people are not aware that it affects bones very badly. It has a negative influence on bone mineral density. It damages bone cells and reduces blood flow to bone. Smokers have almost double the risk of osteoporosis and hip fractures as compared to nonsmokers. As such there has to be big NO to smoking.
Alcohol damages bone cells directly and inhibits calcium absorption. It also damages the liver – the organ where activation of vitamin D occurs. Chronic alcohol abuse certainly increases the risk of osteoporosis and fractures. As such consumption of alcohol has to be avoided.
Soda and Colas have to be avoided as they contain lot of caffeine and phosphoric acid which drain calcium from bones and thus decrease bone mineral density.
We also need to assess risk factors for osteoporosis and fractures, and if there is one, it should be be diagnosed and treated appropriately. In addition we also need to check eyesight in an elderly as poor eyesight can affect mobility and balance, thus increase the risk of falls. Again, hearing needs to be checked as ear problems can also affect the balance.
(The author is Formerly, Vice Principal, Prof. & Head of Orthpaedics, Christian Medical College, Ludhiana , Punjab)