SPF: Don’t Let Your Bones Get Burned

Whether you opt for 15, 30, or 50, it’s rare to find someone amongst us that doesn’t lather up before laying out (or even being out on a summer day!). The sun and its rays are no joke. They can leave their mark in the form of burns, peels, sunspots, and even wrinkles—ugh! And if that wasn’t enough to scare you into some good water-resistant SPF, think skin disease and skin cancer. But while sunscreen fills the shelves at nearly every drugstore, reminding you to lather up or pay the price, what lies under your skin is much quieter. Your bones don’t tell you when they are about to burn (a.k.a. break), and the reminders to protect them are much subtler. However, if they are ignored, the burn can be just as severe as the strongest rays.

In the same way that you would protect your skin during the summer, you should protect what lies under your skin #yourbones all year round. Adequate calcium and vitamin D intake, coupled with a healthy diet, weight-bearing exercises, and estrogen during the reproductive years are the SPF that your bones need. In fact, this is the formula that makes up the SPF 70 sunscreen for your bones!

But while most of us know that milk (a.k.a. calcium and vitamin D) is “what does a body good,” you might be surprised to know that estrogen is equally as important. News flash: estrogen is not just a hormone made by your ovaries to keep your eggs developing. It is also necessary for bone buildup and bone strength. In fact, how much you take in during your adolescent and young adult years can dictate what happens in your later years. No estrogen in your younger years can cause some major breakage in your later years (think osteoporosis and osteopenia).

Bones reach their peak mass by about age 30. However, to reach the “summit,” they need estrogen during your teens and twenties. Therefore, women who are not on hormonal contraception and don’t get regular periods (a lack of periods because of continuous pill usage does not count!), is sort of standing out in the sun without sunscreen. When your bones don’t reach peak bone mass, there is nowhere for them to go but down later.

And as most of us know, the estrogen story does not end at age 30. Your bones continue to rely on their fountain of youth for years and years to come. Estrogen production is essential deep into our 40s and even 50s. Therefore, for women whose periods bid them adieu early it’s important to make sure that you speak to your GYN about hormonal replacement therapy.

While postmenopausal hormone therapy has gotten more bad press than both Democrats and Republicans making a decision combined, it’s actually not bad for most women. In fact, estrogen supplementation, started at the right time in the right woman, can be the key to reducing your chances for heart disease, bone disease, memory loss, and serious vaginal dryness. So, don’t listen to everything you hear on TV; this is one decision for which you should hear what your doctor has to say.

It’s really no different than sun damage. Burns sustained in your younger years make your skin way more susceptible in the later years. And while freckles and sun spots may be cute at age 15, they’re not so much at age 55. Additionally, they pose a risk for skin cancer at age 50. The same goes for how you treat your bones then and now. So, don’t forget to lather them in milk, vitamin D, calcium, and exercise: this SPF will save you big-time breakage in the future.

Step on a Crack and Break Your Mother’s Back?

While most of us can vividly remember playing this game as kids, aimlessly wandering up and down the sidewalk, we never really had any idea what this saying meant. It served as the impetus to jump over every crack, to yell at our friend whenever she landed on one, and to drive our mother crazy as it took us double the amount of time to walk down the street. Unfortunately, as we age, breaking our backs (medically speaking, our vertebrae), our hips, and our wrists becomes a reality. Osteoporosis, a bone disorder characterized by loss of bone mass, a decrease in bone quality, and a breaking down of the bone structure, affects 54 million people in this country; one in two women over the age of 50 will break a bone from osteoporosis. While you would want to play the lottery with those odds, you wouldn’t want to gamble with your life. And osteoporosis is a lot more than a cosmetic problem (broken bones, deformed spine, and hip braces). This disease not only has a significant impact on a woman’s quality of life but also her quantity of life. Approximately 3–6% of women will die in the first few weeks after being admitted to the hospital for a hip fracture and about 20% within the first year of after the fracture. Simply stated, fractures are no joke, and we should do all that we can to avoid them.

So osteoporosis is thin bones…Who gets thin bones and why? Are thin bones just a natural part of aging like grey hair and wrinkles? The answer is somewhat grey (no pun intended). While age is the most important determinant of bone quality, not all postmenopausal women will have osteoporosis. Genetics, race, and ethnicity are also key players. Caucasian women have the highest rates of osteoporosis, and African American women, the lowest. Other important risk factors include smoking, prolonged periods of no period (no period = no estrogen, no estrogen = no “water” for the bones), weight, excessive alcohol consumption, inactivity (a.k.a. couch potatoes!), poor nutrition, family history, and certain medications or medical conditions.

Another important piece to the bone jigsaw puzzle has been locked in for years and years. While it may be hard to believe, most of what will happen to our bones as adults is determined by how we lived as adolescents. During our late teens and 20s, we achieve what is called our peak bone mass. Our peak bone mass is mostly influenced by things like genetics and ethnicity (inherited factors). But even if the cards had you slotted for some good bone numbers, lifestyle, health, and environmental factors during your formation and oh-so-fun years can hinder what you can achieve (in the words of your parents…you aren’t living up to your potential!). This is why it is so important for young women to get that milk mustache, a good steady dose of estrogen, a good amount of exercise, and a good daily complement of vitamins.Even if you failed to live up to your bones’ expectations, any time you make a change is helpful: basically, better late than never.

Diagnosing osteoporosis is fairly simple, painless, and pretty quick. If done in women with some serious risk factors or at a specific age, it can be picked up years before really bad stuff and bad breaks happen. A DEXA (dual-energy X-ray absorptiometry) makes the call. A DEXA takes a picture of the lumbar spine and the hip and provides the necessary information to make the diagnosis of osteoporosis. Additional pictures are often taken of heel and wrist; these images are not as useful for making a diagnosis or for monitoring treatment (if you need it) but can provide helpful information about the extent of the underlying process. Through the DEXA, something called a bone mineral density score for each site is calculated. The numbers at each site are then compared to a young and healthy female to produce another number (ugh, math, math, and more math!). Once you get to the end of this very long equation, you can answer the question: do I have osteoporosis?

When your T score is ≤ -2.5 at ANY of the sites, you have got yourself a diagnosis.

If the T score is ≥ -1, you are in the clear.

For those between -1 and -2.5, you have what is called osteopenia.

Osteopenia is sort of like a yellow light. Your bones are slowing down, but they have yet to stop. This information can be incredibly powerful because lifestyle and medical changes can keep the road ahead clear. DEXA screening should begin no later than 65. However, for some women with any of the previously mentioned risk factors, screening should be initiated even earlier.Bottom line, this issue is fragile and needs to be handled with care! If your doctor doesn’t bring it up, you should!

We all knew milk was good for us, but who knew it was this good? Get that milk mustache ready, because a few glasses a day can help keep the cast away. Good lifestyle decisions such as calcium and vitamin D, exercise/activity, and healthy eating habits can all make a big difference. Currently the recommended daily dose for ALL women is:

1,000–1,300mg/day of calcium and 600–800 IU of vitamin D/day (specific dosing based on age). Postmenopausal woman (51–70) need 1,200 mg/day of calcium and 600 Vitamin D/day. Bottom line, milk really does do a body (and bones) good!

Lifestyle modifications and changes in your surrounding environment can also have a major impact on both on your getting osteoporosis and preventing fractures. Weight-bearing exercises (e.g., walking) and muscle-strengthening exercises can not only make you look good and feel good but also bulk up your bones (i.e., prevent osteoporosis and decrease the risk of fractures). And while we don’t want you to start moving your furniture around, it might not be a bad idea to call some friends over to help you. Modifying your living environment and adopting ways to prevent falls can reduce your risk of falls and subsequent fractures. Some other suggestions include installing better lighting (including nightlights), removing throw rugs and junk from the floor, moving cords/cables, storing items at your height (throw away the stepstool!), putting nonskid strips in the shower, and installing handrails on the steps. While we are not in the business of redecorating and love what you have done with the place, these changes can be very beneficial for your bone health.

Unfortunately, sometimes even our best efforts can’t stave off a disease. You can drink gallons of milk and eat cartons of yogurt and still get osteoporosis. But don’t get all sour; there are excellent medical treatments that can help rebuild your bone and stop future bone destruction. While many options exist, your doctor will tailor the appropriate medical treatments to your lifestyle, the extent of your disease, and your personal needs. Bisphosphonates (Fosamax) are often the first line (inhibit the cells that break down bone); while they have gotten some negative press lately, when taken under the guidance of an experienced physician, they are safe and often quite successful at keeping the damage at bay.

Just in case you were wondering where that saying, “step on a crack and break your mothers back” actually comes from (no, it has nothing to do with osteoporosis!), it is rooted in some serious old-school superstitions. It seems to have originated in the late 19th century when racism was rampant. The original verse was “step on a crack, and your mother’s baby will be black.” Pretty terrible stuff. Somehow, from that we got to the mid-20th century where the saying took some “alternative” paths. Some said that the number of cracks equaled the number of china dishes you would break, while others told children that the number of cracks equaled the number of bears around the corner waiting to eat them for lunch (that’s one way to parent!). While all beyond ridiculous, for some reason the saying has stuck. If for nothing else, use it to remember to be mindful of where you walk and to watch out for bumps in the road. Try to avoid cracks. Let’s face it; you don’t want to trip. Then you may really break some bones!