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Young Bones at Risk

We usually only begin to talk about at risk bones in later years of life. In these recessionary times where every penny of the tax take counts, Bone Health is a public health issue that concerns us all. Broken bones in later years are a huge cost to our health service and place medial, social and financial strain not just on the older person with the fracture but on their family also. Thus, any measure we can take today to ward off problems in the future is worthwhile.

The key to preventing osteoporosis, or fragile bones, usually associated with old age, starts at puberty. In fact today’s adults can do much to ensure the bone health of those who will reach middle age 30 years from now, so if you are reading this as a parent of teenagers or young adults, or if you are a young person are aged 12 – 30 now, read on!

Bone, as a living tissue grows throughout life. The skeleton grows in height in two main growth spurts in early childhood and again around puberty. Having achieved maximal height it continues to strengthen throughout the twenties, reaching peak bone mass around the age of 30. The stronger the skeleton at 30, the more protection you will have in later years against natural bone ageing.

Achieving peak bone mass is dependant on many factors: genetic, lifestyle and diet.

Having healthy bones in the first instance is luck or genetics, predestined from birth. 60-80% of bone density derives from our genetic make-up. This is where parents come in. If the parent is aware of older family members who have broken their wrist or hip or lost height in later years, positive choices need to be taken to beef up the bone structure of potentially at risk young family members.

For example, exercise is a great lifestyle choice in the prevention of osteoporosis in later years. Muscular activity causes bone loading which is essential for strengthening bone. Exercise such as playing sports, running around, climbing in a local playground, all load muscles. Bones get stronger in response to muscle loading.

Thus couch potato kids or computer mad teenagers, who abhor P.E. and don’t participate in any sport will not build up as strong dense bone as those who exercise. So as parents, promoting healthy physical activity, particularly with a family history of osteoporosis is vital.

Conversely, parents also need to watch for excessive exercise. Poor body image or the desire to get very slim can lead to girls particularly becoming fanatical about daily exercise and self limiting calorie intake. High powered aerobic classes, spinning classes, group jogging several nights a week, tag rugby, etc, are each valuable for loading muscles and pulling on the bone, but if taken to excess may begin to leech calcium out of bone.

Every cell in the body requires calcium for ordinary cell activity. Excessive physical activity demands lots of calcium for cell renewal, which if not present in everyday diet, is sought from calcium stores squirreled away in bone, lessening these deep stores for later years.

In fact the bones of top female athletes are at risk for exactly that reason. Many of them train so hard, and over monitor their calories intake to stay light weight, that their bodies stop menstruating. Over exercising or under eating also reduces blood oestrogen levels, a common side effect of which is frequent or recurrent injury, from simple muscle strain, right up to unforced bone fractures, known as stress fractures. Teenagers and young females who reduce oestrogen levels do not achieve good peak bone mass and are thus at greater risk of osteoporosis in later years.

Thus, both ends of the exercise spectrum are at risk: the over exercisers, who probably look slim, trim and brim full of energy, and the never-be-seen-dead exercisers, who may be overweight and sedentary.

Exposure to sunlight is also important in building healthy bones. Vitamin D is essential for the absorption of calcium and protein into bone. Vitamin D is entirely sunshine based, so encouraging kids to play in the sun is really healthy for their bone growth (not that many Irish children have seen much sun here at home for some two summers now). In modern times where we have taken on board the message of preventing skin cancer by wearing sun block, it is important to remember that once the sun block is applied, the sun’s rays are prevented from reaching the skin surface. Though strong sunshine carries other risk factors, weaker sunshine is healthy and good and to be encouraged for healthy bones.

Finally diet. Dietary requirements to create strong dense bones include intake of sufficient proteins and calcium and Vitamin D. Children who are faddy eaters or who get most of their daily calories from carbohydrate foods rather than protein, fruit and vegetables are at risk of not getting enough protein and calcium to develop maximal bone strength, as are the small number of teenagers who choose to become vegetarian.

Family history, exercise patterns, dietary intake and exposure to sunlight are each important in building healthy bones. Children who eat normally, are neither too skinny nor chubby, play sport and love being outdoors are those who will develop stronger bones.

As another school year starts, this is a great time to encourage healthy lifestyle choices, choices which will pay off decades from now.
Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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