It's not if, it's when...

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Ok I’m probably being a bit dramatic here, but what I’m about to talk about has happened to a handful of friends over the last six months (the most recent being a few weeks ago), so I feel compelled to raise it… again.
 
What am I referring to?  Falling and breaking bones.
 
I actually started reframing my thinking a year ago, after tripping (for the umpteenth time) on the sidewalk. Rather than working towards preventing a fall, I realized I also needed to prepare for a fall… that it was just a matter of time before I actually fell hard, given my propensity for tripping.
 
Perhaps a little fatalistic, but I also think pretty realistic. We can’t be complacent and think it’s not going to happen to us.  We can always hope it doesn’t happen to us, but sh*t happens – and sometimes in the most ridiculous ways.
 
What to do?  Think bones and balance.  Yes, I’ve touched on both of these in previous blogs, but given the importance of this subject of falling, I feel a recap is in order.

Bones
I want to start with bones. This is one area where preparation for a fall comes into play.  As in, how can we help minimize the damage WHEN we fall? 
 
I’ve talked in the past about osteoporosis and the frightening statistics when it comes to falls and mortality risk, so I won’t go into that again. Just know that the stats aren’t pretty. 
 
We all know that as we age, our bone density decreases.  It starts around our early 30’s, but speeds up during perimenopause and menopause, when estrogen decreases dramatically (estrogen plays a key role in bone health). 
 
Muscle mass also decreases as we age – another critical player in bone health. 
 
What steps to take?
There are key things we can do to halt or slow down the progression of bone loss.  And a note to all of the younger generation reading this – this absolutely applies to you as well. The sooner you start, the better (although it's never too late).
 
Resistance training
This is key. In short, when we load our muscles, it strengthens our bones.  Bone mass increases in the presence of stress.  

  • Start small – if you don’t have weights, use cans of food to do arm raises and squats. 

  • Think about working with a trainer – even just to get you started, and then do your own thing.  Good guidance at the beginning helps prevent injuries.

  • Climb stairs / walk up a hill – this builds muscle in your quads, your glutes, your hamstrings.  Bonus – it’s also great for your heart and cardiovascular health.  Note that even the walking back down part helps.

The role of estrogen
The signalling process to deposit more bone tissue when putting our body through physical stress (climbing stairs, lifting something heavy) is heavily regulated by estrogen. In the absence of estrogen, the signal gets reduced – hence why menopause can have such a devastating impact on women’s bone mineral density. 
 
I’m not advocating nor dismissing MHT (Menopause Hormone Therapy) – rather communicating that some medical professionals feel that bone health should be a consideration for women as they consider whether or not MHT makes sense for them.  I will say that I regret not knowing this when I was going through menopause, as I would have absolutely considered this option. 
 
Nutrition (and supplements) 
Think calcium, protein, vitamin D and magnesium. 
 
Calcium
The jury is out on how much calcium we really need (many say that our 1200mg/day requirements in North American is inflated).  Regardless:

  • Our bones need calcium

  • It doesn't have to come from dairy

  • It's best to get from food (vs supplements)


Great vegetable sources are green leafy vegetables, especially collard greens, spinach, Chinese cabbage and bok choy.  White beans are also high in calcium, followed by other beans such as chick peas, black and navy beans. Figs, almonds and canned salmon/sardines are also great sources.

If you do feel the need to supplement, don't take more than 500mg at a time, and look for supplements that have a bone formula, vs taking straight calcium. 
 
Protein
Getting enough protein seems to be on all women’s minds lately - and that's a good thing. It gives our bones strength and flexibility, and provides nutrients to help build and repair bones. 
 
Ensure you get protein at every meal - our body needs the amino acids that make up protein “on demand” but can’t store it.  It always needs to be circulating.  Aim for 25-30g per meal. 
 
Vitamin D
We know that Vitamin D3 is essential for the absorption of calcium into our bones. We also know how challenging it is to get from food and/or sun.  Hence supplementation is often recommended.  On average, 1000 iu’s daily seems to be the suggested minimum amount, but as with much nutritional scientific research, it’s a moving target. 
 
Magnesium
Bone health is a team effort of nutrients, and magnesium rounds out the vitamin D and calcium requirements when it comes to their interdependence on each other.
 
Ideally we want to get magnesium from food.  Whole foods provide us with all the right interactions of micronutrients, as well as the amounts we need, should we have a balanced approach to our food consumption.  Here is a list of “Top 10” magnesium filled foods.
 
When should I have a Bone Mineral Density Test
I know doctors won’t be happy with me saying this, but I recommend pushing to have this done as early as your doctor will allow you. Right now in Canada, the age to have a bone mineral density scan is 65 years or older, unless you have had a fragility fracture, parental history of osteoporosis, high alcohol intake and/or these other risk factors.  Having this information earlier can absolutely help us as we age.
 
As an aside - I asked to have a scan done at 58 years old, but was told that I didn’t need one given I was very active and had a healthy diet. I pushed to have it done, which I eventually did, only to find out I had osteopenia (pre-osteoporosis) in one hip.  Ever since then I’ve been super focused on strengthening my bones, to at least try and slow down the potential onset of osteoporosis. 

Balance
I’ve talked about balance before (and loved the many responses to the “blind” balance test of seeing how long you could stand on one foot with your eyes closed!).  On that note, how many of you are still practicing?  This is not a one-off thing – we need to make balance a priority. 
 
Think about standing on one foot while brushing your teeth – one minute one foot, a minute the other foot.  When that’s easy, do it with your eyes closed. Or, on one leg, try using your opposite hand to brush your teeth to get some brain activation happening, while balancing (with eyes open please!).
 
One of the best exercises?  Single leg dead lifts – no need for weight and you can do it anytime.  Plus you can do it in about two minutes.  Not only is this an amazing balance/stability exercise, it’s also great for your glutes, your hamstrings, ankle strength and your core.  All of these are essential for preventing a fall. 
 
Here’s a link to some more balance “tests” you also might enjoy… I confess some were quite hard for me (aka I could not do them for the allotted time).  Obviously I have some work to do!  Note that in the same link, the balance tests are followed by some good exercises to help you improve you balance. 
 
Summary
Net net – falling is inevitable. Not for all of us, but for many. Let’s do everything we can to not only prepare ourselves, but to also ensure we have mobility for as long as possible. We are all living longer… let’s make the most of it.
 
Thanks for reading :)
 
Gillian x