Introduction

Prevention is an important focus for every body system, and the health of the skeleton is no exception. The vertebral bodies, the femur, and other bones must handle a tremendous amount of force throughout a person’s lifetime.  Healthy bone requires a precise balance between bone formation (by osteoblasts) and bone absorption (by osteoclasts).

Around age 30, bone density peaks.  After that, for most people, it steadily decreases with age. It is vital to pay attention to bone health throughout the life cycle, especially before diagnoses such as osteopenia or osteoporosis are made.  Future bone density is influenced by whether or not a person’s mother had healthy calcium and vitamin D levels, and whether or not the person was breast fed.¹  It is vital that children and adolescents maintain healthy calcium and vitamin D levels to optimize their peak bone density.  The first few years of menopause are a period of especially significant bone loss as estrogen levels drop and there is less osteoclast inhibition.  

Why does bone health matter?  The main concern is fracture risk, which increases when bone density and overall bone quality are low. There are 1.5 million osteoporosis-related fractures in the U.S. yearly, and 300,000 of them are hip fractures due to a fall.  These are not only costly financially but also detrimental to quality of life.  Five to 20% of people with hip fractures die within one year, and 60% who have fractures will need assistance with their daily activities for the rest of their lives.^2-3 For more information, see the Washington University School of Medicine handout at Bone and Mineral Diseases: Facts About Osteoporosis (or enter this URL into your browser http://wuphysicians.wustl.edu/dept.aspx?pageID=4&ID=43).

Bone density, because it can be easily measured and because it responds well to drug treatments, understandably receives a great deal of attention when bone health is discussed.    However, it is not the only determinant of a healthy skeleton.  Even at ½ bone density, the human spine should be able to maintain five times the amount of weight it normally has to carry.  Why then, do so many people get spine fractures?  Fracture risk seems to be related not only to bone quantity but also to bone quality. 

This handout is designed to provide an evidence-based approach to maintaining bone health throughout the life cycle, with attention given to bone density as well as to other factors that are tied to bone health.