Podcast: How Can I Build Stronger Bones?

Dr. Erica Eldon: Weight bearing exercise is important. The body is gonna respond to stress. So if you’re increasing force through the bones, your body gets these signals like, okay, I need to strengthen these specific bones. I need to increase the calcium. I need to increase the density of this bone to resist this amount of stress.

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from New York Presbyterian. I’m Courtney Allison.

We all know that weight training helps build muscle, but did you know that it can also build bone?

This week we talked with Dr. Erica Eldon, a physiatrist with Och Spine at NewYork-Presbyterian and Columbia. Dr. Eldon explained bone health and how it’s key to helping us stay active and mobile.  We discuss the ways that lifestyle choices, like how we eat and how we exercise, impact bone density. We also spoke about some surprising bone injuries that can occur, why people lose height as we age, and how to maintain spine health throughout our lives.

Courtney: Dr. Eldon. Thank you so much for joining us today.

Dr. Erica Eldon: Thank you for having me.

Courtney:  So today we want to talk about bone health. Let’s start with some of the basics. What are healthy bones to you?

Dr. Erica Eldon: So I view bone health as how strong are our bones. It’s actually quite interesting because we reach our maximum bone density in our twenties. And then as we age, we gradually lose bone density. Density is like the strength of our bones, our bone mass.

We get concerned when you start losing bone mass. So a lot of people will have heard the words osteopenia or osteoporosis. Osteopenia is considered a lower bone density, and then osteoporosis is fragile bones where you have an increased risk of fracture. And we monitor this using a bone scan. You lay in a scanner, they use x-rays to scan all your bones and then it measures the density of your bones.

And based on that density, they assign you a score. And where you fall within specific ranges basically tells your doctor what is your risk of a fracture. And this isn’t a car accident trauma fracture. This is a fracture because the bones are brittle from things that normally wouldn’t cause a fracture.

Courtney: Right.

Dr. Erica Eldon: Common spine fractures can happen if you bend forward and twist, or if you lift something heavy. That can cause a fracture in the spine. Right. So like bending forward and you break a bone in your back. That type of thing can lead to painful fractures and it’s based on bone density.

Courtney: And can you talk a little about how bones form and how they break down or start to lose density?

Dr. Erica Eldon: Yeah. So as we’re aging, we’re building bone. And then once we reach our peak bone density, throughout our life, we’re continually building bone, remodeling bone, and breaking down bone. Our diet, our hormones, all of this influences how our body responds and whether it’s breaking down more bone or reinforcing that bone. And as we age, we can modify how our bone remodels itself by stimulating bone strength and making it so that our body strengthens the bone more than it breaks down the bone.

Courtney: Could you just elaborate on what else it takes for our body to make bone and what parts of our body’s systems are involved in building bone?

Dr. Erica Eldon: Yeah, so our body uses vitamin D to help with the absorption of calcium. And then our hormones play a part in regulating the amount of calcium in our bones and how much is broken down versus built up in our bones and our kidneys affect that as well.

There’s different enzymes in our body, different cells that are constantly remodeling our bones and so when I visualize it, I visualize it kind of like a construction zone, right? They’re all doing work and all of the work is good work. ‘Cause sometimes you might need more calcium in other parts of your body for other critical functions.

So some chronic illnesses like chronic kidney disease can cause your body to break down more bone. Also, things like smoking, heavy alcohol use, all of those can increase breakdown of your bone and lower your bone density.

On the flip side though, you know, there are things that we can do to increase our bone density: eating calcium rich foods like dairy, leafy greens or fortified foods. Making sure that you have enough vitamin D and calcium in your body with supplementation or getting good sunlight. All of that is important. So those are things that we can control within our diet and our activities, to try and strengthen our bones.

Courtney:  I read a statistic that osteoporosis affects one in four women age 65 or older. So I’m wondering what bone injuries are you most concerned about for people, particularly women?

Dr. Erica Eldon: So the thing that I see the most would be a vertebral compression fracture. The bones in our spine are called vertebrae. And they don’t break the way that you would imagine a fracture of the arm or the leg to happen. The bones in the arm and the leg are long bones, so if they break, usually it’s like snapping a stick.

In our spine, the bones are like bricks stacked on top of each other. They have a honeycomb structure inside. So if that honeycomb structure starts getting weaker, starts getting brittle and thinner, starts getting holes in that honeycomb, imagine pressing down on a honeycomb and it can kind of collapse in on itself.

So it’s not like the bone breaks in half or snaps, it compresses down on itself. So it’s still holding weight. It’s still functional in your spine, but now it’s lost its height. And you can have that and live your life, and you might not even know that it happened.

So everything is attached to the spine. Our spine holds us up, our muscles attach to our spine, our organs are enclosed by our bones, and including our spine. So if we start to have low bone density in the back and if we get a vertebral compression fracture, we start to lean forward. It starts to affect our balance. It starts to affect our ability to do things in our daily life. Get around to the grocery store, clean our house, and it can affect your quality of life.

And so trying to prevent vertebral compression fractures for me in my specialty is usually the biggest thing. And sometimes I don’t get patients until they’ve already experienced one or two. And so then we’re focusing on preventing more and maintaining the independence that they still have.

Courtney: Are there some specific postural things that you often have to address with patients? As I’m asking this question, I feel myself standing up a little straighter.

Dr. Erica Eldon: Yes, I’m sure we’ve all seen as we get older, you start to lose height. You start to crouch forward, and before you know it, you’re looking at the ground as you’re walking down the street.

And, and part of that is natural. In between each bone we have a disc and that disc has kinda like a jelly inside, and that gives us our cushion between the bones when we move around. And as we get older, that cushion loses its height. That disc loses its height, and so even if it’s just a few millimeters at each disc throughout our entire spine, that adds up. And so we get shorter as we get older.

In addition to that, we also start to have some of these fractures start to happen and they might be very, very mild at first, you know. And so, they tend to happen more on the front of the bone than on the back of the bone. So if you’re having decreased bone height in the front, you start to lean forward. Strengthening the muscles of the back, our postural muscles.

We all feel those muscles on either side of our spine bones. They’re called paraspinal muscles. I like to visualize them like railroad tracks running up and down the spine all the way from our hips all the way up to our neck, and they’re working to hold us upright. And if those bones or if those muscles get weak, you know, we start to go forward more and more.

And so sitting in a chair for long periods of time, leaning forward, you know, looking down at a desk for long periods of time, looking down at a book for long periods of time, you can get stuck in that position. You need to look up, pull your shoulder blades together, back behind you. All of these things will start to pull you upright, and so stretching the muscles in the front and strengthening the muscles in the back is very important, and a physical therapist can help with that if you’re unsure if you’re doing it correctly.

Courtney:  Do you have any favorite ways you’d recommend people train and strengthen those muscles?

Dr. Erica Eldon: So if you’re still working or if you’re doing activities that you notice put you in those positions for long periods of time, right? The arms in front of you, the head down, crouching forward. I would recommend setting a timer like every hour. And just five minutes. Get up. Move around, do some stretches at home, pull those shoulders backwards, like you’re trying to pinch a credit card behind the shoulder blades, you know, some gentle neck range of motion exercises.

And if you do that throughout the day, then you’re less likely to get stuck in that forward position. And then if you can do actual exercises like repetitions, setting aside 30 minutes, three to five days a week to do some exercises, to strengthen those postural muscles can be very, very important.

And it takes consistency, you know, and our environment isn’t designed for us to strengthen the back muscles. Everything is in front of us and we’re, you know, we’re very conditioned to this forward flexed, head forward looking down, tech-neck-type body position, and you kind of have to fight that intentionally by activity modifications, setting up your environment to support, you know, good posture and then those reminders throughout the day.

Courtney: Well, on that note, to get into the practical side of things, what can we do to maintain bone health over time, and especially as we get older?

Dr. Erica Eldon: So first, talk with your primary care doctor. Make sure that you’re being evaluated for any chronic illnesses. Look at your medications, see if there’s anything that could, you know, weaken your bones. And as long as your primary care doctor is making sure that you have a good, healthy diet, you’re supplementing as needed, the things that you can do at home really include things to strengthen the bones.

So weight bearing exercise is important. And then you can even add in some strength training. So I usually recommend to my patients to start with resistance bands, increase a little bit of resistance, and if they feel comfortable with that and they’re building up muscle mass and they’re getting stronger, then sometimes even adding in lightweights.

So this is better than just walking alone, right? Walking alone is good for cardiovascular endurance. It is a weight-based exercise, but you know, to increase bone strength, you can start adding in those additional elements. Getting into a routine and maintaining that routine is the best thing you can do. But if you haven’t, that’s okay. You can always start. I usually recommend starting off at about three days a week and then gradually increasing. If you can do, you know, weight-based or resistance-based exercise, you know, four or five, six days a week, that’s better.

Courtney: What is it about weight bearing exercises or strength training that helps our bones versus something like walking or other exercises?

Dr. Erica Eldon: The body is gonna respond to stress. So if you’re increasing force through the bones, your body gets these signals like, okay, I need to strengthen these specific bones. I need to increase the calcium. I need to increase the density of this bone to resist this amount of stress.

So if you do just walking for your exercise around your home or around the community, unfortunately, your body’s only going to strengthen the bones enough to resist gravity, not anything additional. So then if you lift something heavy or if you fall and there’s increased force through those bones you’re at risk of a bone fracture.

Courtney: Okay. I have these little three pound weights near me. Maybe after this I will do a few. That’s very motivating.

Dr. Eldon, thank you so much for joining us to talk about bone health. I feel like I learned so much.

Dr. Erica Eldon: Yes, thank you for having me.

Courtney: Our many thanks to Dr. Erica Eldon. I’m Courtney Allison.

Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Eldon’s work with patients check out the show notes.

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