I'm in my 70s and all articles like this make me want to do is take a trip to Switzerland near my 80th birthday. At some point the game is not worth the candle.
I've heard that bone strength is helped more by silica than calcium. What do you have to say about that? And instead of laxatives, how about psyllium fiber?
Psyllium may be a good option for people who have an aversion to prunes. You can get it ground and put a teaspoon on your cereal every morning, like I do, or in your coffee or whatever.
Thank you for reading and commenting. I have not heard or read that about silica. Psyllium fiber has a similar mechanism to the prune juice I recommend although most people get better results with prune juice in my observation.
Drink two glasses of milk a day and have some yogurt or ice cream for dessert, and then walk a couple miles every day to work off the calories from the ice cream. It's not that hard.
Update 4/14/2025: After reading this article I told my wife about the 6 prune study. She started eating 6 per day. A few days ago she had her 1-year DEXA scan. Our PCP has been pushing for prescriptions to stop the bone loss, but we’ve resisted, in part because of the damage they did to my mother. The scan results came in today and it looks good. Numbers have improved, and the doctor sees no need for medication. No new scan needed for 3 years. Thanks so much for this article!
Hey! That's great news! I don't know how much credit we can give the prunes for the improvement because it's been only a short while, but they didn't hurt, for sure. I'm glad her bones are stronger and her hard work has paid off! Thank you for letting me know!
Thanks for this! I'm going to copy and paste it to my mum, who doesn't use Substack but is concerned about her bone density. She's 77, her bone scans have progressed from "excellent" to "normal for her age" which she really wasn't happy with! One of her friends has broken both hips and lives in a home now, she really doesn't want that. She still works (in a library, up to several days a week), volunteers at a food redistribution charity carrying heavy boxes of food, and spends about ten hours a week in the gym doing classes like Pump, Combat and Balance. She and I both follow a diet that excludes dairy, and I worry about that slightly for her because she doesn't eat the amounts of tofu I eat. We both eat oily fish and leafy greens and take vitamin D. I have MS and was prescribed 5000 IU daily for that (I had a blood test a few years into this and my vitamin D level was back in the healthy range). I run a lot (like I did a 50k ultra yesterday and the only reason I'm writing this today is I finally have time to sit down) and sometimes I fall, which is why I'm concerned with preserving my own bone density while I can. I'm just entering perimenopause so I feel now is the time! (In my 20s and 30s would have been better of course) My dentist tells me my teeth have good bone density but I haven't had a DEXA scan. Keeping my body in top shape is the best way I have of managing my chronic conditions (I also have hEDS).
Thank you for reading, commenting, and sharing with your mom. There are two articles, by the way: osteopenia and osteoporosis. I agree; a broken hip can degrade the quality of one's life tremendously. Your mom is wise to do what she can to avoid it. Your mom has all that weight bearing exercise on her side!
I'm impressed--a 50K is a long distance! It sounds like you are doing what you can to help yourself!
There are no longer recommendations for post-menopausal women to take calcium supplements because of lack of benefit in studies. US Preventive Services Task Force gives it a D, risks>benefits. Cochrane review found no benefit. Vitamin D data is still inconclusive but seems to lean toward some benefit in osteoporosis. Best strategy is a lifetime of weight bearing exercise.
You don’t need to. But thank you for updating. There are an increasing number of studies suggesting that ca supplementation post menopausal might increase risk for calcified coranary and carotid arteries. I have stopped recommending calcium supplement to any women over 30, unless they are deficient for any reason.
Thanks for al this. My PT shared great research article you may want to wade through. One big takeaway supported by evidence- sessions of standing on one leg (being careful to do it where you can touch a wall or surface in support for balance ) will increase bone density in “femoral neck” where leg bone comes into pelvis (if I have that right) I do this while brushing my teeth or watching TV to make it routine. Here is full article. Certain yoga exercises (bridge pose for example) support spinal density. My lower back showed improvement of 14% over 2 years last in my last dexascan. I am 70, dx osteopenia.
Great synopsis. Many of my patients will ask about hip versus spine. I explained that hip can be more debilitating, even deadly, spine often can cause prolonged pain. And currently medication may not be as efficacious for hip. Would you concur?
Thank you for this information. I like your clear writing and "doctoring" style, such as this (and for the record, I think readers do best with the presentation of a framework/scaffold first too, before they get all the details):
I think patients do better if they have a scaffolding to attach all the details I need to tell them. It’s almost always best to start by reminding them why they care about the thing we’re going to talk about and then giving them the medical explanation of what normal is, and what has gone wrong for them at whatever level I think the patient can understand given their attention span, level of pain, curiosity, etc.
Fantastic article, thank you. Please have a look at a Canadian product called AlgaeCal, I’ve had remarkable results following an osteo diagnosis 3 years ago.
My grandmother was born in Poland and until she came to America at age 12, she said she existed mostly on bread and what she called sour cream, though it was probably closer to yogurt. I’m sure she ate other things too, but she remained a milk drinker her whole life. When she was 85, she fell down a flight of concrete steps at the community center and broke nothing. EMTs checked her out, but she was fine. She did lose a couple of inches as she got older, so I’m sure her bones weren’t perfect, but a lifetime of milk made a big difference for her.
I'm in my 70s and all articles like this make me want to do is take a trip to Switzerland near my 80th birthday. At some point the game is not worth the candle.
I've heard that bone strength is helped more by silica than calcium. What do you have to say about that? And instead of laxatives, how about psyllium fiber?
Psyllium may be a good option for people who have an aversion to prunes. You can get it ground and put a teaspoon on your cereal every morning, like I do, or in your coffee or whatever.
Thank you for reading and commenting. I have not heard or read that about silica. Psyllium fiber has a similar mechanism to the prune juice I recommend although most people get better results with prune juice in my observation.
Drink two glasses of milk a day and have some yogurt or ice cream for dessert, and then walk a couple miles every day to work off the calories from the ice cream. It's not that hard.
That's the idea!
Update 4/14/2025: After reading this article I told my wife about the 6 prune study. She started eating 6 per day. A few days ago she had her 1-year DEXA scan. Our PCP has been pushing for prescriptions to stop the bone loss, but we’ve resisted, in part because of the damage they did to my mother. The scan results came in today and it looks good. Numbers have improved, and the doctor sees no need for medication. No new scan needed for 3 years. Thanks so much for this article!
Hey! That's great news! I don't know how much credit we can give the prunes for the improvement because it's been only a short while, but they didn't hurt, for sure. I'm glad her bones are stronger and her hard work has paid off! Thank you for letting me know!
Thanks for this! I'm going to copy and paste it to my mum, who doesn't use Substack but is concerned about her bone density. She's 77, her bone scans have progressed from "excellent" to "normal for her age" which she really wasn't happy with! One of her friends has broken both hips and lives in a home now, she really doesn't want that. She still works (in a library, up to several days a week), volunteers at a food redistribution charity carrying heavy boxes of food, and spends about ten hours a week in the gym doing classes like Pump, Combat and Balance. She and I both follow a diet that excludes dairy, and I worry about that slightly for her because she doesn't eat the amounts of tofu I eat. We both eat oily fish and leafy greens and take vitamin D. I have MS and was prescribed 5000 IU daily for that (I had a blood test a few years into this and my vitamin D level was back in the healthy range). I run a lot (like I did a 50k ultra yesterday and the only reason I'm writing this today is I finally have time to sit down) and sometimes I fall, which is why I'm concerned with preserving my own bone density while I can. I'm just entering perimenopause so I feel now is the time! (In my 20s and 30s would have been better of course) My dentist tells me my teeth have good bone density but I haven't had a DEXA scan. Keeping my body in top shape is the best way I have of managing my chronic conditions (I also have hEDS).
Thank you for reading, commenting, and sharing with your mom. There are two articles, by the way: osteopenia and osteoporosis. I agree; a broken hip can degrade the quality of one's life tremendously. Your mom is wise to do what she can to avoid it. Your mom has all that weight bearing exercise on her side!
I'm impressed--a 50K is a long distance! It sounds like you are doing what you can to help yourself!
Re constipation - wouldn't a calcium with magnesium supplement help?
Yes, probably it would.
There are no longer recommendations for post-menopausal women to take calcium supplements because of lack of benefit in studies. US Preventive Services Task Force gives it a D, risks>benefits. Cochrane review found no benefit. Vitamin D data is still inconclusive but seems to lean toward some benefit in osteoporosis. Best strategy is a lifetime of weight bearing exercise.
Actually, thought about it more and decided to do an update now. Do you want me to mention that you brought it to my attention?
You don’t need to. But thank you for updating. There are an increasing number of studies suggesting that ca supplementation post menopausal might increase risk for calcified coranary and carotid arteries. I have stopped recommending calcium supplement to any women over 30, unless they are deficient for any reason.
Thank you. The USPSTF recommendation is draft, but I am going to need to do a big update to this article when they're done.
This has been an eye opener. Thank you.
You are welcome! I love hearing this kind of feedback. It’s why I write.
I'm so grateful you shared this. Especially, the insurance information and the exercise options.
You are welcome. Thank you for commenting and telling me what was helpful.
.
Thanks for al this. My PT shared great research article you may want to wade through. One big takeaway supported by evidence- sessions of standing on one leg (being careful to do it where you can touch a wall or surface in support for balance ) will increase bone density in “femoral neck” where leg bone comes into pelvis (if I have that right) I do this while brushing my teeth or watching TV to make it routine. Here is full article. Certain yoga exercises (bridge pose for example) support spinal density. My lower back showed improvement of 14% over 2 years last in my last dexascan. I am 70, dx osteopenia.
https://journals.lww.com/jgpt/Fulltext/2022/04000/Physical_Therapist_Management_of_Patients_With.9.aspx
Thank you! I am excited to have things that people can do for themselves that make a difference so I'll wade right in!
Great synopsis. Many of my patients will ask about hip versus spine. I explained that hip can be more debilitating, even deadly, spine often can cause prolonged pain. And currently medication may not be as efficacious for hip. Would you concur?
Thank you. I would, although I do not know the details of the non-bisphosphonates at all.
This was so scary to read
It is. Osteoporosis can really be miserable.
Thank you for this information. I like your clear writing and "doctoring" style, such as this (and for the record, I think readers do best with the presentation of a framework/scaffold first too, before they get all the details):
I think patients do better if they have a scaffolding to attach all the details I need to tell them. It’s almost always best to start by reminding them why they care about the thing we’re going to talk about and then giving them the medical explanation of what normal is, and what has gone wrong for them at whatever level I think the patient can understand given their attention span, level of pain, curiosity, etc.
Thank you! Glad you found it useful.
Fantastic article, thank you. Please have a look at a Canadian product called AlgaeCal, I’ve had remarkable results following an osteo diagnosis 3 years ago.
Thank you. Someone else recommended that in the comments, too. I will check it out.
My grandmother was born in Poland and until she came to America at age 12, she said she existed mostly on bread and what she called sour cream, though it was probably closer to yogurt. I’m sure she ate other things too, but she remained a milk drinker her whole life. When she was 85, she fell down a flight of concrete steps at the community center and broke nothing. EMTs checked her out, but she was fine. She did lose a couple of inches as she got older, so I’m sure her bones weren’t perfect, but a lifetime of milk made a big difference for her.