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Build up bone density to better deal with old age

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Health Advisor is a regular column where contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Follow us @Globe_Health.

If you want to save for retirement, start early. Heard that one before? By starting early, it goes, your investments will grow through the years. When you stop working, you will be able to enjoy the benefits of your hard work. It works the same way for your bone mass.

The risks of developing osteoporosis depend on two factors: Peak bone mass at maturity (i.e., how big is your nest egg when you stop working) and rate of loss in the following years (how you spend it).

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According to the Osteoporosis Association of Canada, one in four women over the age of 50 is affected by osteoporosis. This is not a women-only problem. Men also lose bone mass as they age. But the drop is more pronounced in postmenopausal women. Estrogen has a protective effect on bone mass.

So how do you know if your bones are strong? Most doctors will routinely send you for a bone mineral density (BMD) scan. The scan will usually be of the hips and lower spine. This test will give you a T-score. A score of 0 is normal BMD. Greater than 0 means your bones are stronger than average. A score of -1 indicates you are at the osteopenia stage, with some bone-mass loss, and an increased risk of fracture. And a score of -2.5 indicates you have significant loss of BMD, and are at a greater risk of fracture.

Bone loss can be prevented/slowed down by modifying certain lifestyle factors. You can increase your vitamin D and calcium intake. Also, smoking cessation and reduced alcohol intake will help. A very important one is physical activity. A bulletin published by the World Health Organization in 2003 summed it up this way:

"Physical activity is vital for maintaining healthy bones throughout life and is an important factor in preventing osteoporosis, reducing falls and decreasing the risk of hip fractures. The alarming increase in prevalence of osteoporosis apparently expresses a pressing need for a more active lifestyle among people of all ages."

Not all exercises are equal. A leisure walk is good for your overall health. It may improve your balance and prevent falls. But when it comes to improving bone mass, high impact exercises and resistance training is the way to go. A review article published in Sports Medicine looked at all the recent research on exercise and bone mass. They concluded that high-impact activities, especially before puberty, help bone-mass accumulation. But what can you do if puberty is in your distant past?

Resistance/strength training was found very effective at slowing or stopping bone loss. In some cases it may reverse it. So the sooner you start, the better it is. I know most women shy away from strength training. But there's a correlation between strength and BMD. On top of it, strong muscles will better protect your joints.

You don't have to work at it as if it was a part time job. Strength training one to two times per week for 15 to 20 minutes can be enough. Focus on exercises that work a lot of muscles and aim for two sets of 12-20 repetitions. When 20 gets easy, increase the weight. Your workout could be as simple as one pushing exercise (chest press or shoulder press), one pulling (rowing, chin up, pulldown) and one for legs (squats or lunges). Small, gradual and consistent increases will yield big results.

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Your bone savings account may not look as you expected. But by controlling your spending, it may carry you a long way. Keep on saving and spend wisely.

Gilles Beaudin is a registered clinical exercise physiologist at Cleveland Clinic Canada.

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