6 Things We Learned About Building Bones That Last

Highlights from YVO's Built to Last webinar with Dr. Jocelyn Wittstein, MD, and Jenny Han, PharmD

Two months after her first baby arrived, Jenny Han was gently bouncing her newborn on a yoga ball when she slipped off and fractured her spine. Bones should easily handle a fall like this if they're healthy, but when they don't, doctors call it a fragility fracture.

Weeks of tests and specialist visits followed, and Jenny was eventually diagnosed with pregnancy and lactation osteoporosis, a rare condition that speeds up bone loss in late pregnancy and the months after birth. She was a pharmacist in her late 20s, so she was taken by complete surprise at the news.

She remembers asking herself: "I've been practicing in healthcare as a pharmacist, but why have I not paid attention to my own bone health?"

This kind of question is the reason we created Built to Last, the first webinar in our new YVO series of honest conversations about bone health. Jenny went on to co-found Seen Nutrition, which makes calcium chews from real food. She joined Dr. Jocelyn Wittstein, MD, a board-certified orthopedic surgeon, associate professor of orthopedic surgery at Duke University School of Medicine, former gymnast, and co-author of The Complete Bone and Joint Health Plan.

You can watch the full replay on YouTube. Here are the six lessons we're carrying forward.

1. Start Paying Attention Long Before Menopause

About 90% of your bone mass is already built by the end of your teen years, with a bit more being added on into your mid 20s, Dr. Wittstein explained. After that, the major job is holding on to the bone you've already built.

Women have a stretch of years where holding on to bone gets harder due to declining estrogen. Right before and during menopause, falling estrogen levels speed up the rate of bone loss, and research says women can lose about 5-8% of their bone density during these years.

Because of this, Dr. Wittstein recommends getting a baseline DEXA scan around the menopause transition. The scan measures your bone density so you get a picture of where you stand while you still have plenty of time to do something about it. Knowing more about your bone health can also help you make decisions around things like hormone therapy.

Even earlier screenings are ideal for a lot of women, especially if they have certain risk factors such as long term steroid medication use, conditions that affect nutrient absorption, a history of under-fueling as a young athlete, early or surgical menopause, and rare conditions like the one Dr. Han experienced. If you think you're at risk of any of these, an earlier scan could be worth seeking out.

To help with that, every Warrior Vest comes with a free DEXA scan through BodySpec, so you can get your baseline without worrying about a referral or a long wait.

2. Rethink What "Reversible" Really Means

Social media likes to portray osteoporosis as being reversible, and the experts agree that does make for a great headline, but there's more to the story.

Dr. Han considers osteoporosis to be like any other chronic condition. You can absolutely improve your bone density, but improvement doesn't erase the diagnosis or the need to keep treating it. "We have to think about osteoporosis as a lifelong journey in which you have to make habits, nutritionally and with exercise, that you can maintain forever," she said.

Dr. Wittstein added that bone density naturally declines over time, so even just slowing the loss is a huge win, even if your numbers barely move. DEXA reports include a T-score, which compares your bone density to that of a healthy young adult.

A score between -1 and -2.5 means osteopenia, or lower than ideal density, and -2.5 or below means you have osteoporosis. Dr. Wittstein counts it as a big positive if your good habits help you stay in the osteopenia range year after year instead of progressing and losing more bone, even if you technically still have the condition.

3. Load Your Bones From Two Directions

When you challenge your bone with force, the cells inside sense the strain and respond by building. You can use two types of bone building exercise, according to the experts: top down and bottom up.

From the top down, resistance exercises send weight through your spine and hips. Dr. Wittstein's example exercises for top down resistance include overhead presses, back squats, deadlifts, and farmer's carries (where you walk holding a weight in each hand). Loading up with a weighted vest counts, too.

From the bottom up, impact sends force through your bones from the ground. Squat jumps with a rebound, small drop jumps from a low step, or heel drops and stomping are great examples of this, especially if you progress by wearing a weighted vest that you gradually increase in load.

If you're not quite ready to try any of those exercises yet, then just walk until you're ready. Research suggests walking mainly slows bone loss rather than building new bone, but Dr. Wittstein says walking is worth being a big part of your daily routine. Regular walking improves your walking speed, makes you less likely to fall, and lowers your risk of hip fracture.

Dancing is another fantastic way to get moving. Some styles, like Zumba and Irish step dancing, include a lot of impact, which is great for your bones, and all dancing builds balance and agility. "And dancing is just fun," Dr. Wittstein said.

This is why our YVO groups combine weighted walks and jump squats. Load your bones consistently and add impact when you can.

4. Stand Tall to Protect Your Height

One attendee asked how to elongate her bones so she could stop shrinking, and Dr. Wittstein explained that bones can't be stretched back out.

If you find yourself losing height over the years, that's due to gradual compression in the spine, including the cushioning discs between your vertebrae, as well as changes in your posture. You can't really prevent spinal compression, but you can control your posture.

By strengthening your core and the muscles that pull your shoulder blades back, you can stand taller and prevent rounding of your upper back, Dr. Wittstein explained. She admitted that sitting upright can take quite a bit of effort when you're not used to it, which is the reason bone specialized physical therapists often start clients off with posture training for the biggest impact.

You can help your posture out by wearing your YVO vest, too. Carrying weight close to your center of mass encourages you to stack your spine and engage your core, which are all good things for your postural muscles. It's an easy way to turn your walks into posture training.

5. Put Food First for Calcium

Dr. Han recommends prioritizing food first when it comes to getting your nutrients. Whole foods package vitamins and minerals together with other compounds that help your body absorb them and put them to use. Researchers call this the food matrix, and the calcium you get with dairy is the best studied example. Dairy calcium gets absorbed and used in ways synthetic calcium pills haven't been able to match.

If you don't eat dairy, you can still get what you need, but it takes being intentional since some plant foods contain compounds that bind calcium and block its absorption. It's important to choose sources your body can actually access, like bok choy, broccoli, and arugula. Although spinach is great for you, it doesn't release its calcium for absorption very easily. Same goes for foods like almonds, which Dr. Wittstein pointed out you'd have to eat an awful lot of to get what you need.

If lactose is an issue, consider trying a favorite of the experts', Jarlsberg cheese, which is naturally lactose free and rich in vitamin K2, another bone building powerhouse nutrient.

Dr. Han also explained that calcium needs the helpers vitamin K2 and vitamin D to reach your bone. Vitamin D moves calcium from your gut to your bloodstream, then vitamin K2 helps direct it into your bones where you need it. You can get K2 from eating fermented foods like natto, sauerkraut, and kimchi, plus it's also in liver and certain cheeses. If you don't eat a lot of those foods, Dr. Han recommends adding them to your diet regularly to give your bones a boost.

Supplements still have a place, though. Dr. Han said they're a great tool for filling nutritional gaps, and there are some supplements that will help with that better than others. Her own diagnosis led her to co-found Seen Nutrition, which makes calcium chews from real food, including a newer version with vitamin K2.

6. Build for the Life You Want

We closed the webinar by asking both expert guests what "built to last" means to them. Dr. Wittstein said it's caring for your musculoskeletal system, meaning your bones, muscles, and connective tissue. This is the foundation for everything else, and is what allows you to do the exercise that protects your heart and brain for decades to come. Care for the foundation and you're caring for the whole house.

Dr. Han thinks decades ahead, picturing staying active with her daughter, who is five, and someday even her daughter's kids. The diagnosis felt at first like a period at the end of a sentence, she said, but learning how much she could still do changed that. "What can I do today that's going to make a difference to my bones tomorrow?" she asks herself now. "Because bones are dynamic."

Your bones are listening to what you do every day, and they respond. Watch the full Built to Last replay for everything we couldn't fit here, and keep an eye out for the next conversation in the series.

Carry power!

About the Author

Rachel MacPherson, CSCS, CPT

Rachel is a certified strength and conditioning specialist with over a decade of experience, and a pre- and postnatal exercise specialist. She specializes in helping women build strength and confidence through evidence based training.

Disclaimer: This article is for educational purposes. Always consult a healthcare professional before starting a new exercise routine.