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Yes, you can be too thin

Whenever I go to one of my son’s school events, or see a group of children in other places, my attention is drawn to the number of very thin, almost frail looking young girls. The anthropologist in me always asks, Why would nature select for such thin, small boned girls? The thin children, I muse, cannot possibly have the same degree of bone strength as the sturdier girls. Will they not in later life fracture more than others?

I’ve asked myself this question dozens of times. Here at the Center for Better Bones we’ve seen that being underweight, and particularly losing more weight as we age, is a significant risk factor for osteoporotic fracture. But now, new research suggests that thinness in childhood is also a critical issue. A large study from Finland has confirmed my speculation. This investigation found that, as they aged, the thinnest Finnish children had more than an 8-fold increased risk of hip fracture as compared to the heaviest group of children. Yes indeed, you can be too thin.

OK, so now you might say that’s all well and good but what about obesity? Does being very overweight help or hinder bone? Well, we don’t have data on children right at hand, but we do have research findings on adults. Recently, Italian scientists asked if obesity offered protection from osteoporosis. In a study of middle-aged women and men they found that being overweight was neutral or protected for bone mineral density. However, being obese was associated with low bone mass, often compatible with a diagnosis of osteoporosis. Their conclusion is that skeletal metabolism is likely to be altered by factors related to obesity. Yes indeed, being really heavy does not help bone either.

Research shows us that obesity is related to many health issues, and that losing weight is often beneficial to our health. When it comes to your bones, this issue is a bit more complicated. I always encourage women to take care with weight loss, especially as they age, because the combination of low weight and advancing age are important risk factors for determining low bone density. We all have a healthy weight at which our bodies thrive, and it’s always best to work toward yours. If this means you have to lose a few pounds, do so with your bones and whole body in mind:


• Exercise in a way that builds muscle
• Strive for an alkaline diet
• Supplement with bone-building vitamins and minerals, especially vitamins D and K

References:
Javaid, MK, JG Eriksson, E kajantie, et al. 2010. Growth in childhood predicts hip fracture risk in later life. Osteopor Int, DOI: 10.1007/s00198-010-1224-3, Pub. online April 9.
Greco, EA, R Fornari, F Rossi, et al. 2010. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J of Clin Prac, 64(6):817-820.

 

We created the Osteo Blast blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider. 

Comments

May 11. 2010 12:10

Dear Dr. Brown

I was always under weight but with a small build and a low birth weight, it was never considered an issue.

In high school in the 80s I was diagnosed with scoliosis that had already progressed too far to be treated. Per my HMO regular physician, so who knows? No diet or other recommendations followed.

I have always wondered if a deficient diet was responsible - My working mother only ate dinner each day and at a certain point, she disengaged from my dietary habits. Consequently, I ate mostly dinner and no breakfast or lunch for the majority of my formative years.

At 30 I had a stress fracture of my hip from repetitive stress of running on hard surfaces. I was 5'2" and 98 lbs. I got a bone scan and have minus 2 in the vertebrae in the curve, which is stable.

So far I have resisted all attempts to get me on bisphosphonates and gave up Forteo when my insurance company stopped paying after one month. I have put on 22 lbs in the 8 years since and do weight training and try to keep my meat diet to a minimum.

I can't agree with you more that these drugs -- tested for 5 years in clinical trials -- should be applied only when absolutely necessary, and only in the latest of life if not for cancer or Paget's, since their longer-term use shows additional fractures anecdotally, and jaw necrosis.

Luckily, I have had no more fractures and with HCTZ to treat hypercalciuria, my scores are improving versus the age-matched population, which means I am holding steady.

Sadly, nearly all my doctors know less about this condition than I do and I constantly fend off calls to take Fosamax. One has to stay up to date and be self-informed. Thank you for this web site, which helps.

Sincerely,
Kirstin Rogers

Kirstin Rogers

May 19. 2010 15:32

Dear Kristin.
Thanks for sharing your story.  It is very unusual to have a hip stress fracture at 30, even for a thin woman.  Sounds like you uncovered the hypercalciuria, which is an important cause of bone loss. Be sure to have a full medical osteoporosis work-up to see if there any any other hidden medical causes of bone loss. Some of the important medical test I list here: http://www.betterbones.com/bonehealth/medicaltestingforosteoporosis.aspx.  A marker of bone resorption, as the NTx test I mention, can help you determine the success of your current program. Also keep gaining weight and build strength and keep looking for a physician you feel comfortable with so she/he can help you see if and when bone medications might be useful. Best wishes,Susan

Susan Brown

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