The Better Bones Blog

by Dr. Susan Brown, PhD.

Woman shopping at a summer farmer's market

Early summer superfoods for osteoporosis

There are so many reasons why we should eat fresh whole foods in season, and it’s even better if we select foods that strengthen and support our bones.

As we enter summer, I want to share with you some of my favorite seasonal foods that fit the criteria of “superfoods” for bones — and I also want to share exactly what these criteria are to help you identify even more foods on your own.

In developing my daily diet, I think in terms of 11 major food groups, which you’ll see below with my early summer superfood favorites. Why not add your own favorite summer foods to my list? Have fun with this; putting a little of your attention on the food groups and their ideal daily servings will likely result in more diverse and wholesome summer eating.  Notice the abundance of fresh greens in your market and pick the ones that you enjoy.

Early summer superfoods for bone health

Vegetables
4.5 cups/day
– Green leafy vegetables
– Asparagus
– Snow peas
– Watercress
– Lettuce
– Dandelion greens

Protein
60-80 g/day (as tolerated)
– Fresh salmon
– Lentils
– Lean meats

Nuts and seeds
2-3 servings/day
– Almonds (1st nut of the summer)
– Sesame seeds

Water
8 glasses/day
– Pure water
– Lemon water
– Iced green tea with mint

Fermented foods
1-2 servings/day
– Kombucha
– Lacto-fermented pickles

Root crops & squashes
1-2 servings/day
– Scallions
– Summer squash

Fruits
2-3 servings/day
– Strawberries
– Raspberries
– Blueberries

Dairy
0-2 servings/day
– Kefir
– Yogurt

Oils & fats
1-2 tbsp/day
– Olive oil
– Coconut oil
– Avocado

Whole Grains
1-2 servings/day
– Quinoa
– Whole grain rice

Herbs & spices
1-2 tsp/day
– Parsley
– Mint
– Cilantro

What makes a food a “superfood” for bone health?

Here are the key qualities of food that in my book earn them the title of “bone superfood.”  Think about the foods that you like to eat. How many of them meet these qualifications?

Early summer is a time when Nature wakes from her winter rest and growth abounds. I send each of you my best wishes for a joyous early summer, full of the season’s growth and great tastes and flavors!

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woman looking at her T score and Z score

The infamous T score and neglected Z score

I bet most of the Better Bones community have heard of the infamous bone density T score. But I suspect that few understand what the T score means, and even fewer know about the hidden value of the Z score. Contrary to popular (mis)understanding, the T score does not measure fracture risk or indicate that you need bone drugs.  So what then does the T score indicate?

Putting the T score in perspective

The T score measures how closely your bone density compares to that of an average 30-year-old of the same sex. This comparison is expressed in terms of the “standard deviation,” or SD, which you may recognize from a statistics class as being the amount that represents the typical distance above or below the mean for individual measurements. So, if your bone density differs from the average 30-year-old’s (which it probably will!), that difference will be characterized as “–1.5” if your bones are 1.5 SD below the mean, or “+1.2” if they’re 1.2 SD above the mean.

As the chart shows, a T score of –1.0 is described as osteopenia, and –2.5 is described as osteoporosis — even though bone density bears little relationship to fracture risk (but that’s <a href = “https://www.betterbones.com/testing/bone-density-tests-arent-enough/”>another story</a>).

The T score measures how closely your bone density compares to that of an average 30-year-old of the same sex. This comparison is expressed in terms of the “standard deviation,” or SD, which you may recognize from a statistics class as being the amount that represents the typical distance above or below the mean for individual measurements. So, if your bone density differs from the average 30-year-old’s (which it probably will!), that difference will be characterized as “–1.5” if your bones are 1.5 SD below the mean, or “+1.2” if they’re 1.2 SD above the mean.

As the chart above shows, a T score of –1.0 is described as osteopenia, and –2.5 is described as osteoporosis — even though bone density bears little relationship to fracture risk (but that’s another story).

In this second chart (below), 68%, or around two-thirds, of the population falls within 1 SD of the mean, either lower or higher than the average, and another 32% (the remaining third) of the population falls more than 1 SD beyond the mean. Keep in mind that, starting in her mid-30s, the average woman will lose 35% of her cortical bone mass and 50% of her trabecular bone mass over her lifetime (assuming she doesn’t take steps to limit bone loss). So it is totally reasonable to expect that an older woman is not going to have the bone density of a 30-year-old woman, and that her T score will be a negative rather than a positive number.

The overlooked Z score

Elsewhere in your testing results, you will find out your Z score. The Z score compares an individual to others their own age and sex — which makes it a much more realistic assessment of how your bones are faring in their lifelong journey. Where an active, healthy 80-year-old woman, compared to a 30-year-old, might have a T score of –2.0, when compared to other 80-year-old women, she could very well have a Z score of +1.0 or even +2.0!

 

It’s a pity that the Z score, which “compares apples to apples,” gets so much less attention than the T score. It hardly seems realistic to be worried about having lower bone density that a 30-year-old — but there’s good reason to pay attention when your bone density is much lower than people your own age. For instance, if your Z score is –2.0 or more, it means that very few people your age have a bone density that low, and it signals the need for a complete medical workup looking for all possible cause of excessive bone loss.

Unraveling the mysteries of bone density test results

Now that you know the story of the infamous T score and the neglected Z score, hopefully it will encourage you to learn more from your bone density test. If you want to do just that, look into our new online class: A worried woman’s micro-course on understanding bone density tests.  This class includes a live group Q&A with Dr. Brown where you can ask your questions about the course material. Details coming soon!

Reference:
Hunter, D, and Sambrook, PN. Bone loss: Epidemiology of bone loss. Arthritis Res. 2000:2(6):441-445.

thin women and bone fracture

Helping thin women reduce their fracture risk

The saying,  “You can never be too rich or too thin” is definitely not true when it comes to bone health! It’s well established that women with low body weight have lower bone density and are at increased risk for many types of fracture.

Let’s better understand this link between body weight and fracture risk and then look at the many steps thinner women can take to start strengthening their bones.

 Underweight women…

  • Experience twice the rate of hip fracture as do “healthy weight” women.  (See chart below.)
  • Have lower hip bone density, lower cross-sectional bone area, and less bone bending strength than “normal” weight women.
  • Experience more vertebral and wrist fractures (but fewer lower leg fractures).
  • Tend to lose more bone during the menopause transition than do heavier women.

So just who is included in this “underweight” category?

The “underweight” designation is determined by body mass index (BMI) using weight and height. A BMI of 18.5 or less (which would translate into a 5’3” women weighing 105 lbs or less, or a 5’5” person weighing 115 lbs or less) is considered underweight.

While the “underweight” category includes only very thin folks, there exists a weight–bone gradient link whereby lighter weight individuals have both decreased bone density and increased risk of various fractures.  Those falling into the “underweight” category are at highest risk, but slender individuals (that is, those whose BMI is 18.6–21.5) are often reported to be at increased fracture risk, too, particularly if they also have low muscle mass.

How can underweight or slender women reduce their fracture risk?

This is indeed a complicated topic, which I can only begin to address here. As always, at the Center for Better Bones we look for the root cause of the problem and seek a solution with this in mind. Being significantly underweight likely indicates a serious imbalance within the system, such as digestive, emotional, or disease-related issues:

  • Low body weight is often associated with weak digestion, food allergies, or food intolerances. Addressing these issues is central to improving your metabolism. Check out our 10 steps to stronger digestion and try a simple elimination diet.
  • Clinically, I also see low body weight associated with a tendency towards anxiety, nervousness, and at times even straight out emotional distress and fear. While uprooting these negative emotional responses can take some time and good guidance, a good place to begin is with our free e-book, 7 secrets to reducing stress.
  • If you’re an “eat-and-run” person or you regularly skip meals, discipline yourself to sit down, relax, and consume three tasty, wholesome meals every day.
  • Try not to get extra calories from simple carbohydrates like sugars, pastas, and flours. Instead, increase your intake of root crops and wholesome fats like avocado, nuts, seeds, and olive oil.
  • Remember, bone and muscle are built together — so include some weight-bearing, muscle-building exercise in your weekly routine.

As you can see, there’s a lot that a thin, small-framed person can do to strengthen bone and reduce their fracture risk.  Being aware of your risk is the important first step!

Take this survey to help us see how body mass relates to fracture incidence among the Better Bones, Better Body Community. We’ll report back on what we find!

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References

Johansson, H. et al. A meta‐analysis of the association of fracture risk and body mass index in women. J Bone Miner Res., 2014;29: 223-233. doi:10.1002/jbmr.2017

Søgaard AJ, et al. Abdominal obesity increases the risk of hip fracture. A population‐based study of 43 000 women and men aged 60–79 years followed for 8 years. Cohort of Norway. J Intern Med. 2015;277: 306–317.

Compston, J. E., et al. Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: The Global Longitudinal Study of Osteoporosis in Women (GLOW). J Bone Miner Res. 2014;29: 487-493. doi:10.1002/jbmr.2051


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