Osteoporosis increases the risk of fractures, particularly hip fractures, which can raise the one-year mortality risk in older people by two to five times. On the “Health 1+1“ program, Kuo-Pin Wu, superintendent of Taiwan Xinyitang Chinese Medicine Clinic, discussed the symptoms, causes, and prevention of osteoporosis.

Osteoporosis, the most common age-related bone disease worldwide, is characterized by low bone density, deterioration of bone microarchitecture, and reduced bone strength. These changes make bones extremely fragile, significantly increasing the risk of fractures, even from minor falls or collisions.

Throughout adulthood, bones continually undergo remodeling, during which bone loss typically matches the amount of new bone formation. However, with aging or other factors, the rate of new bone formation may no longer keep pace with bone loss, leading to osteoporosis.

Osteoporosis is often called a “silent disease” as it usually remains undetected until a fracture occurs. Fractures are the most common complication of osteoporosis, affecting one-third of women and one-fifth of men over the age of 50.

Wu noted that fractures are generally classified into two main types: vertebral and nonvertebral fractures. Vertebral fractures most commonly occur in the 11th and 12th thoracic vertebrae or the first and second lumbar vertebrae, while nonvertebral fractures are typically seen in the distal radius and hip. Among these, hip fractures are the most severe.

The Severity of Hip Fractures

A hip fracture is a fracture in the femur (thigh bone) closest to the hip joint. The risk of hip fractures increases with age and is particularly high among older adults, who also face a significantly higher mortality rate associated with this injury.

Each year in the United States, about 300,000 older adults are hospitalized for hip fractures caused by falls, according to the Centers for Disease Control and Prevention. In 2019, 83 percent of hip fracture-related deaths in the United States were caused by falls.

Data indicate that 20 percent to 24 percent of individuals with hip fractures die within one year of the injury, and the increased risk of mortality can persist for up to five years.

The high mortality rate following hip fractures can be attributed to multiple factors, Wu said. First, patients often experience limited mobility after a hip fracture, leading to reduced physical activity, slower metabolism, and a rapid decline in physical strength and immunity.

Additionally, the pain from the fracture may lead to excessive use of painkillers, which can have side effects that harm the gastrointestinal system, kidneys, and heart, further weakening the body.

Prolonged bed rest is often required for most patients, increasing the risk of complications such as pressure ulcers (bedsores), urinary tract infections, and potentially fatal conditions like pulmonary embolism.

Factors Contributing to Osteoporosis

The factors contributing to osteoporosis, according to Wu, can be categorized into two main types: intrinsic and extrinsic.

Intrinsic Factors

Intrinsic factors are unmodifiable, such as sex, age, and race.

White people or those of Asian descent have a higher prevalence of osteoporosis. Those with small body frames are also at greater risk, as they often experience poorer nutrient absorption. Additional risk factors include advanced age, family history of age-related fractures, and hormonal changes in women following menopause.

Nearly 75 percent of hip fractures occur in women, a rate almost three times higher than that of men. Therefore, middle-aged and older women should pay particular attention to preventing osteoporosis.

Extrinsic Factors

Extrinsic factors are typically modifiable, at least to some degree, and include the following:

• Lifestyle Habits: Smoking, excessive alcohol consumption, high intake of coffee and tea, improper dieting for weight loss, overly bland diets, and lack of exercise contributed to osteoporosis.
• Nutrition: Nutritional imbalances in the diet, excessive or insufficient protein intake, high-salt diets, low body weight, calcium deficiency, and vitamin D deficiency are also factors.
• Diseases: Chronic gastrointestinal dysfunction, impaired liver or kidney function, diabetes, hyperthyroidism, and a history of surgical removal of the ovaries, uterus, stomach, or intestines contribute to osteoporosis. These cannot always be avoided.
• Medications: Glucocorticoids, commonly prescribed to treat asthma, arthritis, and other conditions, can lead to osteoporosis if taken for more than three months. Fractures occur in 30 percent to 50 percent of patients undergoing this type of steroid treatment. While medications can be changed or stopped, their use is not always avoidable.

Symptoms of Osteoporosis

While osteoporosis is difficult to detect, certain symptoms in daily life can act as warning signs, Wu noted. These include:

• Lower Back Pain: Persistent lower back pain worsens after maintaining a fixed posture for long periods, such as prolonged sitting or standing.
• Vertebral Deformities: Degeneration and compression of the vertebrae can lead to a hunched back, inability to lie flat, and shortening of the spine.
• Respiratory Symptoms: Issues such as chest tightness, shortness of breath, and difficulty breathing can potentially be caused by compression of the thoracic vertebrae, impaired autonomic nerve conduction, and restricted movement of the ribcage.

TCM’s Take on Osteoporosis

Osteoporosis is a metabolic bone disease characterized by a decrease in osteoblasts (bone-forming cells) and an increase in osteoclasts (bone-resorbing cells), leading to bone loss, Wu said.

In traditional Chinese medicine (TCM), osteoporosis is seen as a deficiency of qi (energy) and blood (nutrients) in the body, resulting in a decline in organ function. Additionally, patients with osteoporosis often have limited physical activity, which hinders the delivery of nutrients to the bones and reduces the stimuli needed to promote bone density.

TCM holds that the kidneys govern the bones, meaning bone health is closely tied to kidney function. Additionally, the bones are also influenced by the liver and spleen. The spleen governs the muscles, and when its function is impaired, energy and nutrients become insufficient, resulting in muscle loss and weakness. The liver governs the tendons, and when liver blood is deficient, the tendons become undernourished and weak.

In TCM, osteoporosis treatment often includes herbs that strengthen the spleen and replenish nutrients and energy. Examples include lotus seeds, Chinese yam, jujube (red dates), and white hyacinth beans. These nutrient-rich foods are commonly available at Asian grocery stores.

To increase bone density, it is essential to strengthen both muscles and tendons. Focusing solely on calcium supplementation is insufficient; adequate protein intake and regular exercise are also necessary.

Exercises to Enhance Bone Density

Fractures can have a significant impact on our lives, causing pain, disability, and a loss of independence. Therefore, preventing osteoporosis is crucial, and exercise is one of the most effective ways to strengthen bone density. Wu recommends the following strategies:

• Increase Daily Physical Activity: Regular movement provides vertical stimulation to the bones, helping strengthen them.
• Strengthen the Muscles: Stronger muscles enhance blood flow through vessels that supply essential nutrients to the bones.
• Focus on Balance Training: Improving balance, especially in older adults, helps prevent falls and reduces the risk of fractures.

Wu’s Exclusive Exercise Routine

• Practice Toe Raises and Heel Presses Combined With Waist Rubbing: This exercise strengthens the muscles and ligaments in the calves and provides vertical stimulation to improve bone density.
• Stimulate the Shenshu Acupoint on the Lower Back: This helps nourish the kidney essence, which benefits kidney health.
• Walk Forward or Backward on Tiptoes for Five to 10 Minutes Daily: This practice further strengthens the calves and promotes overall balance and bone health.

Dietary Approaches to Prevent Osteoporosis

Diet plays a crucial role in preventing osteoporosis. Wu noted that when it comes to improving bone health, people often think of taking calcium supplements and getting more sunlight to boost vitamin D levels for enhanced calcium absorption.

In addition to calcium and phosphorus, protein is essential as it enhances bone flexibility, lowering the risk of fractures. Therefore, a balanced diet is key to preventing osteoporosis. Wu recommends the following:

• Recommended Foods: Milk, legumes, and lean meat are excellent protein sources. Dried small fish and dried shrimp provide a rich source of calcium. Black sesame paste, walnuts, and eggs not only supply calcium but also help strengthen the kidneys. Additionally, seaweed, kelp, and shiitake mushrooms are known for their kidney-strengthening properties.
• Avoid Bad Habits: To prevent calcium loss, avoid smoking and drinking alcohol, avoid overconsuming coffee and strong tea, and refrain from drinking carbonated beverages. It is also essential to avoid consuming excessive amounts of salt or protein. Minimize late nights and manage stress, as both can contribute to chronic inflammation in the body.
• Black Sesame and Walnut Powder: Combine 8.82 ounces (250 grams) each of black sesame seeds and walnuts, grind into a fine powder, and mix with 1.76 ounces (50 grams) of brown sugar. Consume twice daily to strengthen the kidneys and supplement calcium.
• Bone-Strengthening Soup: Prepare a nourishing soup using pork spine, tofu, eggs, and dried shrimp. Season it with appropriate amounts of scallions, ginger, and garlic. This soup helps supplement calcium and strengthens bones.
• Wu’s Exclusive Remedy: Boil pork tail bones with jianbu wan, a traditional Chinese herbal formula, to make a medicinal soup. This remedy has been shown to alleviate lower back pain within three days. Ensure you receive a high-quality supplement by consulting a TCM practitioner.