Teens

Why should I care about promoting strong bones?

Did you know that your skeleton is a living tissue? In your skeleton there is a normal process of bone turnover called remodeling that involves cells called osteoblasts and osteoclasts. Osteoblasts are cells that build bone and osteoclasts are cells that remove a small portion of your bone. When your skeleton is growing your osteoblasts will be working more than the osteoclasts. There are many things that you can do that will affect how these cells work. 

Many people have compared the skeleton to a savings bank. During youth and young adulthood you can deposit calcium into your bone bank. Between the ages of 9 and 18 your bone bank can build at it's fastest rate. For optimal bone building you need enough calcium and vitamin D, physical activity, hormonal balance, and healthy lifestyle choices like the avoidance of smoking. Peak bone mass, the maximum bone density an individual can attain, is reached between the ages of 16 and 25. It is important to reach your peak bone mass so that when you are older and your body needs to take calcium from your skeleton, you will have a lower risk for osteoporosis. Osteoporosis is a bone thinning disease that can weaken the bones and increase the risk for fractures (broken bones).

What causes of osteoporosis later in life?

There are many potential causes of osteoporosis that are important to be aware of in your teen years. Genetics or a strong family history of osteoporosis is a primary cause of osteoporosis later in life. Your genetics can lead to either lower peak bone mass and or greater rates of bone loss later in life. It is important to try to build your strongest skeleton as a teen or young adult, regardless of whether you are at a genetic risk for developing osteoporosis later in life. Lifestyle factors that can contribute to osteoporosis later in your life include eating a poor diet, especially if it is low in calcium and vitamin D, getting too little physical activity, smoking or using tobacco products, and drinking excessive alcoholic beverages. Excessive dieting and infrequent menstruation from any cause may also contribute to osteoporosis. There are a number of other secondary causes of osteoporosis including certain diseases, medical conditions, and/or medications that interfere with reaching peak bone mass.

What can I do now to prevent osteoporosis in my future?

There are many steps you can take to build strong bones now and to help prevent bone loss and lower your risk for osteoporosis in later life. These steps include eating a nutrient rich diet with the recommended amount of calcium, getting the right amount of vitamin D, exercising regularly, avoiding smoking and not drinking alcoholic beverages. 

Exercise

Regular exercise or physical activity is absolutely necessary for building strong bones. It is recommended that teens get 60 minutes of physical activity most days. It is not completely understood how exercise and activity improve peak bone mass, however, the findings from most research has been the following:

• Exercise places physical stress on the body. Bones, like muscles, respond to stress by becoming bigger and stronger, and like muscles, bones weaken if not used.
• Exercise increases blood flow to the bones, bringing in vital bone-building nutrients.
• Exercise creates small electrical potentials (differences) in bone tissue that stimulate the growth of new bone.
• Exercise affects various components of the body's hormonal control of bone remodeling, shifting the balance toward new bone formation (more osteoblasts)

Eat a Nutrient Rich Diet with the Recommended Calcium and Vitamin D

It is important to eat a nutrient rich diet with the recommended calcium. 99% of the calcium in your body is stored in your bones and teeth. The remaining small amount of calcium that is found in blood and tissue plays a critical role in supporting your body's vital functions: such as controlling your blood pressure and maintaining your heartbeat. If you don't eat the recommended amount of calcium, your body takes the calcium it needs to support your body's vital functions from your bones. During the teen years, if you don't get the calcium you need in your diet, your body will take calcium from your bones.

You need to get the recommended calcium to reach your peak bone mass. During the teen years (age 9 to 18), your calcium requirement is higher than at any other time of life. You need 1300 milligrams of calcium each day. To meet these recommendations, teens need to make sure to include a calcium rich food or beverage at each meal and snack. 

Calcium-rich foods include dairy products (milk, yogurt and cheese), calcium-rich non-dairy foods (certain green leafy vegetables, almonds, soy nuts) and calcium-fortified foods (especially cereals and citrus juices). Beverage choices can make a big difference in your calcium intake. If you drink lots of carbonated beverages, you will tend to drink less milk and calcium-fortified juice and be more likely to have a low calcium intake. It is also a good idea to keep your intake of caffeinated beverages low, too. Caffeine slightly reduces calcium absorption but more importantly high amounts of caffeine-containing beverages may be problematic if they replace beverages that contain calcium in your diet. So, think about what you drink and choose beverages that contain calcium as your first choice.

You can get the recommended amount of calcium in your diet, even if you are lactose intolerant, allergic to milk or following a strict vegetarian diet. If you have lactose intolerance, you can get the amount of calcium you need by taking lactase enzyme replacement along with dairy products or by choosing dairy products with lactase enzyme added. If you are allergic to milk or are following a strict vegetarian diet, you can get the recommended calcium by choosing non-dairy beverages with calcium added (such as fortified rice milk, fortified soymilk, fortified juice, as well as calcium rich non-dairy foods). Be sure to shake these products before serving to prevent the calcium from settling at the bottom of the container.  

It is also important that you get the recommended amount of vitamin D. Vitamin D helps your body use calcium so your skeleton can become as strong as possible.  To reach your peak mass, you need to get 600 IU of vitamin D in your diet each day. There are foods that are natural sources of vitamin D and foods that are fortified with vitamin D. Beverages fortified with Vitamin D include all varieties of milk., some almond, rice, coconut and soy beverages and even some yogurts. It is important to read food labels for vitamin D content per serving.  

Many teenagers need vitamin D supplementation to reach the amount of vitamin D recommended. Most multivitamins include 400 IU of vitamin D but it is important to always read the label to find out how much vitamin D a vitamin contains. Vitamin D is also available as a separate supplement. Speak to your healthcare provider to find out if a you need a multivitamin or a vitamin D supplement.

It is important that your diet is well balanced in order to meet the needs of your growing body and growing bones. Teens need to eat the right amount of calories to have a healthy body weight and in order for girls to maintain normal menstrual function. It is also important to consume the right amount of protein, carbohydrate, fat, vitamins and minerals to fuel an active body.  A recent study in teens showed that higher consumption of fruits and vegetables was related to better bones.  Choosing to eat plentiful amounts of brightly colored fruits and vegetables is a step that you can take towards achieving a diet that is good for your bones and for your overall health, too! For information about how to select a healthy diet, visit: www.chooseyourplate.gov

Prevent Disordered Eating

Disordered eating behaviors include anorexia nervosa, bulimia, and binge eating disorders, among others. Anorexia Nervosa is a very serious and sometimes deadly eating disorder that many teens face today. People with anorexia often have unrealistic body images related to weight and become obsessed with unhealthy thinness. Individuals with anorexia become preoccupied with self-control by withholding food, sometimes to the point of starvation.  

Bulimia is an eating disorder characterized by cycles of binge eating followed by dangerous attempts to purge already eaten food by vomiting, taking laxatives, or exercising too much. Like those with anorexia, teens with bulimia  often have their sense of self-esteem enormously tied to their perception of how they look. Unlike those with anorexia, teens with bulimia typically maintain their normal weight although their diet may be poor in many important nutrients.

Binge Eating Disorder is an eating disorder similar to bulimia because the two disorders share a common core of binge eating behavior. Unlike bulimia, behaviors like vomiting, exercise, and taking laxatives don't follow binges in Binge Eating Disorder. Many binge eaters do not meet the nutritional needs for a growing skeleton.

Good nutrition, a well balanced diet, and getting the recommended amount of calcium and vitamin D are essential to build strong bones. Disordered eating deprives the body of essential nutrients and minerals such as calories, protein, and calcium. Food restriction and the excessive thinness, especially associated with anorexia nervosa, often lead to hormonal imbalance. In females, this can lead to irregular or absent menstrual cycles. Proper hormonal balance is critical for both males and females especially during the bone building years. Teens with eating disorders are at greater risk of not reaching their peak bone mass. In fact, people with eating disorders tend to have bones that are thinner and more fragile than people without eating disorders. Disordered eating, especially anorexia nervosa, will not allow one to reach peak bone mass and may even result in bone loss!

Maintain Normal Menstruation

A normal period is defined as at least 10 cycles a year in a girl who is not taking oral contraceptives. Getting a regular period is important for overall health and strong bones. The most rapid bone growth usually occurs approximately two years after the first time you get your period. During this time your body needs more calcium. If as a teenage girl you go without regular periods, you may not absorb the amount of calcium needed to help you reach peak bone mass. Lower bone mass may increase your risk of stress fractures and increase your risk for osteoporosis later in life.

Amenorrhea (pronounced: ay-meh-nuh-ree-uh) is when you do not have your menstrual period for three months or more. If you haven't had your first period by the age of 16, it is also considered amenorrhea. If you are not having your period, it is important to tell an adult you trust (a parent/guardian, school nurse, or healthcare provider) so they can help you get the medical attention you need. A healthcare provider will know what you can do to get a regular period.  Amenorrhea can occur for many reasons that can be diagnosed and treated by your doctor or healthcare provider.

Beware of the Female Athlete Triad

Exercise and physical activity is recommended as part of a healthy lifestyle for teens and people of all ages. Exercising to excess and overtraining, on the other hand, can actually hurt performance and cause medical problems. The female athlete triad, also know as athletic female triad, is a combination of three conditions: disordered eating, amenorrhea, and osteoporosis. A female athlete can have one, two, or all three parts of the triad. Poor nutrition and over-exercising disrupts the hormonal balance necessary for bone building. This often results in an increased risk for stress fractures, bone loss, lower peak bone mass, and the potential for increased risk of osteoporosis.  Early recognition and intervention for teens with the female athlete triad is critically important. See your healthcare provider right away if you have amenorrhea, stress fractures, excessive thinness, or tendencies toward disordered eating. Intervention can help you to build bone in the bone-building years, prevent stress fractures, and reduce your risk of osteoporosis.

Avoid the Use of Steroids Without A Doctor's Prescription

Steroid medications, often called corticosteroids, include medications like prednisone and cortisone. Corticosteroids can be prescribed to be taken in many ways but they are mostly given by mouth or inhaler. Steroid medications are medically necessary to treat many conditions and diseases. The most common diseases requiring steroid treatment are asthma, rheumatoid arthritis, lupus, inflammatory bowel disease, and multiple sclerosis. It is important to follow the recommendations of your healthcare provider regarding steroid use and to discuss the actions you can take to protect and promote strong bones.

Another type of steroids, anabolic steroids, are manmade substances that are similar to male sex hormones. Anabolic steroids may be taken three ways: orally from a pill, injected into the muscles, or inhaled. Doctors never prescribe anabolic steroids to young, healthy people. The use of anabolic steroids without a prescription is illegal. 

Anabolic steroids may make one's body look deceivingly good on the outside, adding weight, bulking up muscles, and creating six-pack abs. However, it is imperative to know the risks of what happens on the inside when someone takes steroids. There are many dangerous health hazards connected with the use of steroids, some of which may be permanent. These include acne, facial hair growth,change in voice,cholesterol changes in the blood, liver disease, and possibly heart disease. Dangerous mood swings and impaired mental health status have been associated with the use of anabolic steroids, as well. The major impact of steroid medication on the skeleton is early and permanent slowing of growth among boys and girls. That means, if you take anabolic steroids during your teens, you take the lifelong risk of being shorter in stature among other serious medical risks.  

Avoid Alcohol:

There are many reasons to avoid underage drinking of alcoholic beverages. Among the many dangers of drinking alcohol, it is known to be bad for your bones. Alcohol can affect bone health because it interferes with the bone building cells known as osteoblasts. In fact, it may decrease the number of osteoblast cells and interfere with their ability to form bone. This will lead to a lower peak bone mass, and potential bone loss.

Avoid smoking:

Tobacco products are bad for your overall health, and are linked to the development of heart attacks, strokes, many cancers, and lung diseases. Smoking is also very bad for your bones! If you are a smoker and decide to continue to smoke, you are taking the chance of developing all of these diseases including osteoporosis and may be increasing your risk for fracture. Smoking directly affects the bone building cells and acts to decrease bone formation. This can be particularly bad for bones during youth and young adulthood when smoking can result in reaching a lower peak bone mass than expected. According to studies, smokers may also have lower bone mass because they tend to lead a more sedentary lifestyle than nonsmokers.

The Surgeon General's Report on Smoking for Kids http://www.cdc.gov/tobacco/sgr/sgr4kids/sgrmenu.htm

Take safety precautions for strong bones seriously.

As a teenager, it is up to you to make safe choices. You can protect your bones and overall health by wearing seatbelts in any moving vehicle and by using appropriate protective equipment when participating in sports.