Recap: Strengthen your bones and avoid osteoporosis | Professor Tim Spector & Professor Cyrus Cooper

Summary

ZOE Science & Nutrition Podcast Summary

Episode Title: Recap: Strengthen your Bones and Avoid Osteoporosis
Guests: Professor Tim Spector & Professor Cyrus Cooper
Host: Jonathan Wolf
Release Date: December 3, 2024

In this insightful episode of ZOE Science & Nutrition, host Jonathan Wolf engages with renowned experts Professor Tim Spector and Professor Cyrus Cooper to delve deep into the crucial topic of bone health and osteoporosis. The discussion unravels the complexities of bone density, the silent nature of osteoporosis, the significant role of diet, and the paramount importance of exercise in maintaining strong bones throughout life.

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1. Introduction to Bone Health and Osteoporosis

Timestamp: 00:01 - 00:39

Jonathan Wolf sets the stage by highlighting the prevalence of osteoporosis, affecting 1 in 4 individuals over 50, and its association with increased risks of painful fractures. He emphasizes the often-late realization of bone weakness, typically only discovered post-fracture, and introduces Professors Tim Spector and Cyrus Cooper to explore strategies for maintaining bone strength.

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2. Understanding Osteoporosis

Timestamp: 00:39 - 02:17

Professor Tim Spector elucidates osteoporosis as the most common bone disorder globally, characterized by reduced bone density and compromised bone microarchitecture, leading to a heightened fracture risk. He specifies that the primary fracture sites in osteoporosis include the hip, spine, and distal forearm or wrist, constituting about half of all fractures in older populations.

“Osteoporosis is the commonest bone disorder worldwide, and it's associated with reduced bone density, a disruption of the microarchitectural content of bone, and an increased risk of fracture.”
— Professor Tim Spector [00:39]

Professor Spector contrasts fracture causes in younger individuals, where trauma predominates, with those in older adults, where fractures often occur without significant trauma, underscoring bone fragility as the culprit.

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3. The Silent Epidemic: Fractures Without Trauma

Timestamp: 02:17 - 03:37

The conversation shifts to the alarming phenomenon of fractures occurring without trauma, particularly prevalent in women post-menopause and men over 70. Professor Cyrus Cooper describes how everyday movements, such as rolling over in bed, can trigger vertebral fractures—often unnoticed by the individual.

“Just by doing that or twisting in a certain way.”
— Professor Cyrus Cooper [02:11]

These fractures can lead to a bent spine, contributing to the stereotypical image of an aged, hunched posture. The experts label osteoporosis a "silent epidemic" due to its asymptomatic progression until significant fractures occur.

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4. Importance of Bone Density and Development

Timestamp: 03:37 - 04:52

The discussion delves into the critical phase of bone density acquisition during childhood and adolescence. Professor Spector explains that bones gain strength through layers of collagen and mineral deposition, which are compromised in osteoporosis, resulting in weaker bones.

“There are layers of collagen, and those collagen protein layers have gaps in them within which the calcium sits. In osteoporosis, there's a reduced amount of collagen, and there's also a reduced amount of mineral, and that's what makes the bone weak.”
— Professor Tim Spector [03:59]

They further highlight trabecular bone's susceptibility to rapid bone loss and its role in common osteoporotic fractures.

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5. Dietary Factors in Bone Health

Timestamp: 04:52 - 08:25

A pivotal part of the conversation centers on nutrition's role in osteoporosis prevention. Contrary to popular belief, the experts argue that overall diet quality outweighs the impact of individual nutrients like calcium or zinc.

Professor Cyrus Cooper emphasizes that diets rich in vegetables and low in processed foods significantly reduce fracture risk, independent of calcium intake.

“It's about having small amounts of processed food. It's not having lots of junk food, not having lots of fizzy drinks. So it's that health quality aspect which has come out globally when you look at the meta analyses as being really important.”
— Professor Cyrus Cooper [05:16]

Professor Tim Spector adds that merely increasing dietary calcium doesn't directly translate to stronger bones, debunking the myth that calcium supplementation alone is sufficient.

“Just because the calcium is in the bone does not mean that modifying it by increasing its level in your stomach will actually have any impact on your bones.”
— Professor Tim Spector [07:48]

The experts advocate for a holistic dietary approach, rich in diverse plant-based foods to ensure a balanced intake of essential minerals and compounds that collectively bolster bone health.

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6. Exercise and Bone Health

Timestamp: 08:25 - 13:07

Transitioning to physical activity, Professors Spector and Cooper underscore the crucial role of weight-bearing exercise at all life stages in enhancing bone density and reducing fracture risks.

Professor Tim Spector illustrates this with the example of tennis players, where the serving arm showcases 15 to 20% higher bone density compared to the non-serving arm due to consistent use.

“If you send someone into space, their skeleton will dissolve, you know, with calcium leaving the bone and being passed out in the urine. Because they're weightless and therefore no action of the muscles on the bone.”
— Professor Tim Spector [12:11]

Professor Cyrus Cooper reassures listeners that even moderate exercise, such as walking an hour three days a week, can significantly improve bone density and reduce fall risks, emphasizing that it doesn't require extreme physical activity to reap benefits.

“Weight bearing exercise is crucial really at all stages of life. And I think that's the sort of number one lesson people need to learn.”
— Professor Cyrus Cooper [12:22]

The discussion reinforces that maintaining an active lifestyle is as vital as a quality diet in preserving bone strength and preventing osteoporosis.

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Conclusion

The episode culminates with a comprehensive understanding that preventing osteoporosis is a multifaceted endeavor, involving a high-quality, diverse diet and regular weight-bearing exercise. Professors Spector and Cooper dismantle common misconceptions about osteoporosis, shifting the focus from isolated nutrients to a holistic approach in diet and lifestyle. By adopting these evidence-based strategies, individuals can significantly enhance their bone health and mitigate the risks associated with osteoporosis as they age.

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Key Takeaways:

• Osteoporosis is a widespread bone disorder leading to increased fracture risk, particularly in older adults.
• Silent Fractures can occur without noticeable trauma, often going undetected until severe.
• Overall Diet Quality is more influential on bone health than specific nutrients like calcium.
• Weight-Bearing Exercise, even in moderate forms, is essential for maintaining and improving bone density.
• Holistic Lifestyle Changes encompassing diet and physical activity are crucial in preventing osteoporosis.

For those seeking to enhance their bone health, this episode offers actionable insights grounded in the latest scientific research, empowering listeners to make informed lifestyle choices.

Transcript

[Zoe]

Hello and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today we're discussing bone health. How strong is your skeleton? It's a tough question, and often we only find out the answer when a bone breaks. The reality is many of us have weak bones. Osteoporosis affects 1 in 4 people over 50, significantly increasing their risk of painful and debilitating fractures. So what can you do to keep your bones strong as you age? Professor Tim Spector and Professor Cyrus Cooper explain how you can tailor your lifestyle to maintain a strong skeleton.

[Professor Tim Spector]

Osteoporosis is the commonest bone disorder worldwide, and it's associated with reduced bone density, a disruption of the microarchitectural content of bone, and an increased risk of fracture. The fractures that typically arise from osteoporosis are fractures of the hip, the spine, and the distal forearm or wrist. Those three fracture sites account for about half of all fractures in older people, and the other half are from all the other sites combined around the skeleton.

[Host/Interviewer]

The places you're talking about feel to me like not the most common places that people tend to break their bones when they're children or in their 20s or 30s. Is that so?

[Professor Tim Spector]

That's exactly correct. In their 20s and 30s, trauma plays a much bigger role than bone density.

[Host/Interviewer]

So this is like falling out of.

[Professor Tim Spector]

A tree or having a road traffic accident.

[Professor Cyrus Cooper]

Breaking your nose.

[Professor Tim Spector]

Yeah. Whereas as you get to later life, particularly for women above the age of 50, up to the average age of menopause, and men more so after age 70, low trauma, or in fact, absent trauma, is associated with many of the fractures, and those truly are ones due to bone fragility.

[Host/Interviewer]

So what does it mean to break a bone without trauma? I think of it always being like you.

[Professor Cyrus Cooper]

No, it means just rolling over in bed, for example. You can actually trigger a vertebral fracture.

[Host/Interviewer]

Wow.

[Professor Cyrus Cooper]

Just by doing that or twisting in a certain way.

[Professor Tim Spector]

Most of our vertebral fractures present on an incidental finding on a radiograph and a vert.

[Host/Interviewer]

Just help me out. Vertebral fracture. Where are my vertebrae?

[Professor Tim Spector]

And typically, the bones that break in your spine. The spine contains small vertebral bodies all the way down the mid thoracic, which is the middle part of the back, and the lower lumbar, which is down towards the pelvis. Those are the main sites at which osteoporotic vertebral fractures occur.

[Professor Cyrus Cooper]

That's what a wedge. So you have these sort of square looking Vertebrae, lots of them, all on the spine, which act as these sort of shock absorbers. And when you get a fracture, it sort of crunches in on itself. And so. And if it does it in a certain direction, you can end up with a bent spine often.

[Host/Interviewer]

In fact, your example of us thinking about, you know, in the past, like, old ladies sort of being bent over.

[Professor Cyrus Cooper]

And some of these old ladies don't feel any pain. They just gradually comes on. They don't notice. It happens at night or whenever. You can have, you know, five or six of these without any pain at all. And that's why it's often called the silent epidemic, which for this reason, that people actually getting fractures without knowing about it and not realizing what the cause is and not realizing that it's preventable.

[Host/Interviewer]

So it's slightly terrifying idea that you might just roll over and, you know, things break in your bones. Could you help me, Cyrus, to understand what's going on? Why does this start to happen now? But, you know, Nobody in their 20s is worried this happening.

[Professor Tim Spector]

How do all of us gain bone density through our childhood and adolescence?

[Host/Interviewer]

What does bone density mean?

[Professor Tim Spector]

So if we were to look inside a bone, we'd find that there are layers of collagen, and those collagen protein layers have gaps in them within which the calcium sits. In osteoporosis, there's a reduced amount of collagen, and there's also a reduced amount of mineral, and that's what makes the bone weak.

[Host/Interviewer]

Why are you talking about these fractures in these particular bones? Right. Like, I've got bones all over. Why these ones?

[Professor Tim Spector]

Well, these fractures are particularly rich in what is called trabecular bone, which is a honeycomb end of the long bones, which loses bone fastest and which, when it gets subjected to trauma, fractures earlier.

[Host/Interviewer]

So I'm thinking about my very simple, you know, almost cartoon picture of a skeleton with, like, long bones, the little round bits at the end. And you're describing sort of those round bits at the end of the things.

[Professor Tim Spector]

That are getting just beneath the round bit at the end, that part of the bone. So the fractured neck of femur, the area just underneath the head of the femur, which is what gives way and breaks.

[Professor Cyrus Cooper]

Diet has a big role to play in osteoporosis. And if you looked at some meta analyses where you're combining lots of these studies together from all these cohorts around the world, you find that once you've accounted for lots of other factors, the quality of the diet has a big impact on the risk of fracture and it's not things like the amount of calcium in the diet. It's not things, you know, amount of zinc or any one item. It's the sort of things we talk about in this podcast all the time. You know, having plenty of vegetables, being protective. It's about having small amounts of processed food. It's not having lots of junk food, not having lots of fizzy drinks. So it's that health quality aspect which has come out globally when you look at the meta analyses as being really.

[Host/Interviewer]

Important, and it's significant. Is it this difference between a high quality diet and an average diet, 2%, that only scientists can see?

[Professor Cyrus Cooper]

No, we're talking sort of 30, 40% differences. It's a huge difference. These are really big ones. But it's highlighting that the same things that are good for many other diseases are also good for osteoporosis and bone. But it's also telling us that it's not, you know, as we used to think, all about calcium or all about protein. It's actually the quality of the diet, the combination of foods rather than these individual ingredients which people use to sell supplements. Completely.

[Professor Tim Spector]

That's right.

[Professor Cyrus Cooper]

And this is true at all ages, as far as I know. So, I mean, you've done some of this work.

[Professor Tim Spector]

Children, adolescents, older adults, the move towards dietary quality as compared with micronutrients that are specific for bone health has definitely been the direction.

[Host/Interviewer]

I think that's really interesting because I think, you know, one of the things that was most surprising to me in my journey from Zoe over the last seven years is, you know, seven years ago, I assumed that there are these very specific vitamins because they're the things that are on the, you know, the back of the pack and that you see being sold in the stores and that those were really mattered everywhere. And I think I've subsequently discovered that there's a hundred thousand chemicals in food and all these other sorts of things, even before they hit your microbiome and they make all these other things. But I had, at least until this morning, thought, well, at least calcium is really important for bones. I'm sure I learned that when I was 11. And what you're saying, I think is even there, your total diet may be really important, but it's not because there's calcium in that diet. It's something to do with all the different things.

[Professor Tim Spector]

Just because the calcium is in the bone does not mean that modifying it by increasing its level in your stomach will actually have any impact on your bones.

[Professor Cyrus Cooper]

And Cyrus and I had been brought up on this myth that calcium was all important, and we just assumed it was a fact. And it's only really in the last 10 years, with all these massive analyses and people starting to look at diet differently, a more global, holistic way of looking at food, that we start to see that actually calcium doesn't even make the list of contenders. So it doesn't matter whether you actually drink milk or not. It's about the quality of your diet.

[Host/Interviewer]

It's really interesting. What you're saying is the calcium does really matter in my bones. Like, I need to have the calcium, is what you're saying, but in order to get more calcium in my bones, like, eating or drinking more calcium doesn't help. You were saying, like, if the road's dug up outside, I can't just give you a bunch of asphalt. That doesn't make it happen. Like, I need someone to come with that fancy machine that lays it. And so I sort of need to pay the person who's going to lay it rather than just say, oh, I'll eat some asphalt. This will solve the problem.

[Professor Cyrus Cooper]

Eat more gravel.

[Host/Interviewer]

Yeah, that's fascinating. Now, I think one question a lot of people will be saying is, is there anything specifically, however, that I should be thinking about adjusting? So imagine that maybe I'm going through perimenopause. I've been through menopause. Is there anything that we know about, sort of way that I might want to think about changing my diet? Or is this just like, overall, I need to have care more about the quality of my diet perhaps, than when I was.

[Professor Cyrus Cooper]

I think the number one message is care more about the quality of diet. Try and get more plants now, because they are all these sources of other minerals. You know, as you said, there are 100,000 different chemicals in food. So the more diversity we get, the more we are going to get a balance of these things. And so that's why a rich balance of particularly plants is going to give you all these, whether it's zinc or magnesium or phosphate in exactly the right amounts that your body needs. Because we're evolved to take it up and absorb it in those ways. That's more important than any saying, okay, I'm going to forget all that. I'm just going to take some vitamin D capsules and drink a pint of milk. So I think in a way, that's where we've got it wrong. In the past, we've said, well, there's one quick fix here where actually it's going back to. There isn't a quick fix. It's this holistic idea. Again, it comes back to food quality. But I think get the food quality right and then as Cyrus will tell us, there's some really good exercise tips now that at all stages of life that are really important.

[Host/Interviewer]

So could you talk about that? Because actually we haven't mentioned exercise yet.

[Professor Tim Spector]

One of the reasons we have a skeleton and bones is for the muscles to work off and for locomotion, for walking around, running, evading hunters. In the olden days, that role of exercise is very close to the starting function of the skeleton itself. We already know that when we start in the earliest stages of life, weight bearing, we can start to see an acceleration in the mineralization of the skeleton.

[Professor Cyrus Cooper]

At those very early stages when the toddler's first steps.

[Professor Tim Spector]

Yes, absolutely.

[Host/Interviewer]

So you're saying once the toddler starts walking, suddenly their bones get strong, been.

[Professor Tim Spector]

Weightless in utero, they come out and they start to ambulate. And you can see a discernible change in their mineral accrual from the blood, if you like, into the skeletal tissue. Thereafter there's a rapid gain up to age 25. Examples. The serving arm of a tennis player is 15 to 20% higher bone density than the non serving arm. A stroke or reason for paralysis of a limb leads to massive demineralization of the bones.

[Host/Interviewer]

So I just want to make sure, because everyone, everyone sort of is familiar with the idea that their muscles shrink if they're not using them. But what you're saying is that if I use my arm, for example, your tennis example, is like, I'm using that arm more and hitting something with it, my bone is actually going to get bigger and stronger or like denser and stronger.

[Professor Tim Spector]

Absolutely. That's exactly what happens.

[Host/Interviewer]

That's crazy.

[Professor Tim Spector]

If you send someone into space, their skeleton will dissolve, you know, with calcium leaving the bone and being passed out in the urine.

[Host/Interviewer]

Because they're weightless.

[Professor Tim Spector]

Because they're weightless and therefore no action of the muscles on the bone.

[Professor Cyrus Cooper]

Weight bearing exercise is crucial really at all stages of life. And I think that's the sort of number one lesson people need to learn. And what we also learned from a number of experiments is it doesn't have to be huge amounts of time. You don't have to run marathons or anything.

[Professor Tim Spector]

That's the point. Of course you'll do well if you run marathons, but if you just walk an hour, three days a week as an older person, you'll still have an improvement in both your bone density and your falls. Risk your muscle function and falls risk such that you'll have an impact on fracture.

[Zoe]

That's it for today's recap. If you want to continue your health journey with Zoe, why not try our membership? Zoe is your daily coach to Better Health for Life. Click the link in the show notes to get started today. And don't forget to follow Zoe sites in your nutrition and your favorite podcast player so you never miss an episode. See you next time.