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Bone Health

therapist hands pointing to spine bones

Bone Health

By: Karin Michalk, MS PT CN CNS
Functional Nutritionist and Physical Therapist

How much do you think about your bones? Have you ever considered your risk for developing osteoporosis? If you haven’t, let me encourage you to start. Bones are a living, metabolically active, hormone-producing tissue. Some of those hormones are necessary for processes such as kidney function and energy metabolism. Bones provide structure to the body and serve as a mineral reserve. They also produce immune cells. The entire skeleton is remodeled every 5 to 10 years.

Bone is maintained by the immune system through a repair and renewal process called remodeling. This process is harmed by body-wide inflammation which underlies all chronic diseases. Bone metabolism (referring to all the chemical processes that occur in bone) is impacted by the function of many organ systems in the body. For example, the kidneys produce a hormone called calcitriol, which increases calcium absorption from the intestines, that may eventually find its way to the bone to be deposited. The ovaries produce estrogen that prevents bone loss via many mechanisms. Estrogen is lost in menopause contributing to the increased risk of developing osteoporosis and related fractures in older women.

As a Physical Therapist who used to work in inpatient settings, my desire is to help keep people from requiring the services of these facilities. The primary underlying cause for admission to a Skilled Nursing Facility is frailty. Frailty develops when there is significant loss of muscle and bone which leads to falls and fractures. Therefore, in order to maintain good health, we need to maintain our muscles and bones. And because the health of bone is so intricately tied to the health of the rest of the body, we need to optimize our health in whatever area needs the attention.

When do we need to start assessing our risk for osteoporosis? Ideally this would start at age 40 by looking at simple blood biomarkers. There are many blood and urine biomarkers that can be collected to monitor processes happening in the body that would give insight into the health of bones and elsewhere. Women should get a DEXA bone scan by age 50 and men by age 55. DEXA bone scans can be obtained along with a Trabecular Bone Score to measure both the quantity and quality of bone. Anyone who has a family history of osteoporosis, is physically inactive, has abdominal obesity, heart disease, or anything that causes a chronic inflammatory state should have their bone health assessed and should do so sooner rather than later.

If you learn that you are at higher risk for developing osteoporosis or have been diagnosed with the disease, then what can be done? Your doctor will guide you if a pharmaceutical intervention is necessary. However, there is a lot more we can do within the scope of a Certified Nutrition Specialist. The approach I take is an osteoimmunological one. This means we address bone metabolism and the immune system using Medical Nutrition Therapy, nutraceuticals, and lifestyle changes. We will also use certain blood biomarkers to track bone remodeling and inflammation to make sure we have chosen the right strategies.


Karin Michalk, MS PT CN CNS
Functional Nutritionist and Physical Therapist