Osteoporosis increases the risk of fractures, especially hip fractures, which can raise the one-year mortality risk in older people by two to five times. That makes it one of the leading causes of death in senior citizens.

What is osteoporosis? The simple answer is fragile or weak bones. But how do they get that way and what can be done about this?

Osteoporosis, the most common age-related bone disease worldwide, is characterized by low bone density, deterioration of bone microarchitecture, and reduced bone strength. To understand how bones get this way, you must first grasp that bones are living cells, just like any other tissue in the body. There are two kinds of bone cells: osteoblasts that make bone, and osteoclasts that absorb bone. The normal bone condition is a balance between making bone by osteoblasts and removing bone by osteoclasts.

Osteoporosis occurs when there is less bone making by osteoblasts and more bone removing by osteoclasts.  This imbalance leads to less density in the bone, which makes the bone weaker. Then the bone is more vulnerable to fractures.

Shan Lam and JoJo Novaes, writing in The Epoch Times, tell use 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. 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. 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 such as pulmonary embolism.

For these reasons, surgery is the preferred treatment of all displaced hip fractures since this allows the patient to get out of bed faster. Surgery is considered the conservative approach since non-surgical treatment carries a higher mortality rate.

What causes osteoporosis?

Intrinsic Factors

Intrinsic factors are unmodifiable, such as sex, age, and race. Caucasians 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 change in women following menopause. Nearly 75 percent of hip fractures occur in women. 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 to 50 percent of patients undergoing this type of steroid treatment. While medications can be changed or stopped, their use is not always avoidable.

What else can you do to prevent osteoporosis?

Exercise is important to good bone formation. Weight-bearing exercises, such as walking or running, are especially beneficial since bones respond to the impact of gravity by producing more bone. On the other hand, bones become weaker when not adequately stimulated by weight-bearing activity. This is known as Wolff’s Law. A daily walk is an excellent way to strengthen your bones.

Diet can also have an impact. You want to get plenty of calcium and Vitamin D, which are essential to healthy bone formation. This may come from dietary supplements or from foods such as milk, legumes, and lean meat. Dried small fish and dried shrimp provide rich sources of calcium. Walnuts, and eggs not only supply calcium but also help strengthen the kidneys.

On the other hand, avoid smoking and drinking alcohol, avoid overconsuming coffee and strong tea, and refrain from drinking carbonated beverages. These may contribute to declining bone density.

In summary, osteoporosis is a common condition in the elderly and women are more vulnerable than men due to menopause changes in hormone levels. A good diet, combined with calcium and Vitamin D supplements, and weight-bearing exercises are all good measures to prevent osteoporosis. But if you’re in a high-risk category, you should see your doctor to consider medications that can be prescribed to strengthen your bones.

In Part I of this series, we discussed how researchers have discovered a previously unknown system in the brain for clearing out waste. The normal system in the body for this is called the lymphatic system. This new system in the brain has been called the “glymphatic system” from the word “glial” which refers to the glial cells in the brain.

We learned that deep sleep is more effective in this cleansing mechanism. We reach deep sleep in a circular process that begins with Nonrapid Eye Movement (NREM) sleep and progresses to Rapid Eye Movement (REM) sleep. The deeper the sleep, the better.

Flora Zhao, writing in The Epoch Times, tells us Americans today are sleeping less than ever.In 2023, 42 percent of Americans perceived that they got enough sleep, according to Gallup’s December 2023 poll. One in five people sleep less than five hours a night—compared with just 3 percent in 1942.

Shorter sleep duration can also be attributed to people going to bed later. One study found that delaying bedtime by just one hour reduces total sleep by 14 to 33 minutes each night.

In addition to going to bed later and sleeping less, we are also not sleeping well. According to the American Psychiatric Association, more than 50 million people in the United States suffer from chronic sleep disorders such as insomnia and sleep apnea.

These issues directly reduce and disrupt deep sleep, shortening the critical window during which the glymphatic system works at peak efficiency. This, in turn, leads to greater waste accumulation in the brain. People reporting less adequate sleep and more sleep problems had a greater amyloid burden in Alzheimer’s disease-sensitive brain regions.

The accumulation of waste in the brain can lead to various symptoms. For instance, if this waste is not cleared and continues to accumulate, it can become difficult to stay clear-headed, Junge explained. “The most common symptom is a decline in cognitive function,” including memory loss, difficulty concentrating, and trouble managing complex tasks, Yang told The Epoch Times.

The long-term accumulation of these waste products can also affect mood, leading to anxiety, depression, or irritability. Yang further explained that this accumulation may be directly linked to neurodegenerative diseases, such as Alzheimer’s or Parkinson’s, as both conditions are closely associated with the buildup of beta-amyloid and tau proteins in the brain.

A 2021 longitudinal study with an average follow-up of 25 years and involving 7,959 older adults found that those who consistently slept less than six hours per night had a 30 percent higher risk of developing dementia than those who slept seven hours.

A 2019 study tracking more than 13,000 Dutch older adults over an average of eight years showed that declines in sleep quality and reduction in sleep duration increased the risk of developing Parkinson’s disease within the next six years by 76 percent and 72 percent, respectively.

Interestingly, there is evidence that your sleep posture may impact the brain’s waste clearance. The glymphatic system operates more efficiently in the side-lying position than when sleeping on the back or stomach. Prone is especially bade as it impairs cerebral blood flow and increases sympathetic nervous activity, triggering the release of stress hormones that suppress glymphatic function. In contrast, side sleeping reduces sympathetic tone, possibly improving glymphatic influx.

Some experts go so far as to suggest sleeping on the right side is better than the left. They postulate that with the heart positioned higher, blood circulation improves, and venous return increases, allowing the heart to work more efficiently while keeping sympathetic nervous activity low. Who knew that sleeping was so complicated? Sleep well tonight!

We all know sleep is good for you, but did you know it cleanses your brain? This is actually new information, but increases the evidence that getting more sleep may help prevent dementia as well as fatigue.

Flora Zhao, writing in The Epoch Times, tells us “As we fall asleep, the brain begins clearing out waste. It operates like a late-night laundry service, with all the water valves opened and washing machines running at full capacity to remove dirt from piles of clothes, flushing the wastewater into the drain. The brain continuously produces various wastes, and if these are not cleared regularly, we feel it. The signs can range from feeling foggy and fatigued to experiencing cognitive impairment.”

The human brain is one of the most metabolically active organs, accounting for about 20 percent of the body’s total energy expenditure. This high level of activity generates significant waste. Smaller by-products, such as carbon dioxide, urea, and ammonia, diffuse into capillaries and are cleared through the bloodstream. Larger neurotoxic proteins—including beta-amyloid and tau, both widely associated with an increased risk of Alzheimer’s disease, cannot be eliminated through the bloodstream alone due to their size.

In the past it was believed that the brain lacked a lymphatic system to remove waste and relied solely on internal mechanisms for clearance. However, in 2012, researchers discovered a specialized mechanism within the brain, analogous to the lymphatic system and capable of flushing out larger waste products from deep within the organ. This system was named the glymphatic system, a portmanteau of “glial” (referring to glial cells) and “lymphatic.” It is also known as the pseudo-lymphatic system.

Surrounding the arteries in the brain is a sheath-like structure, and cerebrospinal fluid flows through the space between the arteries and this sheath. During sleep, the brain’s blood vessels constrict, increasing the space between the vessels and the sheath, which allows more cerebrospinal fluid to flow in. As the arteries pulse, the cerebrospinal fluid is pumped through brain tissue, flushing out waste—such as beta-amyloid and tau proteins—from the deeper spaces between brain cells, eventually clearing it from the brain.

Sleep is divided into two states: rapid eye movement (REM) sleep and nonrapid eye movement (NREM) sleep. NREM makes up 75 percent of total sleep time and is further divided into three stages, N1, N2, and N3—each reflecting progressively deeper levels of sleep. During N3, brainwaves are at their slowest. During sleep, the body moves through the stages sequentially, forming a complete sleep cycle lasting around 90 minutes. Throughout the night, a person typically experiences four to five sleep cycles.

The glymphatic system becomes more active during sleep, especially during deep sleep, allowing for more effective waste clearance, said psychiatrist Dr. Jingduan Yang, founder of the Yang Institute of Integrative Medicine in Pennsylvania and a contributor to The Epoch Times.

In a mouse study published in Science, researchers used tracers to monitor changes in cerebrospinal fluid flow. They found that during sleep, the interstitial, or intervening, space expanded by more than 60 percent, and the tracer influx increased. The brain’s clearance rate of beta-amyloid doubled during sleep (or under anesthesia) compared with the awake state.

(For more on this subject, see Part II of this series next post.)