We recently interviewed Dr. James Ting about bone density, osteoporosis
and how to prevent vulnerability and bone loss. Here are his answers to
What is bone density?
Bone density is a measure of bone mass, and refers to the amount of mineral
matter per unit volume in bone. It is an indicator of osteoporosis and
How is bone density measured?
It is measured by a DXA (dual-energy x-ray absorptiometry) test, which
compares a patient’s bone density with that of control subjects
of a young age who are at their peak bone density (T-score) as well as
with that of other patients matched for age and gender.
What is osteoporosis?
Osteoporosis is defined by the WHO (World Health Organization) based on
BMD (Bone Mineral Density) measurements. Specifically, osteoporosis is
defined as a T-score that is less than or equal to -2.5, which equates
to a BMD that is equal to or more than 2.5 standard deviations below the
normal mean for young adult women.
Why is preventing bone loss so important?
Preventing bone loss is important in regards to preventing fractures.
There is significant morbidity in regards to pain, disability, and diminished
quality of life secondary to osteoporosis-related fractures. There is
in some cases as well the chance of a significant associated mortality,
particularly in regards to hip fractures.
Why is bone health so important in athletes?
Bone health is particularly important in regards to young female athletes.
The years of peak bone mass typically occur by age 18 in females. Over-training
in addition to inadequate nutrition or disordered eating can result in
what can be referred to as an energy deficit. This energy deficit has
a significant impact on various endocrine/hormonal pathways which may
result in decreased bone density. Clinically this can manifest as stress
fractures and/or ultimately, early osteoporosis. This has been commonly
referred to as the “Female Athlete Triad.”
How can exercise prevent osteoporosis?
Exercise, specifically weight-bearing exercise, is critical to strengthening
bones by helping to maintain and build bone mass and density. It also
is helpful in improving flexibility, building and maintaining supporting
muscles, and balance as well, which indirectly helps in preventing falls
and therefore fractures.
What are the best exercises for building bone?
In adults, aerobic, low-impact exercises such as walking or jogging are
best. Weight-bearing exercise performed in 45-60 minute sessions 3-5 times/week
is also recommended.
When exercising, why is it important to ensure you are using the proper
Proper technique is important to prevent falls and injury, including related
or unrelated musculotendinous injuries.
Aside from exercise, how else can you prevent bone loss?
It is especially important to maintain adequate calcium and vitamin D
intake. Recommended intake may vary according to age and/or gender.
James Ting, MD, FAAFP is a board-certified Primary Care Sports Medicine
physician who specializes in the
non-operative treatment of sports and orthopedic injuries and conditions.
Dr. Ting has served on the medical staff for international events such
as the Ironman World Championship in Kona, Hawaii, as well as other events
such as the Los Angeles Triathlon, the Long Beach Marathon, and several
NCAA Conference Championships.