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Surviving the COVID-19 Pandemic: Improving Bone and Muscle Strength in People with Arthritis

Living with any type of arthritis like osteoarthritis, inflammatory arthritis or fibromyalgia in the middle of the COVID-19 pandemic can definitely heighten one’s stress. Daily activities such as getting dressed, climbing up the stairs or running after a toddler can be hard to do when you’re having a bad flare-up. I completely understand this- especially since I recently experienced a flare-up of my own. There is one thing that can help ease the stress during this pandemic: knowing how to improve our bone and muscle strength.

What is Osteoarthritis, Inflammatory Arthritis and Fibromyalgia?

In very simple terms, osteoarthritis is the "wear-and-tear" type of arthritis, which occurs when the joint’s cartilage and the bone that it surrounds breaks down and the body can’t repair it. This is the most common type of arthritis and typically occurs in places like the knees, spine, hands, toes and hips. On the other hand, inflammatory arthritis is a group of autoimmune disorders where the body's immune cells begin to attack its own joints and other organs. As a result, pain, stiffness, damage and deformities can arise. And fibromyalgia affects the central nervous system, which causes widespread pain throughout the body.

All of these conditions have one thing in common- they cause excruciating pain that can be debilitating in performing just simple everyday activities. Let alone the impact on one's quality of life when we live with a combination of them.

Why are People with Arthritis at a Higher Risk of Suffering Bone and Muscle Problems?

It seems obvious to think that if we have arthritis, then our muscles and bones are automatically weak. It's not that simple and there are several elements that increase the risk of poor bone and muscle strength:

1. Risk Factors

Source: wix images
Source: Wix images

Age: as someone gets older, bone and muscle mass decrease more quickly.

Gender: women (especially post-menopausal women) are more likely to develop osteoarthritis and/or fibromyalgia, which affects the strength of the muscles and bones.

Family History: if you have a family member who has osteoarthritis and/or fibromyalgia, you’re more likely to develop it too.

Sedentary Lifestyle: if you hardly exercise or move your body this can increase your risk. Performing weight-bearing exercises, which force you to work against gravity such as, squats, are the best for bone and muscle strength.

Excess Weight: extra weight puts more strain on your feet, hips, spine and knees and can cause their deterioration.

2. Disease Process

Inflammation: our bones are constantly being broken down by osteoclasts and being rebuilt by osteoblasts. When there are high levels of inflammation in the body, a protein called cytokine is produced. Cytokines stimulate osteoclasts, the cells that breakdown bone, meaning more bone is being broken then it is being formed (seems unfair for us, don’t you think?).

Muscle Weakness: this is commonly reported in patients who have inflammatory arthritis, specifically rheumatoid arthritis because their muscle size is smaller.

3. Medications

Corticosteroids: are used to lower the inflammation of the body and reduce immune system activity. They cause poor absorption of calcium and vitamin D, which are needed to build healthy, strong bones.

Proton Pump Inhibitors: are used to protect one’s stomach from nonsteroidal anti-inflammatory medication but they negatively affect the absorption of calcium.

In addition to living with pain and fatigue, the aforementioned factors can further increase one’s risk of developing osteopenia (when your bones are weaker than normal, but they don’t break easily) or osteoporosis (bones are weak, and they do break easily). As well as, sarcopenia (the loss of skeletal muscle and strength). This can be overwhelming but not to worry- I’m here to explain how nutrition plays a key role in reducing your risk!

What Pantry Staples are Helpful in Maintaining Bone and Muscle Strength?

Below is a list of food items that can help strengthen your bones and muscles. There is a mixture of foods to satisfy any diet (like, vegetarian or vegan) that you follow.

Paneer Kebabs @arthritisdietitian

Dairy Products: cheese, yogurt and milk provide high amounts of calcium, Vitamin D (if the food product is fortified), phosphate and protein. These four components are essential for maintaining healthy bones and preventing osteoporosis. They are also important for the functioning and the size of skeletal muscles, which helps prevent sarcopenia. There’s controversy about eating dairy products and how they can cause inflammation in the body but having small amounts is acceptable in an anti-inflammatory diet.

Tofu is a soy-based product, a protein-packed food that contains isoflavones (an estrogen compound) that supports strong bones and muscles. Protein is the foundation for muscles, eating tofu can ensure your muscles are strong. Also, in a systemic literature review, it was shown that in comparison with red meat, soy products decrease calcium excretion whereas, red meats increase it. This means tofu is more beneficial than red meats because it stores calcium to help build strong bones. Good thing for all vegetarians and vegans! Soy is another controversial food, but it has been shown to decrease inflammation in the body and protect the joints.

Source: Wix images

Salmon is rich in the anti-inflammatory healthy fats omega-3s. It is naturally high in vitamin D and has a smaller amount of calcium. Vitamin D helps increase the absorption of calcium, thus maintaining healthy bones. For an extra tip, try canned salmon with the bones! Don’t be afraid of the bones in it, they are well-grounded up and you won’t even notice them.

Iranian dates @arthritisdietian

Prunes and Dates contain phenolic compounds that signal cells to increase bone formation by influencing the osteoblasts and osteoclasts. This has been shown to improve bone mineral density, which helps decrease bone loss. They are also a good source of vitamin K! This vitamin aids in the breakdown and reformation of bone because it keeps calcium in the body balanced. It sounds like eating a prune or date a day does wonder.

Source: Wix images

Nuts are a great source of protein and magnesium, so they can help build muscle. Eating nuts or nut butters after exercise is important because their proteins get broken down in your body and the amino acids are used to repair muscle tears to help build bigger and stronger muscles. Magnesium helps to increase bone strength because it stimulates a hormone called calcitonin, which is used to balance calcium levels in the body when your supply is low.

Source: Wix images

Spinach has a controversial side. This dark leafy green contains calcium, magnesium and vitamin K, which have all been proven to maintain bone health. But they contain oxalates, which is a natural compound in many foods. Oxalates weaken calcium absorption because this compound binds to calcium during digestion to leave the body. Spinach is high in oxalates, meaning it shouldn’t be counted as your primary source of bone-strengthening vitamins and minerals. Conversely, kale is also high in calcium but has a lower content of oxalate.

Source: Wix images

Broccoli is high in calcium- it contains just as much as a glass of milk! Also, calcium absorption is twice as high in dark green vegetables like broccoli, which

supports strong bones. It is high in vitamin K too. Low vitamin K levels have shown an increased risk in fractures because bone density has been decreased. The calcium contained in broccoli, kale and bok choy seems to absorb better compared to other veggies. I think eating a broccoli a day should be the new saying!

It is important to eat food (like the ones above) that are filled with vitamin D and K, magnesium and calcium, all of which are important in improving bone and muscle strength. Speak to your healthcare provider if you need to take vitamin D and/or calcium supplements when you can’t eat some or most of these foods or when your exposure to sunlight must be limited.

Start doing weight-bearing exercises (it doesn’t have to be crazy weight lifting, you could do dancing and swimming to bring some fun into your exercises too). Also, talk more to your doctor about bone density screening and other medications to see what works best with your body and the type of arthritis you have. Arthritis Consumer Experts have great tips to care for your joints at home.

These are challenging times, but I am here for you. We have a double burden of stress with trying to manage the challenges of our arthritis and cope with the stresses and uncertainties of COVID-19. But we can get through this together. If you have any questions, please don’t hesitate to ask away. As always, stay safe and healthy.

Special thanks to Emily Malfara, 4th-year nutrition student at Ryerson University who assisted with the research and writing for this post.


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