Musculoskeletal health: An emerging crossover opportunity in healthy aging

Editor’s note: This article is part one of a three-part series.

Joints, bones and muscles have long been considered three distinct systems. Natural products designed to support one of these systems rarely target another. Yet all three are related to healthy aging, and tremendous crossover exists between them. For example, age-related muscle loss can contribute to joint pain. Joint pain leads to lack of exercise which leads to changes in bone density and muscle loss.

It’s not a big leap to begin looking at musculoskeletal health as one overarching category offering huge opportunities for the nutrition and dietary supplement industries, both for active lifestyle products as well as formulations targeting the healthy aging community.

Frailty was once believed an inevitable part of aging. Now research suggests taking simple measures as early as one’s 30s and 40s can improve quality of life both immediately and as people age. The dietary supplement industry, which is rooted in supporting long-term well-being, will play an increasingly important role in musculoskeletal health.

As a board-certified preventive medicine specialist, this idea is tremendously exciting. Preventive medicine is very proactive. My goals are to protect, promote and maintain health while preventing disease, disability and premature death. I’ll explain this in greater detail a little later.

The biomechanics of unhealthy aging

Pain is one of the most debilitating signs of an unhealthy musculoskeletal system. Osteoarthritis (OA) is an example of one condition that can involve cartilage, tendons, synovial fluid, synovium (joint capsule), muscle and the bone marrow cavity, each of which can be a source of life-altering pain.

Typically, OA treatment focuses on the individual system, such as cartilage, where the condition is believed to have originated. However, new evidence shows OA can originate from the bone, synovium, inflammatory-inducing crystals (such as gout and pseudogout) and trauma. Moving forward, a more comprehensive approach of supporting the health of every system impacted by OA may yield better management results.

Millions of Americans have osteoporosis, and the risk of developing it increases with age. People don’t typically associate gradual bone loss with pain, just as they don’t feel gradual cartilage loss (because no nerves are involved). However, as vertebrae start to compress due to osteoporosis, changes in posture can pull on ligaments, tendons and fascia. The results can include chronic and often severe neck and back pain.

Muscle degradation is an emerging concern in the healthy aging industry. Involuntary age-related muscle loss affects the entire population, often affecting quality of life in adults over age 60. Muscle weakness can exacerbate other symptoms and increase vulnerability to injuries. Conversely, strengthening muscles can improve outcomes, enhance balance and promote overall well-being.

For example, muscles are designed to absorb force and shock. If weakness is in the quadriceps, the amount of force on the knee joints goes up dramatically. Even without sudden injury, over time muscle loss can lead to excessive and debilitating wear of the joints and ligaments.

Lack of nutrients puts people in harm’s way

The body is constantly breaking down and building up tissue. Raw materials—macronutrients and micronutrients—are necessary to do this effectively. Given the interconnectedness of the various components of the musculoskeletal system, it stands to reason that what nourishes one part of the system will directly or indirectly benefit the others.

A good example of this is vitamin D3. In addition to being integral to bone health, a 2020 study supported by a grant from the National Institutes of Health (NIH) demonstrated that when D3 is combined with beta-hydroxy-beta-methylbutyrate (as myHMB), greater strength and superior muscle function is involved, especially in older adults (J Gerontol A Biol Sci Med Sci. 75[11]:2089-2097).

Almost every year, scientists discover new beneficial nutrients in food, from lycopene in tomatoes to sulforaphane in broccoli. As such, a healthy diet can deliver known constituents, as well as those that are yet to be quantified.

But food is fundamentally different in the U.S. compared with Europe and other countries. Highly processed foods containing large amounts of preservatives can negatively impact a healthy microbiome. And these food quality differences are causing a lot of health problems. The likelihood of getting sufficient micronutrients by eating fast foods and microwave meals is low.

This reality opens opportunities for the natural products and dietary supplement industries to incorporate nutrient combinations into formulas for overall musculoskeletal health aging.

Get to know DALY

Some diseases kill people early; others may disable them. An increasing number of researchers are talking about disability-adjusted life years (DALY) as a measure of the years of life people have with a disability plus years of life lost.

Preventive medicine practitioners such as myself want to teach people how to live up to their genetic potential, then die in their sleep without enduring years of disability or sickness. It’s a concept called “squaring the curve.” Modern technology, along with all the tools that the scientific method has verified—including genetic subtyping—are used to help patients maintain the best health possible.

But society is going the opposite direction as it battles the effects of obesity, poor diet and sedentary lifestyles. So, preventive medicine practitioners are also tasked with secondary prevention: identifying risk factors and making modifications to prevent the disease. This approach would apply to someone who has high blood pressure but who hasn’t yet had a heart attack or stroke.

Our tertiary level of prevention involves patients who are already sick. Maybe they already have OA, osteoporosis or muscle loss. Our goal then becomes preventing more damage to improve quality of life.

Success requires a clear understanding of current science, as well as how to market to the growing number of consumers and health care providers within these billion-dollar categories. As important, success will come as consumers become better informed and educated about how these healthy aging categories are interrelated.

Jason Theodosakis, M.D., (“Dr. Theo”) is a board-certified physician, bestselling author, researcher, consultant, lecturer and fellow in preventive medicine. He has a second medical specialty (sports medicine), along with master's degrees in both exercise physiology and public health. For more information, visit the Dr. Theo website.