The problem with osteoporosis is it can creep up on you slowly, so you may not even realise you have a problem until you suffer a bone fracture (though having osteoporosis doesn’t automatically mean you will break any bones). The other problem is awareness about osteoporosis is low: according to the National Osteoporosis Society, only 25 percent of adults are familiar with the term.
What causes osteoporosis?
When the mesh-like structure within your bones becomes thin, the result is osteoporosis. Because the structure of your bones has become more fragile, it means you could have a fracture following a relatively minor bump or fall (the most common bones broken as a result of osteoporosis are wrist, hip and vertebrae – the bones in your spine – but you could also suffer a broken arm, rib or pelvis.
Up until the age of 16 to 18, your bones are growing, and they keep increasing in density until you’re in your late 20s. But when you reach the age of 35 or thereabouts, your bone density starts to decrease very gradually as part of the natural ageing process. After the menopause, women lose bone density quite rapidly for a few years, which may go some way to explaining why more women are affected by osteoporosis than men.
Are you at risk?
Age is arguably the most significant risk factor when it comes to osteoporosis. However, there are other things that could make you more susceptible, including the following:
- Having a family history of osteoporosis or hip fracture.
- Having an inflammatory condition such as rheumatoid arthritis, chronic obstructive pulmonary disorder (COPD) or Crohn’s disease.
- Having an overactive thyroid or parathyroid gland, or another condition that affects your hormone-producing glands.
- Being a heavy drinker and/or smoker.
- Taking certain medicines in the long term, such as steroid tablets, anti-epileptic drugs and some treatments for breast or prostate cancer.
- Other groups of people who may have a higher-than-average risk of developing osteoporosis include those who don’t do much or any exercise, people who have an eating disorder or who are underweight, those who have mal absorption problems (such as with coeliac disease, for example) and women who’ve had their ovaries removed.
How to keep your bones strong
While there may not be anything you can do about the bone density you inherited when you were born, there are lots of everyday things you can do to keep your bones as healthy as possible:
Eat a calcium-rich diet
The National Osteoporosis Society suggests that adults need 700mg of calcium each day to help keep their bones healthy. That’s around the amount you’d find in a pint of semi-skimmed milk. The best sources include dairy products, as the calcium in milk products is most easily absorbed by the body. Other calcium-rich foods include oily fish such as salmon, tuna, pilchards and sardines, plus sesame seeds, almonds, fortified soya milk, figs, oysters and prawns.
Get out into the sun, especially during the summer months
When your skin is exposed to the ultraviolet rays in sunlight, it produces vitamin D, a nutrient that helps your body to absorb calcium. There are some foods that contain vitamin D – including oily fish, eggs, dairy products, soya foods, fat spreads and meat –but most of the vitamin D stored in your body comes from exposure to sunlight.
If you’re fair-skinned, get out into the sunshine for just 10 or 15 minutes every day without sunscreen (or less than the time it takes your skin to start going red) between April and October. At all other times, remember to protect your skin against burning by covering up or using sun protection.
Avoid processed foods that contain a lot of salt
Eating too much salt in the diet is linked with decreased bone density because increases the amount of calcium the body loses in urine. So stick to the recommended salt intake, which is 6g per day (just over a teaspoon), and swap ready meals for meals made from fresh ingredients.
Nicotine over-stresses the adrenal glands, which produce bone-building hormones. Some experts also believe that smoking hinders the body’s absorption of calcium, which could also weaken your bones. If you need help with giving up smoking, there are products that could give you support, such as gum, lozenges and patches.
Stick to recommended alcohol guidelines
Drinking too much may also affect your bones, as heavy drinkers are thought to be more susceptible to bone loss and fractures. To stay within the official limits, stick to two to three units a day if you’re a woman and three to four if you’re a man, and have at least one or two alcohol-free days each week. To give you an idea of alcohol units, half a pint of weak beer or lager (4 percent alcohol) contains one unit, a pint of strong lager (5 percent alcohol) or cider has three units, while two small (125ml) glasses of wine (12 percent alcohol) contain three units.
Besides alcohol, other stimulants that may also be bad for your bones include caffeine and fizzy drinks. Fizzy drinks contain phosphoric acid, which some experts believe affects bone strength. Caffeine, meanwhile, is thought to increase the amount of calcium you lose through urine.
Maintain a healthy weight
Losing too much weight too quickly by crash dieting could increase your risk of osteoporosis, especially if you avoid eating dairy products to cut down on fat and calories. Being underweight could also affect your bone health, as it may reduce your body’s production of bone-building hormones such as estrogen (having a low body weight may also mean your bones are smaller and finer, so as you get older you may be more likely to develop osteoporosis). Instead of trying to lose too much weight, aim to maintain a healthy weight with a body mass index of between 19 and 25.
Osteoporosis and exercise
Exercise is an important element of osteoporosis prevention. It’s also important if you already have osteoporosis, as it can help to increase your bone strength.
Weight-bearing exercise –that is, any type of exercise where you support the weight of your own body – is the best type of activity for your bones. That’s because your bones react when you load more weight on them by becoming stronger.
Examples of weight-bearing activities include walking, skipping, running, jogging, dancing, aerobics, tennis and resistance training such as weight lifting. Even activities such as gardening, playing golf, swimming, carrying shopping and doing housework will help, not just because they keep your bones healthy but also because they may keep you fit and reduce your risk of falling and suffering a fracture.
Other exercises such as swimming and cycling aren’t weight-bearing activities, so they don’t help keep your bones strong. However, they do help to keep your fitness levels up.
According to the NHS, the best way to strengthen your bones is to do at least five hours of weight-bearing exercise a week, so aim to be active on a regular basis. Remember, however, not to overdo it, especially if you’re not used to doing much exercise (exercising too much can also increase your risk of developing osteoporosis).
What is high-impact exercise?
According to the National Osteoporosis Society, one of the most effective ways of loading your bones is by doing short bouts of high-impact exercise. This is any exercise where a high impact is created by a large force or jolt, such as when your heel hits the ground while you’re running or jogging. This jolt affects the bones in your foot, leg, hip and spine.
The good news is the National Osteoporosis Society claims you only need about 100 jolts a day to produce a positive effect on your bone density – that’s about the equivalent of running up and down an average flight of stairs five times (10 stairs up provides 10 jolts, as does 10 stairs down). So instead of going jogging for half an hour or so (which provides about 2,000 jolts), you really only need to do a shorter bout of high-impact exercise to stimulate your bone density, as any more than 100 jolts isn’t necessary.
However, never attempt running up stairs if you’re not fit enough. Instead, you could consider going for a short brisk walk (the brisker pace means higher-impact jolts). Whatever exercise you do, start slowly, and build up your fitness levels gradually if you haven’t been very active lately. Always speak to your GP before starting any new exercise regime if you have a medical condition.
How to prevent falls in the home
As you get older, your risk of suffering a broken bone becomes higher. So if you’re not as young as you used to be –or you have an older friend or relative –it’s important to make your or their home as safe as possible to make falls less likely.
Here are a few simple changes you could make to prevent accidents from happening in the first place:
- Check for things that could make your or somebody else trip, such as wires from electrical appliances and other clutter. Make sure your carpets and rugs are secure with no loose edges (use anti-slip tape on rugs if you have wooden floors). Also take steps to prevent any floors from becoming slippery, and use non-slip mats next to and in the bath to prevent slipping, as well as in front of your kitchen and bathroom sinks.
- Always wear well-fitting shoes (including slippers indoors) and never walk on slippery floors in just your socks or tights. Also avoid wearing clothes that might trip you up.
- Make sure your home is well lit by using high-wattage light bulbs.
- If necessary, have special rails or grab bars installed to prevent you or somebody else falling on your stairs or in your bathroom. Ask your local authority about a home hazard assessment if you need help dealing with potential problem areas inside your home or speak to your GP about advice and support that may be available in your area.
- Go for regular eyesight and hearing tests. Not being able to see as well as you should could increase your risk of falling. Meanwhile, having some forms of hearing problems could affect your balance.
- Some medicines or combinations of medicines can cause dizziness, lightheadedness or drowsiness, all of which could cause a fall. If you think your medicines are affecting you in this way, speak to your GP about it as there may be an alternative medicine you could take instead.
- Also be aware that some medical conditions – such as Parkinson’s disease, arthritis and stroke –are common causes of falls.
Natural remedies for osteoporosis
If you’re diagnosed with osteoporosis, you may need treatment in the form of prescription drugs in tablet or injection form. There are, however, several natural remedies that may strengthen your bones, which may also help reduce your risk for the disease.
This mineral is essential for strong bones, but many people may not be getting enough of it in their diet (according to the NHS, adults need 700mg of calcium a day). Numerous studies show the bone benefits of taking calcium – for instance, several show that calcium supplements may help slow down bone loss in women after the menopause (i).
Strong bones also need vitamin D, as it helps your body to absorb calcium (indeed, your body can’t absorb calcium without it). Again, many people may be deficient, especially older people and those who don’t get enough sunlight exposure during the summer. Studies show that taking vitamin D alongside calcium may help prevent bone loss (ii).
Studies show that vitamin K may also help prevent osteoporosis by reducing the rate of bone breakdown. For instance, in a study of postmenopausal women, bone density scans showed those taking vitamin K alongside calcium, vitamin D and magnesium lost less bone mass than those taking a placebo or those taking calcium, vitamin C and magnesium without vitamin K (iii).
This may also be helpful, as magnesium may be necessary to convert vitamin D into the form that helps with calcium absorption.
Having an inflammatory condition increases your risk of osteoporosis, so there’s an argument for taking fish oils, as they are thought to have an anti-inflammatory action. There’s also some evidence that essential fatty acids – including the omega-3 fatty acids found in fish oils – may boost the effectiveness of calcium (iv).
Substances called isoflavones, such as those found in soya foods, may help prevent bone loss. For example, a study involving women aged 47 to 57 shows supplements of genistein (one type of soya isoflavone) may prevent bone loss in the back and the hip as effectively as hormone replacement therapy (HRT) (v). Eating more soya and other isoflavone-enriched foods may not have any effect on bone density, however (vi).
Collagen may be associated more with skin health, but healthy bones need it too. Unfortunately, the production of collagen slows down with age, which may lead to a reduction in bone mass. Taking a vitamin C supplement, however, may help your body to boost its collagen production and help keep your bones strong.
(i) Reid IR, Mason B, Horne A, et al. Randomized controlled trial of calcium in healthy older women. Am J Med. 2006;119:777-785. Prince RL, Devine A, Dhaliwal SS, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med. 2006;166:869-875. Avenell A, Campbell MK, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people: a randomised placebo-controlled trial. Lancet. 2005;365:1621-1628.
(ii) Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337:670-676. Dawson-Hughes B, Dallal GE, Krall EA, et al. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med. 1991;115:505-512.
(iii) Braam LA, Knapen MH, Geusens P, et al. Vitamin K1 supplementation retards bone loss in postmenopausal women between 50 and 60 years of age. Calcif Tissue Int. 2003;73:21-26.
(iv) Kruger MC, Coetzer H, de Winter R, et al. Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis. Aging (Milano). 1998;10:385-394.
(v) Morabito N, Crisafulli A, Vergara C, et al. Effects of genistein and hormone-replacement therapy on bone loss in early postmenopausal women: a randomized double-blind, placebo-controlled study. J Bone Miner Res. 2002;17:1904-1912.
(vi) Brink E, Coxam V, Robins S, et al. Long-term consumption of isoflavone-enriched foods does not affect bone mineral density, bone metabolism, or hormonal status in early postmenopausal women: a randomized, double-blind, placebo controlled study. Am J ClinNutr. 2008;87:761-770.