Osteoporosis and bone health

There’s a lot we can do to help build strong bones and prevent osteoporosis, including paying attention to diet, exercise, and our lifestyle choices, and the earlier we start, the better.

Most of us tend not to think about bone health until we enter our 50s or 60s, or perhaps when we start to feel some aches or pains. But it’s important to start looking after our bones when we’re much younger.

It may come as a surprise to know most people will reach their peak bone mass between the ages of 25 and 30. By the time we reach age 40, we slowly begin to lose bone mass.¹ This is a natural part of the ageing process but for some the process is faster, leaving them at risk of developing osteoporosis.

So, the stronger your bones are at their peak – and the more you do to boost your bone health throughout your lifetime – the less likely you are to suffer from potentially debilitating problems later on.

Why is bone health important?

Low bone density can lead to a higher risk of osteoporosis, a condition that results in particularly weak and porous bones that can break easily.² These breaks are often referred to as fragility fractures. Osteoporosis develops slowly and usually goes undetected until a fracture following a relatively minor fall or impact prompts further investigation – usually in the form of a bone density (or DEXA) scan.³

Fragility fractures⁴ can occur anywhere in the body but the most common injuries suffered by people with osteoporosis are fractures of the wrist, hip and spine. Spinal fractures can be difficult to diagnose, with the pain often being attributed to muscle damage. However, they can be incapacitating, sometimes causing severe long-term pain.

They can also lead to height loss and a stooped posture, when multiple fractures cause the spine to compress and eventually become unable to support the body in an upright position.

Although osteoporosis itself isn’t painful, the resulting fragility fractures can cause both immediate and long-term (chronic) pain, arthritis and restricted mobility.

How common is osteoporosis?

Osteoporosis affects over three million people in the UK with more than 500,000 receiving hospital treatment for fragility fractures as a result of the condition annually.⁵

Women are more at risk of osteoporosis than men, especially if their menopause began before the age of 45, or they've had their ovaries removed.⁶ Research suggests more than half of women over 50 and one in five men of the same age will sustain one or more fragility fractures in their lifetime.⁷

The good news is there are things you can start to do right now to keep your bones stronger for longer and reduce the risk of fractures in later life.

Steps to boost bone health and help prevent osteoporosis, at any age

Diet and bone health – what to eat for stronger, healthier bones

Healthy bones need a well-balanced diet, incorporating minerals, vitamins, and protein from a range of different food groups, including:

• Fruit and vegetables,
• Starchy carbohydrates like bread, pasta, rice and potatoes,
• Dairy products or fortified plant-based alternatives,
• Protein sources like beans and pulses, meat, fish, eggs, nuts and seeds.

>Visit out diet and nutrition hub for more information.

Calcium acts as the building blocks for bones, with 99% of the calcium in our bodies stored in bones and teeth.⁸

Our bodies constantly remove little bits of calcium and replace them with new calcium to remodel our bones, keeping them healthy. If we’re unable to replace the calcium removed from the bones, they can slowly become weaker. Dairy products are the richest source of calcium, with milk, cheese and yoghurt all providing great options.

Fear not if your dietary choices restrict your consumption of dairy products; there are plenty of other non-dairy based foods that can contribute towards your daily calcium intake. Including plenty of:

• Fortified plant-based milk alternatives,
• broccoli,
• kale,
• calcium-set tofu,
• fish with edible bones such as sardines.

which will help keep your calcium stores topped up.⁹

Vitamin D is also essential for bone health,¹⁰ as low levels can lead to inadequate absorption of calcium from the foods that we eat.

We absorb most of our vitamin D through the skin from sunlight. There are many factors that affect how much sunlight is enough to make sure we’re getting enough vitamin D, including our skin colour and clothing.

It is recommended for all adults in the UK to take a 10 microgram Vitamin D supplement in the winter months when we do not get enough sunlight. Vitamin D is also present in small amounts from dietary sources such as:

• mackerel,
• salmon,
• egg yolks
• and fortified dairy and cereals.

>Read more about the role of vitamin D

There are also other nutrients that have been shown to assist in maintaining healthy bones, which should be covered in a well-balanced diet. These include zinc, potassium and B vitamins, among many others.¹¹

Getting physical – exercise to keep bones stronger for longer

Exercise is essential for building bone strength. It can also help us maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.

Visit our exercise and fitness hub for older adults and see the types of recommended exercise to try.

Exercising later in life not only helps to increase bone density but also improves flexibility and stability, reducing the chances of a fall. Studies suggest that older people who walk outside every day for just 20 minutes, are less likely to suffer a fracture.¹²

Type of exercise

The best types of exercise for building and maintaining strong bones is a combination of weight-bearing, resistance and balance training exercises.¹³

Weight-bearing exercises – where you’re supporting the weight of your own body. These cover a wide range of activities, including brisk walking, jogging, hiking, aerobics, climbing stairs, skipping, tennis or dancing. So there’s something for everyone, regardless of age, agility or fitness level.

Resistance exercises – using resistance bands or the machines found in gyms and increasingly in parks and other public spaces. Dancing and even gardening can also come into this category.

Exercises that involve resistance or lifting weights boost bone health. If the whole idea of weights is a little daunting, exercises as simple as lifting a tin of beans up and down while you’re watching TV can help to strengthen your wrists – a common area for osteoporosis to cause broken bones.

Other muscle-strengthening exercises to try include yoga, and pilates.

We would suggest talking to your GP to rule out osteoporosis or any physical issues that may limit your choice of activity. You may also want to consider working with a personal trainer to assess your ability.

Other lifestyle factors to consider that can lead to osteoporosis

Smoking – this has been shown to increase the risk of developing osteoporosis and the risk of bone fracture.¹⁴ Smoking has also been shown to impair the bone healing process after a break.

If you smoke, the best thing you can do to protect your bones is to quit smoking. Even those who stop later in life can help limit smoking-related bone loss.

Excessive alcohol consumption – this can be detrimental to bone health both physiologically – by interfering with our calcium levels and the production of certain bone-protecting hormones – and by increasing our risk of a fall.¹⁵

Even relatively small amounts make us more vulnerable to accidents and injury and as with smoking, a list of related health and other problems.

Are you at risk?

Many factors influence whether you are likely to develop osteoporosis. You are more at risk if you:

• are female,
• have had irregular periods, an early menopause or a hysterectomy before 45,
• have a family history of osteoporosis or fractures,
• are of European or Asian descent,
• are over 60,
• have suffered from an eating disorder or are underweight,
• have a calorie-restricted diet – low calorie diets (<1000kcal) have been linked with loss of bone density even when combined with exercise,¹⁶
• have taken long-term steroid medication,
• drink to excess,
• smoke,
• have a medical condition that affects food absorption such as Crohn’s disease or coeliac disease,
• are a man with low levels of testosterone,
• have reduced mobility,
• are pregnant.

If you have three or more of the risk factors above – particularly if you are post-menopausal – or if you have suffered a fracture after a minor fall, it's a good idea to talk to your GP about having a scan.

This can measure your bone mineral density and assess whether you have osteoporosis or are at increased risk of developing it.

References

1. Peak Bone Density age – Orthoinfo
2. Osteoporosis – NHS
3. DEXA Scan – NHS
4. Fragility Fractures – NIH
5. Osteoporosis – Age UK
6. Women at more risk of Osteoporosis – NHS
7. Epidemiology of fractures – NIH
8. Calcium stores – NIH
9. Calcium – British Dietetic Association (BDA)
10. Vitamin D helps your body absorb calcium – NHS
11. Nutrition for bones – Royal Osteoporosis Society
12. Physical Activity and Risk of Fracture – Journal of Bone and Mineral Research
13. Exercises for bone health – NIH
14. Smoking and osteoporosis – NIH
15. Alcohol and osteoporosis – NIH
16. Low calorie intake and bone health – NIH