What is osteoporosis?

Osteoporosis is a condition where the bones have lost strength and structure. This results in fragile bones that have an increased likelihood of incurring fractures from a fall that would otherwise cause a minor trauma. Common bones to fracture are hip, spine, wrist and forearm. Hip fractures are very common in older people and can lead to fatality. Osteoporosis is a serious progressive condition that can result in pain, disability and reduction of life quality.

How common is osteoporosis?

In the UK, osteoporosis is estimated to affect around 9% of women and 1% of males.

What are the symptoms of osteoporosis?

Osteoporosis develops over many years, often with no detectable symptoms. Symptoms can include:
  • Fracture (with lower force than would be expected to a cause a fracture)
  • Frequent falls
  • Back pain
  • Postural changes
  • Reduced height

What causes osteoporosis?

Bone is a living tissue that is resorbed and remodelled to allow for growth. A peak bone density is achieved in early adulthood, following which bone is resorbed faster than it is remodelled, resulting in inevitable age-related bone loss. Factors associated with the pronounced bone thinning categorised as osteoporosis include:

Early menopause: oestrogen is protective against bone loss.

Diseases and conditions: certain conditions, including hormonal diseases (e.g. Cushing’s disease, hyperthyroidism and hyperparathyroidism) and inflammatory diseases (e.g. rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease) are associated with increased risk of bone loss.

Medication: bone loss is a side affect of long-term use of corticosteroids. Other drugs may also indirectly contribute to osteoporosis.

Age: older age groups have higher rates of osteoporosis because as we age more bone is lost than is made.

Sex: more females develop osteoporosis compared to males.

Family history: genetic factors play a role in bone growth.

Being underweight: low body weight can reduce oestrogen levels and is associated with malnutrition and low intake of nutrients required to build strong bones. People with low body weight also tend to have thinner bones, which have less density to lose than thicker bones.

What is the treatment for osteoporosis?

Management of osteoporosis depends on an individual’s risk of fracture based on current bone mineral density, factors which put individuals at increased risk of falls (e.g. vision or cognitive impairment) and co-existing health conditions or lifestyle factors which affect bone health (e.g. diabetes mellitus, hyperthyroidism, premature menopause, smoking and high alcohol intake). Treatment options include prescription of bone sparing drugs (bisphosphonates), calcium and vitamin D supplementation, hormone replacement therapy, lifestyle advice and drugs to manage pain.

What diet and lifestyle strategies can support osteoporosis?

Strategies to prevent and support osteoporosis treatment should promote a balanced diet that provides adequate nutrients that are required for bone growth and an increase in appropriately tailored activity and exercise. Helpful dietary and lifestyle strategies include:

Regular weight bearing exercise: force on the bones from movement and the jolting of weight bearing exercise encourages the turnover of bone tissue resulting in stronger healthier bones. Useful exercises (following advice from your GP or physiotherapist) include: lifting weights, brisk walking or jogging, push-ups, dancing and aerobics.

Balance your fats: high fat diets could reduce absorption of calcium and increase production of inflammatory messengers that trigger bone tissue breakdown and loss. To reduce inflammation, increasing dietary intake of healthy fats is important in combination with limiting inflammatory fats. Eat foods rich in Omega 3 fatty acids (found in oily fish, nuts and seeds) and monounsaturated fats (olive oil), whilst limiting intake of saturated fat and trans fats that are found in processed meats, red meats, refined oils, cakes, biscuits, pastries and spreads.

Get your daily calcium intake: getting enough daily calcium is very important to support bone health. Good sources of calcium include green leafy vegetables (e.g. kale, greens and broccoli), fish - especially canned whole fish including the bones, dairy foods and fortified dairy alternative milks. Supplements should be used to boost daily calcium intake if sources of dietary calcium are inadequate.
Get some sunshine: vitamin D is required for calcium absorption and may increase muscle strength. The best source of vitamin D is made by skin exposed to sunlight, getting at least 10 minutes of sunshine daily can help to boost levels. Many people are deficient in vitamin D due to not getting enough sunshine because they spend the majority of time indoors or covered up with clothes. A nutritional therapist can give advice on vitamin D supplement dosage to increase vitamin D levels.

Reduce salt consumption: eating a diet high in salt can increase the amount of calcium lost from the body. Check food labels to avoid high salt products and reduce salt added during cooking and at the table. Flavour food instead with herbs and spices.

Eat plenty of fruit and vegetables: eating a wide range of fruit and vegetables of many different colours every day will help to provide vital nutrients including vitamin C, potassium, calcium, vitamin K, magnesium and fibre which are essential nutrients of a balanced diet to help build strong bones. Vegetables and fruit are also a source of antioxidants, which help to protect tissue against damage from oxidative stress. This mechanism could be important in bone health because connective tissue in the bones can be damaged by free radicals, which are counteracted by the body’s antioxidant defence system.

Reduce alcohol and caffeine consumption: even moderate alcohol and caffeine intake increases the risk of osteoporosis.