Osteoporosis

Osteoporosis is a medical condition that causes bones to weaken, making them more prone to fractures. This means, even if a bump or fall is minor, an osteoporosis sufferer may still break a bone.

Fractures (broken bones) through osteoporosis can happen in any part of the body, however the hips, wrists and spine are most commonly affected. It's estimated that the condition affects around three million people in the UK.

Here we'll look at osteoporosis in more depth and explain how nutrition plays a key role in maintaining bone health.

skeleton

What is osteoporosis?

Our bones are made up of collagen (protein), calcium salts and other materials. They all have an outer shell covering a mesh of trabecular bone, which resembles honeycomb. Like the rest of our bodies, bone is alive and changes throughout our lives. Worn out bone gets broken down by osteoclast cells and is replaced with bone-building cells called osteoblasts.

When we're young, this process happens quickly. In childhood, it takes just two years for the entire skeleton to renew itself. By the time we reach adulthood, this process slows to seven or even 10 years. Between the ages of 16 and 18, our bones stop growing in length, but bone density continues to increase until our late 20s.

After the age of 35, our bones begin to lose their density, gradually becoming weaker as we age. For some people, this leads to osteoporosis. Women tend to suffer from the condition more; this is because bone loss happens more rapidly in the years following menopause.

Is osteoporosis painful?

The condition is only painful when it leads to a fracture. If you don't have a fracture, you won't feel pain in the bones. It is also important to note that having osteoporosis only means you are more likely to break a bone, it doesn't mean you will definitely break a bone when/if you fall.

If a fracture does occur, your bones will heal in the same way as those who don't have the condition. Of course, fractures are painful and can lead to other complications.

What causes osteoporosis?

Anyone can develop osteoporosis, however certain risk factors can make you more susceptible. These include:

Your genes

Genetics are a key factor in osteoporosis risk. This will all depend on the build of your family. If your parents have small, fine builds, you may be more at risk. If broken hips are common in your family too, you may need to take extra care.

Your age

The older you get, the more at risk you will be. This is because our bones naturally become more fragile as we age. By the age of 75, it is estimated that around half of the population will have osteoporosis as measured on a bone density scan.

Your gender

Women are more at risk than men. This is because they have smaller bones. The menopause also accelerates the rate of bone turnover, making them more prone to breakage.

Alcohol consumption

Consuming too much alcohol has been found to link to osteoporosis and fractures. Staying within the recommended daily allowance is advised.

drink

Whether or not you smoke

Research has found that those who smoke are more likely to break bones. This is because the toxins in cigarette smoke affect cells, organs and hormones involved in bone health. Smoking, therefore, leads to more rapid bone loss as you age, increasing your risk of osteoporosis.

Low body weight

Having a low body weight usually means bones are smaller, increasing the risk of bone loss in later life. In women, fatty tissue produces small amounts of oestrogen which helps to protect bones, so those with less fat won't have as much protection. Those with anorexia (or a history of anorexia) may also be at a higher risk. This is because the eating disorder tends to lead to very low body weight, affecting oestrogen production in women and contributing a significant loss in bone density.

Inflammatory conditions

Autoimmune disorders and chronic inflammatory conditions can put you at a greater risk of developing osteoporosis because they increase the rate of bone turnover. Long-term use of certain medications can also impact your risk.

Thyroid problems

In particular, hyperthyroidism is linked to osteoporosis. This is because it increases the number of bone-remodelling cycles your body goes through. After the age of 30, the more of these cycles you go through, the more bone density you lose.

Malabsorption problems

Digestive disorders like Crohn's disease and celiac disease can also put your bones at risk. These kinds of conditions affect your body's ability to absorb nutrients important to bone health, like calcium and vitamin D. This means you are more likely to have low bone density and suffer fractures.

Diagnosing osteoporosis

If you think you might be at risk of having osteoporosis you are advised to speak to your doctor. If they suspect you have the condition they can use an online programme to assess you. They may also advise you to have a DEXA (DXA) scan. This measures your bone mineral density and can assess your risk of fracture.

Once a diagnosis has been made, your doctor will advise you on whether or not you require treatment.

How is osteoporosis treated?

For osteoporosis, treatment tends to revolve around the prevention of fractures. This means using medication to strengthen bones and making lifestyle changes to boost bone health. Treating fractures when they happen and encouraging healing is also a key element of osteoporosis treatment.

To help reduce your chances of falling you are recommended to remove trip hazards from your home and to take extra caution in icy weather. Having regular sight and hearing tests can also be useful.

Preventing osteoporosis

If you are at risk of developing osteoporosis, there are steps you can take to help prevent it. These include lifestyle changes such as quitting smoking, reducing alcohol consumption, taking regular exercise and eating a well-balanced diet.

Regular exercise is essential for staying healthy. Weight-bearing exercise and resistance exercise in particular are known to improve bone density. Weight-bearing exercise involves using your legs and feet to support your weight. Examples of this kind of exercise include running, dancing and aerobics.

Resistance exercise involves muscle strength, where the tendons pull on the bones. This helps to increase bone strength. Examples of resistance exercise include weight-lifting, push-ups and pull-ups.

As we mentioned previously, excessive alcohol consumption and smoking both increase your chances of developing osteoporosis. Reducing the amount you drink and quitting smoking will help reduce your risk and improve overall health.

One of the most important factors in osteoporosis prevention and treatment is diet. What we eat has a big impact on our health, and that includes bone health.

cooking

Osteoporosis diet plan

Eating a balanced diet that contains a variety of foods is important when looking at bone health. This ensures you get enough vitamins, minerals and energy you need to maintain health and reduces your risk of developing chronic conditions.

If you have been diagnosed with osteoporosis, or are at risk of developing the condition, looking at your diet can help. In particular, you should ensure you are getting enough calcium and vitamin D.

Calcium

This mineral is important for building strong bones and teeth. Our bodies contain around 1kg of calcium and 99% of this is found in our bones. Current guidelines state that most adults need 700mgs of calcium a day. However, you should check with your doctor if you think you may require a different amount (for example, pregnant women require more).

Don't worry if you don't have exactly 700mgs every day, it is the average daily amount that's important. Most people will be able to get the recommended amount through diet alone, however, some may be recommended to take calcium supplements. If you have been diagnosed with osteoporosis, you may need 1000mgs a day and so your doctor may advise a supplement alongside your other medication.

Ensuring you have enough calcium in your diet is an important factor for bone health. You can have too much calcium though; having over 2,500mg of calcium a day regularly could cause medical problems. It can also affect the way your body absorbs other minerals like magnesium and iron.

To ensure you are getting the right balance, you may find it useful to consult a nutrition professional

The following foods are known for containing calcium and will typically form part of an osteoporosis diet plan:

  • dairy - milk, yoghurt, cream, cheese etc.
  • green leafy vegetables such as cabbage, broccoli, kale and okra also fennel, spinach
  • fortified orange juice
  • sesame seeds
  • dried figs and apricots
  • tofu, calcium-fortified
  • soya drinks with added calcium
  • soya beans
  • nuts
  • bakery produce made from fortified flour
  • calcium-fortified breakfast cereals
  • fish with small edible bones, such as sardines and pilchards

Vitamin D

This vitamin is important as it helps your body to absorb calcium. Most vitamin D is made by our bodies when our skin is exposed to sunlight. Short-term exposure to sunlight without sunscreen (around 10 minutes, twice a day), when the sun is shining, should be enough for the whole year.

Vitamin D can also be found in certain foods, including:

  • eggs
  • oily fish such as sardines and salmon
  • fortified fat spreads
  • powdered milk
  • fortified breakfast cereals

You should be able to get all the vitamin D you need through diet and lifestyle alone. An osteoporosis diet plan will look to provide adequate amounts of vitamin D, however, there are some cases where a supplement may be required. Check this with a doctor or nutrition professional.

While calcium and vitamin D are essential, they're not the only important nutrients for bone health.

"Zinc, boron and manganese are also essential as they are like glue that holds a framework together. We also rely on vitamin K2 to transport the minerals in to your bones. K2 also comes from green leafy vegetables."

- Melody Mackeown

open sandwiches

Foods to limit

As well as ensuring you eat a balanced diet containing bone-healthy foods, it is important to note that some foods can decrease bone density. Such foods should be limited, especially if you're at risk of developing osteoporosis.

Salt

Consuming too much salt can lead to calcium loss, which weakens bones over time. High-salt diets can also lead to high blood pressure, heart disease and even diabetes - plenty of reasons to limit your intake.

Experts advise that we eat just 6g of salt a day. To stay within the recommended daily amount, try the following:

  • Check food labels for salt content to monitor your intake.
  • Use herbs and spices to flavour food instead of salt.
  • Avoid high-salt items e.g. processed foods, baked goods and canned soups/sauces.

Carbonated drinks

Many soft drinks contain phosphoric acid. This can increase calcium excretion when you urinate, which can be a problem if your calcium intake is already low.

Try to limit your intake of carbonated drinks and opt for water and fruit juices instead.

Caffeine

While not as damaging as salt, caffeine also has a detrimental effect on bone density. Limiting your intake to 300mg a day while ensuring you are getting enough calcium from your diet is advised.

Interestingly, tea has been found to do less harm than coffee. This is thought to be because tea contains plant compounds that protect bones. Try to switch from coffee to tea and drink plenty of water and milk too.

How can a nutrition professional help?

As we have discussed, there are many factors that can cause osteoporosis. There are also many things you can do to help prevent it and build bone strength. A big part of this is diet.

Ensuring your diet is varied and provides key nutrients for bone health (such as calcium and vitamin D) is important. Gaining the support and advice from a professional can make this process simple and easy to maintain. 

A trained nutrition professional will work with you (and your doctors if necessary) to develop a tailored osteoporosis diet plan. This will help to improve overall health while working to keep bones healthy and strong. Many professionals will also be able to offer lifestyle and exercise tips to support your new way of eating.

Further help 

Content reviewed by dietitian, Claudia Ehrlicher. All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.

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