Osteoporosis

What is osteoporosis?

Bones are living tissue that continually break down and rebuild throughout our lives. When we're young, new bone is produced faster than old bone is broken down, helping bones grow and become stronger.

As we get older, we gradually lose bone density. Osteoporosis develops when bones become less dense and more fragile, increasing the risk of fractures.

Is osteoporosis painful?

Osteoporosis itself doesn't usually cause pain, but the fractures it can cause may be painful. Having osteoporosis increases your risk of breaking a bone, but it doesn't mean that every fall will result in a fracture.

What causes osteoporosis?

Anyone can develop osteoporosis; however, certain risk factors can increase your susceptibility. These include:

Your genes

Genetics are a key factor in osteoporosis risk. This will all depend on your family's build. If your parents have small, fine builds, you may be more at risk.

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 age 75, it is estimated that around half of the population will have osteoporosis as measured by a bone density scan.

Menopause

Menopause accelerates bone turnover due to the sharp drop in oestrogen, making bones more prone to fractures. Approximately 2% of bone density is lost year-on-year following menopause, which can lead to osteoporosis. 

Alcohol and smoking

Smoking and regularly drinking too much alcohol can affect bone health and increase the risk of osteoporosis and fractures. If you smoke, stopping can help protect your bones as well as your overall health. If you drink alcohol, aim to stay within the recommended limit of no more than 14 units a week.

Low body weight

Having a low body weight usually means smaller bones, increasing the risk of bone loss in later life. Those with anorexia (or a history of anorexia) may also be at a higher risk. 

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

An overactive thyroid (hyperthyroidism) can increase the risk of osteoporosis and bone fractures.

Malabsorption problems

Conditions that affect nutrient absorption, including Crohn's disease and coeliac disease,  can increase the risk of poor bone health.

Diagnosing osteoporosis

If you're concerned about your risk of osteoporosis, speak to your GP. They can assess your risk and may recommend a DEXA (DXA) scan to measure bone mineral density. If you're diagnosed with osteoporosis, they'll discuss whether treatment is appropriate.

How is osteoporosis treated?

Treatment for osteoporosis aims to strengthen bones and reduce the risk of fractures. Depending on your individual risk, your doctor may recommend medication alongside lifestyle measures such as regular exercise, a balanced diet, stopping smoking and limiting alcohol. Taking steps to reduce your risk of falls can also help prevent fractures.

Preventing osteoporosis

If you are at risk of developing osteoporosis (e.g. you’ve had an osteopenia diagnosis), there are steps you can take to help prevent it.

These include lifestyle changes such as quitting smoking, reducing alcohol consumption, exercising regularly, and eating a well-balanced diet.

Diet and osteoporosis

Eating a balanced diet that includes a variety of foods is important for bone health. In particular, you should ensure you get enough calcium, vitamin D, and protein.

Calcium

Calcium is important for maintaining healthy bones and teeth. Most adults need around 700 mg of calcium a day, and many people can get enough through a balanced diet.

Good sources include:

• milk, cheese and yoghurt
• green leafy vegetables such as broccoli, cabbage and kale
• calcium-fortified plant-based drinks and breakfast cereals
• tofu made with calcium
• nuts and sesame seeds
• fish where the bones are eaten, such as sardines and pilchards.

Some people with osteoporosis may need additional calcium. If you're concerned about your calcium intake or are considering a supplement, speak to your doctor or a nutrition professional about your individual needs.

Vitamin D

Vitamin D helps the body absorb calcium and is important for healthy bones.

In the UK, most people can make enough vitamin D from sunlight during spring and summer, but it can be difficult to get enough from food alone. Everyone should consider taking a daily supplement containing 10 micrograms (400 IU) of vitamin D during autumn and winter. Some people may be advised to take a supplement year-round.

Dietary sources of vitamin D include:

• oily fish, such as salmon, sardines and mackerel
• egg yolks
• fortified foods, such as some breakfast cereals and fat spreads.

If you're unsure whether you need a vitamin D supplement, speak to your doctor or a nutrition professional.

Many micronutrients are needed for healthy bones including sulphur, iron, zinc, copper, manganese, boron, silicon, vitamin C and B12, so it's clear to see that a very diverse diet with a wide range of foods containing these nutrients is needed for good bone health.

- Sara Kirkham BSc (Hons) mBANT, CNHC in 'Osteoporosis and diet'.

Foods to limit

A balanced diet is more important for bone health than avoiding particular foods.

However, as part of a healthy diet, it can be helpful to limit:

• foods high in salt
• foods and drinks high in sugar
• excessive caffeine.

If you have osteoporosis or are concerned about your bone health, a nutrition professional can help you understand how to maintain a balanced diet that meets your individual needs.

How can a nutrition professional help?

A nutrition professional can help you understand whether you're getting enough nutrients to support your bone health and suggest practical ways to maintain a balanced diet that meets your individual needs.

For a personal perspective, Registered Nutrition Practitioner Helen Ritchie shares her experience of making diet and lifestyle changes after an osteoporosis diagnosis.