How to reduce the risk of developing osteoporosis

What is osteoporosis? Who’s most at risk of developing it? How do you know if you have it? Is there anything that can be done to reduce the risk?

What is osteoporosis?

Osteoporosis literally means “bones with holes”.  It occurs when bones lose calcium more quickly than the body can replace it.  Bones then become less dense, lose strength and break more easily.  

Osteoporosis is a significant problem. Studies in the US have shown that 50% of women over the age of 50 will at some point fracture a bone due to osteoporosis. 

In Australia it’s estimated there are currently around 6.2 million Australians over the age of 50 with osteoporosis or osteopenia (poor bone health), a 31% increase from 2012.

Who’s most at risk of developing osteoporosis?

Unfortunately being female automatically puts you at higher risk particularly after menopause. 

Females are born with less bone density than males.  Hormones such as oestrogen and testosterone also play an important role in bone growth and replacement.  After menopause the levels of these hormones are reduced.  As a result in the first 5 years after menopause an average woman will lose around 10% of her total bone mass, increasing the risk of developing osteoporosis.

Other medical conditions which can increase the risk even further include:

• thyroid disease or an overactive thyroid gland
• rheumatoid arthritis
• chronic liver and kidney disease
• conditions that affect the body’s ability to absorb nutrients, such as Crohn’s disease and coeliac disease
• long term use of corticosteroids (commonly used for asthma prevention)
• going through menopause before the age of 45
• a family history of osteoporosis

How do you know if you have osteoporosis?

For most people the first sign they have osteoporosis is unfortunately when they break a bone as there aren’t any symptoms.  The only real way to determine if you have it is a bone density test, known as a DXA scan.  These are readily available at most medical imaging centres. 

It’s recommended that women start having DXA tests each 12-24 months from around age 65, younger if there are other risk factors present. 

What can you do to decrease the risk?

The good news is there are lifestyles and dietary choices you can make which will help reduce the likelihood of developing osteoporosis later in life and if you already have it prevent further bone loss and reduce your risk of bone fractures.

Eat calcium rich foods

Adequate calcium is extremely important for keeping your bones healthy.  99% of the calcium in your body is found in your bones.  If you don’t consume enough calcium you won’t be able to replace bone which is lost, which can make them weak and brittle.  If you have insufficient calcium in your blood, your body will take it from your bones, further exasperating the problem.

It’s recommended that women consume 1,000 mg of calcium per day, increasing to 1,300 mg per day after menopause.

The biggest source of calcium is dairy products.  The Australian Government Health Guidelines recommend that women have 2 ½ serves of dairy a day, increasing to 4 serves after age 50.

A serve of dairy is equal to:

• 1 cup (250ml) of milk
• ¾ cup (200g) of yoghurt
• 2 slices (40g) of hard cheese
• ½ cup (120g) of ricotta cheese

Other dietary sources of calcium include:

• calcium-fortified juices and foods, like cereal, soy milk, and tofu,
• sardines and salmon with bones
• dark green vegetables, like kale, spinach and broccoli

As these sources are all lower in calcium than dairy, you need to include between 3–5 serves each day.

Nutrition labels on packaged food will often indicate what percentage of your daily calcium needs are in a serving and in 100ml / 100g. These labels are based on a daily allowance of 1000 mg, so if the label says, “25% of daily calcium,” that means you’re getting 250 mg of calcium per serving. If you’re post menopausal you should be consuming around 1,300mg so it will only be around 19% of your daily calcium needs.

While the best way to get sufficient calcium is from your diet, if you are struggling to get enough calcium for example because you are lactose intolerant or vegan it’s worth discussing with your GP whether calcium supplements might be suitable. 

Get some sun

Vitamin D is important in preventing osteoporosis because it helps the body absorb calcium. 

Vitamin D can be found in small quantities in foods such as fatty fish, liver, egg yolks, cheese and Vitamin D fortified milk, cereals and orange juice.  However, it’s very difficult to get enough Vitamin D from diet alone.  The easiest way is via sunlight. 

In Australia we have been taught to avoid the sun where possible especially during the middle of the day and use sunscreen whenever we are outdoors.  While this has helped reduce the rates of skin cancer, it has conversely lead to an increase in the amount of Australians who aren’t getting enough Vitamin D.  Studies have shown that around 30% of Australian adults are deficient in Vitamin D.  The number is higher in women and in the southern states, especially during winter. 

Therefore, it’s important to continue to spend some time in the sun, while balancing the risk of skin cancer and premature aging. The amount of sun exposure needed to get adequate amounts of Vitamin D will depend upon your skin tone, where you are located, the time of the day and the season.  But as a guide, in summer you should be able to get adequate Vitamin D from a few minutes in the sun.  Avoid high UV times, so go outside early-morning or late-afternoon.  In winter, where the UV index is typically below 3, aim to go out in the middle of the day for 10-15 minutes.  It’s important to make sure you leave some skin uncovered. 

Do weight bearing and strength / resistance training exercises

Exercise is an extremely important factor in osteoporosis prevention. 

Weight bearing exercises such as brisk walking, hiking, jogging, tennis, basketball or netball, tennis and yoga force your legs to work against gravity as you move.  The force you exert to counteract gravity stimulates your bones to get stronger.

When you land a jump or pound the ground with each step as you run, you multiply the weight-bearing effect of gravity. This means that higher-impact activities such as jogging and tennis will have a more pronounced effect on bone than lower-impact exercises.

Exercises that require balance are really helpful. They don’t necessarily increase your bone density but they do help prevent you falling, which is a leading cause of fractures.

Strength or resistance training is also important for bone health and osteoporosis prevention.  When you apply resistance to a muscle it pulls against the bone, causing the bone to also strengthen.  Strength training can maintain or even increase bone density as well as having a lot of other health benefits for women. 

While working out in a gym using free weights or machines is great for strength training, there are still plenty of ways to improve muscle and bone strength if you don’t have access to a gym.  Try a workout at home with some resistance bands or do body weight exercises such as push ups, squats and lunges. 

Consistency is key in building bone and muscle strength. Aim to do 30-40 minutes of weight bearing exercises and strength training exercises 4-5 times per week.  Mix up the type of exercises you do as variety is also important. 

Get enough protein

Protein is an important factor in bone density.  Studies have shown that protein intake is associated with higher bone mass density, a slower rate of bone loss, and reduced risk of hip fractures, provided that you also have enough calcium in your diet.

How much protein you need will depend upon how much you weigh and how active you are, but as a guide the recommended intake for women aged up to age 50 is 2 1/2 serves of lean meats, fish, poultry, eggs, nuts, seeds, legumes or beans and 2 1/2 serves of milk, yoghurt or cheese per day. For women over 50 the recommended intake reduces to 2 per day.

Limit alcohol

Excessive alcohol consumption increases your risk of osteoporosis.  Limit alcohol intake to no more than 2 standard drinks per day and try to have at least two alcohol free days per week. 

Watch your caffeine intake

While coffee has a lot of health benefits, consuming more than the recommended amount of 400mg of caffeine per day can decrease your body’s ability to absorb calcium, leading to bone loss. 

Give up smoking

Smoking is another risk factor. Studies have shown that smoking doubles the chance of having a bone fracture due to osteoporosis. This is because smoking decreases the body’s ability to absorb calcium, resulting in bone loss.

Maintain a healthy weight

Being obese can lead to lower bone density and increased risk of fractures.

Conversely being underweight (having a BMI of under 19) can also lower your bone density, increasing the risk of developing osteoporosis.

Medications

As well as diet and lifestyle choices, there are various medications available which can be effective to treat osteoporosis or prevent osteoporosis developing, including bisphosphonates, selective oestrogen receptor modulators and menopausal hormone therapy (previously known as HRT).   If you are in a higher risk category of developing osteoporosis, it’s worth discussing with your GP whether these might be suitable for you.