Prevention and lifestyle management of osteoporosis

What is osteoporosis?

Osteoporosis is an age-related condition where bone strength is compromised due to deterioration in bone mass and quality; this decrease leads to an increase in bone fragility and susceptibility to fractures. Bone fractures from osteoporosis can occur in the wrist, femur, hip or vertebrae, and can have a devastating impact on an individuals quality of life. Living with osteoporosis involves not only looking after the strength of your bones but also reducing your fracture risk as your age.

Keeping your bones strong

What is bone?

Bone is living, growing tissue, compiled mostly of collagen and calcium phosphate. This combination of calcium and collagen makes bones flexible and strong, helping the bone withstand the physical stress of day-to-day life. Ninety-nine per cent of the body’s calcium is in the bones and teeth. The remaining one per cent is in the blood.

During your lifetime, old bone is removed (bone resorption) and new bone is added to your skeleton. When you’re a child and teenager, new bone is added faster than old bone is removed, helping your bones become larger, heavier, and denser. Bone formation outpaces bone resorption until your late 20s (when you reach peak bone mass). After reaching peak bone mass, bone resorption gradually begins to overtake bone formation.

For women, bone loss occurs more rapidly just after menopause and continues into the postmenopausal years. Osteoporosis develops when bone resorption happens too quickly or when bone formation happens too slowly. Osteoporosis is also more likely to develop if you fail to reach optimal peak bone mass density during your bone-building years.

What can cause osteoporosis?

Certain factors can impact bone density and contribute to your likelihood of developing osteoporosis. Many people with osteoporosis have multiple risk factors, but others can have osteoporosis with no known risk factors. Some risk factors are genetic; others are related to diet and lifestyle.

Risk factors for osteoporosis

• Gender — Women have a greater chance of developing osteoporosis as they have less bone tissue and lose bone faster than men.

• Age — Your risk of developing osteoporosis increases with age, as does your risk of fall and fracture.

• Body size — Women with low body weight are at greater risk of developing low bone density and osteoporosis.

• Cultural background — White and Asian women are at highest risk of developing osteoporosis.

• Family history — Fracture risk may be hereditary. If your parents have had a fracture, you may also be at risk of reduced bone mass and fracture.

• Hormones — Low oestrogen due to menopause or abnormal absence of your period (amenorrhea) and low testosterone in men can increase your risk of osteoporosis.

• Medication use — Long-term use of certain medications (eg. glucocorticoids) can lead to loss of bone density.

• Sedentary lifestyle — An inactive lifestyle or extended bed rest can weaken bones and decrease your coordination, increasing your risk of falls and fracture as you age.

• Smoking — Smoking can impact bone density and contribute to osteoporosis.

• Alcohol intake — Drinking more than two standard drinks a day can increase your risk of osteoporosis and fracture.

• Digestive conditions — Poor general health coupled with digestive disorders affecting absorption of minerals (eg. coeliacs disease) can also impact bone density and increase your risk of fracture.

• Malnutrition — Malnutrition, especially of protein, vitamin D and calcium, can reduce bone density and increase fracture risk.

Symptoms of Osteoporosis

Osteoporosis develops slowly over many years, and the first symptoms may be what is known as a ‘fragility fracture’, a broken bone as a result of a minor fall.

Some other signs of osteoporosis may include:

• Back pain — Back pain associated with fractured or collapsed vertebra can occur almost anywhere in the spine.

• A gradual loss of height — A gradual loss of height, as much as 15 centimetres can also occur.

• A stooped posture — A stooped posture may develop as a result of fractures in the bone of the next

• A bone fracture from a minor fall — Fractures can occur from minor injuries or falls, or they can occur without an injury.

Diagnosing Osteoporosis

A bone density test can help diagnose osteoporosis. It’s a short scan that will tell how your bone density compares to that of a young, healthy adult.

While bone density tests can help diagnose osteoporosis, they are not the only determinant of your risk of bone fractures. Your doctor will also consider your age, gender and health history before deciding whether you need treatment for osteoporosis.

How do I keep my bones strong and healthy?

Several nutrients are known as the building blocks of healthy bone. Combine a bone-building diet with exercise, and you can help keep your bones strong and healthy as you age.

Calcium for strong bones

Calcium performs numerous biological functions in the body, one of the most vital being bone density. Calcium is needed for bone development and maintaining bone strength and structure throughout your life. Dietary sources of calcium include dairy products such as milk, yoghurt and cheese, green leafy vegetables, tofu, sardines and salmon with soft edible bones, brazil nuts, almonds, unhulled tahini and calcium‐fortified foods. Speak to your healthcare practitioner to determine the right dose for you.

Vitamin D

Vitamin D plays an essential role in maintaining bone mineralisation. Vitamin D is needed for calcium to perform vital functions in healthy bone growth and development. Vitamin D also helps maintain muscle function and strength in elderly individuals.

Most vitamin D is produced by the skin after sunlight exposure. Ageing, sunscreen use and seasonal changes in sun exposure can dramatically affect your levels of vitamin D.

Speak to your healthcare practitioner to determine the right dose of Vitamin D for you.

Magnesium

Like calcium, magnesium is an integral part of the structure of bones and maintaining adequate dietary magnesium is essential for bone health. Approximately sixty per cent of magnesium is stored in bone, and magnesium is necessary for bone cells to function. Magnesium can be found in green vegetables, nuts, seeds, unprocessed grains and legumes such as chickpeas, lentils and soybeans.  Your healthcare practitioner can advise on a recommended dose of magnesium for you.

Exercise

Exercise not only helps you achieve greater peak bone mass when your young, but it helps prevent bone loss as you age.

When stress is placed on the bones through exercises such as running, jumping, and weight lifting, bone cells called osteocytes send signals to other bone cells to help make the bones denser and stronger.

Fracture prevention in osteoporosis

Fall is the direct cause of almost all non-vertebral and some vertebral fractures in osteoporosis. Reducing the risk of falls can help prevent fractures that could impact your quality of life as you age.

Fall prevention involves:

• Strength and balance training — Exercises that improve strength and balance can help reduce the risk of falls and subsequent fractures.
• Treat gait disorders — Health issues that can impact balance and walking, such as osteoarthritis can lead to falls. Addressing these issues with your healthcare professional can help minimise the risk.
• Eliminating environmental fall risk factors — Fall risk factors around the home can include poor lighting, obstacles on the floor, slippery mats, improper shoes, lack of handles in the bathroom, doorsteps or stairs and uneven footpaths.
• Improve vision — Improvements in visual function, circulation and cognitive function need to be addressed to help prevent falls.
• Medications — Review medications that may be causing dizziness or sleepiness and verify that important medicines are being taken.
• Provide orthopaedic equipment — Orthopaedic equipment such as a walker may be needed.

Keeping your bones healthy and strong helps you maintain your quality of life as you age, reducing your risk of osteoporosis and fractures.

Incorporating exercise and a healthy diet rich in calcium, vitamin D and magnesium into your daily routine will help keep your bones strong and support bone density as you age.

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