Say No to Fragile Bones This World Osteoporosis Day

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It's often referred to as a "silent disease" because there are no early warning signs, and most people don't realise they have it until they experience a fracture.

Over 3.5 million people in the UK are currently affected by osteoporosis. While the condition isn't reversible, it can be manageable with the right treatment.

This World Osteoporosis Day, we're here to help you understand what osteoporosis is, who is at increased risk, and how we can look after the health of our bones to prevent them losing strength and density.

What is Osteoporosis?

Osteoporosis occurs when the body loses too much bone, makes too little bone, or both. Bones are living tissues that are constantly being broken down and rebuilt. However, with osteoporosis, bone loss outpaces bone formation, leading to decreased bone density and a porous structure. This condition often develops without symptoms, so it can progress and still remain unnoticed for years - until a sudden fracture reveals the bone weakness.

In severe cases, even a minor bump or fall can lead to a broken bone. Commonly, people with osteoporosis will experience a wrist fracture as the first sign of weakness, often as a result of trying to break a fall with their hands. Just how easily these breaks can occur makes osteoporosis a significant health concern, particularly for older adults.

What Are the Risk Factors for Osteoporosis?

There are several risk factors that can increase the likelihood of developing osteoporosis. These factors are often broken down into two categories: non-modifiable (things you can't change) and modifiable (things you can change).

Non-Modifiable Risk Factors

• Age: Bones stop growing in length typically between the ages of 16 and 18, but bone density (the amount of bone tissue you have) continues to increase slowly, usually until your late twenties. After this, bones gradually lose strength. The risk of osteoporosis increases significantly for men and women over the age of 50.
• Gender: Women are more likely to develop osteoporosis than men; currently, over 78% of the individuals affected by osteoporosis in the UK are women (2). The female sex hormone, oestrogen, plays a role in keeping bones strong - after the menopause as oestrogen levels decrease, your bones lose strength at a faster rate. On average, women also tend to have smaller bones than men which may mean they're more prone to breaks and fractures.
• Genetics: If your parents or grandparents had osteoporosis or suffered from frequent bone breaks, there's a greater chance that you will too. However, a family history of the condition doesn't mean you are guaranteed to develop osteoporosis.
• Ethnicity: The prevalence of osteoporosis varies depending on ethnicity - research indicates that white men and women are at increased risk compared with other ethnic groups (3).
• Body Frame: Low body weight means you're more likely to have less bone tissue, so people with smaller body frames tend to have less bone mass to draw from as they age, in turn increasing their risk.

Modifiable Risk Factors

• Diet: A diet low in calcium and vitamin D can contribute to weak bones. Calcium is essential for bone formation, while vitamin D helps the body absorb calcium.
• Physical Activity: Keeping your bones working helps them to stay strong, and a sedentary lifestyle can increase the risk of weakened bones. Weight-bearing and muscle-strengthening exercises are crucial for bone health - if you're standing, you're weight-bearing, so think walking, jogging, or even running. Using weights or resistance bands, focusing on slow and controlled movements, is a great way to work on your muscle strength.
• Smoking & Alcohol: Smoking and heavy alcohol consumption can impact the body's ability to absorb calcium, which in turn can increase the likelihood of your bones losing strength.
• Hormonal Imbalances: Low levels of sex hormones, especially oestrogen in women after menopause, or testosterone in men, can accelerate bone loss. Thyroid problems can also contribute to the development of osteoporosis - if your thyroid hormone levels are too high, and stay this way for prolonged periods of time, you may be at increased risk of low bone density and osteoporosis (4).
• Certain Medications: Long-term use of steroids, some cancer treatments, or other medications can affect bone strength. However, it's important to note that you shouldn't stop taking any prescribed medication without speaking to your GP first - your doctor will be able to advise you on how you can limit the impact of the medication on your bones, and may also be able to recommend some tips or lifestyle changes to support your bone health.

Groups at Increased Risk of Osteoporosis

While osteoporosis can affect anyone, some groups are at a higher risk:

1. Postmenopausal Women
   Women over 50, especially those who are postmenopausal, are at the highest risk. Oestrogen plays a key role in maintaining bone density, and after menopause, oestrogen levels drop sharply. As a result, bone loss accelerates, especially in the first 10 years after menopause.
2. Men Over 70
   Although osteoporosis affects significantly more women, men are also at risk, particularly as they age. By age 70, men experience a decline in testosterone which plays a crucial role in bone maintenance. Men tend to develop osteoporosis around 10 years later than women, but the consequences can be just as severe.
3. Individuals with a Family History of Osteoporosis
   If osteoporosis runs in your family, you have a higher chance of developing it too, regardless of your age or gender. Genetics play a significant role in bone density and the likelihood of fractures.
4. People with Certain Medical Conditions
   Conditions like rheumatoid arthritis, coeliac disease, or hyperthyroidism can increase the risk of osteoporosis. Similarly, chronic illnesses that may lead to malabsorption, such as Chron’s disease, can affect bone health by reducing absorption of key nutrients.
5. People Taking Long-term Medications
   Taking certain medications like glucocorticoids (steroids), some cancer treatments, and antiepileptics, for example, can weaken bones over time, in turn raising the risk of osteoporosis.

Preventing Osteoporosis and Reducing Risk

Although osteoporosis may not be completely preventable, there are effective ways to reduce your risk of fractures and improve your bone health.

A Diet for Healthy Bones

Calcium is vital for maintaining bone health. Adults need 700mg calcium a day (5), which you should be able to get from a balanced diet - foods like leafy green vegetables, tofu, and dairy products are rich in calcium and can help you meet your daily intake requirements. If you follow a plant-based diet, or worry you're not getting enough calcium just from the food you're eating, a supplement can help you safeguard your needs.

Vitamin D helps the body absorb calcium and is important for keeping your bones and teeth healthy. It's recommended that adults should consume 10 micrograms of vitamin D a day. Some good dietary sources of vitamin D include red meat, liver, oily fish, and fortified foods like breakfast cereals. Many people find it difficult to get enough vitamin D from food alone, so getting some extra support from a supplement may be beneficial, particularly in the autumn and winter months where it's recommended that everyone in the UK should consider supplementing their daily intake due to the decreased levels of sunlight (6).

Exercising for Strength

Weight-bearing exercises like walking, running, hiking or even dancing can help maintain bone density.

Muscle-strength training (lifting weights) increases muscle mass - this kind of exercise builds strength by providing some resistance for your muscles to work against, whether that's your own body weight, resistance bands, or heavier weights. As your muscles get stronger, the more work they'll give your bones to do.

Working on your core strength or practicing balance exercises can help you feel steadier on your feet and may help prevent falls, reducing the risk of fractures.

Smoking & Alcohol Consumption

Smoking tobacco and excessive alcohol consumption can both impact bone health. Smoking can decrease oestrogen production in women, which as we know, is a key hormone for our bone health. Drinking too much alcohol can affect calcium absorption which negatively impacts the formation and maintenance of healthy bones.

Research shows that individuals who either smoke tobacco, or both smoke and consume alcohol, were more likely to develop osteoporosis than those who neither drink alcohol or smoke (7).

Awareness of Your Risk

Most people don’t know they have osteoporosis until they actually experience a fracture. While it’s a condition that can be managed with a variety of treatments, being aware of the health of your bones and your potential risk of developing osteoporosis can help you implement prevention strategies earlier.

The Royal Osteoporosis Society have a quick and easy to use risk checker where you answer some questions about your lifestyle and medical history and receive a personalised report on your bone health in minutes. Click here to check your risk.

Bone density scans (also known as a DEXA scan) are often used to both diagnose or assess risk of osteoporosis. A quick and painless procedure, a bone density scan is more effective than a traditional X-ray in identifying low bone density and helps doctors get a better understanding of your bone health in comparison with a typically healthy individual of the same age, gender and ethnicity as you.

You may be offered a bone density scan if you are over the age of 50 with a risk of developing osteoporosis, or if you are under the age of 50 and have other increased risk factors, such as being postmenopausal, smoking, or taking certain long-term medications.

Treatments & Medication

Osteoporosis isn’t reversible and can’t be cured, but there are many treatment options that can help prevent fractures. Following diagnosis, the best treatment for you will be decided based several factors, such as your age, sex, and history of broken bones.

There are a variety of medications which can help to maintain bone density, slow down the rate of bone loss, and help regulate levels of calcium in your bones. Hormone replacement therapy (HRT) is often recommended for women who are going through the menopause to keep their bones strong and reduce the risk of developing osteoporosis.

Osteoporosis is a silent condition. Being proactive in taking care of your bones, understanding your risk factors for developing the condition and putting prevention strategies in place early can help you maintain strong, healthy bones well into old age.

If you’re concerned about your bone health or want to discuss your potential risk of getting osteoporosis, speak with your GP about the tests and treatments available.

Sources



1. Osteoporosis: Age and Bone Strength. Available at: https://theros.org.uk/information-and-support/osteoporosis/causes/age-and-bone-strength (Accessed: 17 October 2024). 
2. Scope ScoreCard for OsteoPorosis in Europe. Osteoporosis Foundation. Available at: https://www.osteoporosis.foundation/sites/iofbonehealth/files/scope-2021/UK%20report.pdf (Accessed: 17 October 2024). 
3. Cauley, J.A. (2011) ‘Defining ethnic and racial differences in osteoporosis and fragility fractures’, Clinical Orthopaedics & Related Research, 469(7), pp. 1891–1899. doi:10.1007/s11999-011-1863-5. 
4. Thyroid disease and Bone Health. Royal Osteoporosis Society - Better Bone Health for Everybody. Available at: https://theros.org.uk/information-and-support/osteoporosis/causes/thyroid-disease/ (Accessed: 17 October 2024). 
5. Vitamins and minerals - Calcium. NHS choices. Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/ (Accessed: 17 October 2024). 
6. Vitamins and minerals - Vitamin D. NHS choices. Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ (Accessed: 17 October 2024). 
7. Yang, C.-Y. et al. (2021) Effects of sex, tobacco smoking, and alcohol consumption osteoporosis development: Evidence from Taiwan biobank participants, Tobacco induced diseases. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8210532/ (Accessed: 17 October 2024).