Your bones are made up of a hard outer shell and a softer, spongier mesh of bone that looks kind of like a honeycomb. Bones are continually renewing themselves, with cells called osteoclasts breaking down old bone and cells called osteoblasts creating new bone tissue.

What is osteoporosis?

Osteoporosis is a condition where the bone tissue is broken down faster than the new bone tissue is formed. This means the honeycomb structure becomes more hole than tissue, leading to a high chance of fracture.

Who gets osteoporosis?

Over the age of 50, one in two women and around one in six men will suffer an osteoporosis-related fracture at some point in their lives. That’s a huge amount, and as you can see it disproportionately impacts women.

How do I know if I have osteoporosis?

Chances are, you won’t know until you break a bone. People with osteoporosis have low density bones which mean that they are likely to fracture a bone with the smallest amount of impact. 

If you break a bone in a low impact injury, such as a minor fall or bump, your doctor may suggest you have a special type of x-ray called a bone mineral density scan (BMD). This will allow them to check if you have osteoporosis and advise you on the next steps.

What are the risk factors for osteoporosis?

There are some factors that you can’t change, and some that you can, to minimise your risk of osteoporosis. 

Some that you cannot change include:

• sex

• ethnicity

• family history

Some of the factors that you can change include:

• Giving up smoking.

• Drinking less alcohol.

• Eating a more balanced diet.

• Exercising more.

• Oestrogen levels in the body.

That last one may seem like something you can’t change, but there are certain medications you can be prescribed to help in some cases. For example, if you experience early menopause or have a procedure like a hysterectomy that causes the body to quickly stop producing oestrogen, it can affect the bones. Hormone replacement therapy (HRT) can help balance this as well as tackle any other pesky symptoms you may experience during menopause.

How do I prevent osteoporosis?

Although osteoporosis can’t be entirely prevented, there are things you can do to minimize the loss of bone density that occurs.

Calcium

Calcium is the big one when it comes to bone health. Everyone knows about it and knows that it helps your bones grow strong, but it also helps keep them that way too.

Adults aged 19 to 64 need 700mg of calcium a day, and you’ll be pleased to know that you should be able to get all the calcium you need from your diet. 

According to the NHS, some foods that are high in calcium include:

• milk, cheese and other dairy foods

• green leafy vegetables - except for spinach

• soya drinks that have had calcium added 

• bread and anything made with fortified flour

• fish where you eat the bones - such as sardines and pilchards

Here’s a handy calculator to see if you’re getting enough calcium in your diet. I was pretty shocked to see how little I get compared to what the recommendations are. Having said that, this makes it pretty difficult to have too much calcium, which is a good thing because high doses of calcium can cause some pretty unwanted side effects, such as stomach pain and diarrhoea. 

Vitamin D

Known as the sunshine vitamin, vitamin D, helps your body absorb calcium more effectively.

Between the end of  March to the end of September, most people should be able to get all the vitamin D they need from the sun. This assumes, however, that people are spending enough time outside. A lot of people spend a great deal of time inside, so if you’re stuck indoors when the sun is shining you might want to consider supplements to increase your vitamin D intake.

Otherwise, it is also possible to get some vitamin D from your diet. 

According to the NHS, some foods that include vitamin D are:

• oily fish - such as salmon, sardines, herring and mackerel

• red meat

• liver

• egg yolks

They also recommend choosing fortified foods, such as some fat spreads and breakfast cereals where possible.

Sodium

Too much sodium has been linked to increased amounts of calcium leaving the body, through urine. This means that people with high amounts of sodium in their diet need to consume more calcium than those following low sodium diets.

Protein

There is a delicate balance required for protein and bone health. While we need protein to help heal fractures, too much can also lead to extra calcium leaving the body through urine. Therefore, people should ensure they have the recommended daily allowance of protein but not exceed it too much.

Exercise

It can be tempting to stop exercising if you know you’re at risk of developing osteoporosis, as you may worry about injuring yourself. However, it is usually recommended that you keep at it to preserve bone density and even prevent falling through increasing your strength.

There are two main categories of exercise which are useful for building and maintaining bone density. These are weight-bearing and resistance. 

Weight bearing includes things such as:

• walking

• climbing stairs

• dancing

• playing tennis

Resistance exercises are those that use weights, either handheld ones or machines.

Choose low impact exercises that have the lowest risk of falling, to minimize your chance of injury while trying to actually protect your bones.

Reduce falling risk

While this doesn’t prevent the bones from losing density, it can help stop you from causing fractures if you do develop osteoporosis (and to be honest, it can help avoid injuries regardless). 

Activities such as yoga can help improve your balance, whereas flexibility can be improved through swimming and gentle stretching too.

Bottom line

Some people can feel disheartened when they receive a diagnosis of osteoporosis but others may find it a relief to be able to understand why they keep managing to injure themselves. Either way, it’s often not as bad as people worry.

There are even some new medications that can slow and even stop the progression of bones getting weaker, so if you develop osteoporosis it’s important to chat with your doctor about the options.