As we age, our bones tend to become thinner and lose density. This can increase our risk of developing osteoporosis and suffering from bone fractures or breaks.
Over three and a half million people in the UK are living with osteoporosis. But, because it develops slowly, many people have no idea they have it until a fall or impact causes a fracture. For this reason, osteoporosis is often referred to as the ‘silent disease’.
So, what are the symptoms of osteoporosis, and how can we prevent it? And if you already have osteoporosis, how can you improve symptoms and protect your bones?
To help explain everything you need to know, we’ve teamed up with the Royal Osteoporosis Society (ROS) – the UK’s only national charity dedicated to bone health and osteoporosis. The ROS works to raise awareness of bone health, provide information and support for people living with osteoporosis, and improve diagnosis, care, and treatments.
What is osteoporosis?
Osteoporosis is a condition where bones become porous or spongey and lose strength and density. This causes them to break more easily, even after a minor bump or fall. The name ‘osteoporosis’ comes from the Latin for ‘porous bones’.
Bones are living tissues made up of different minerals (mainly calcium salts) that are joined together by collagen fibres. Each bone is encased in a hard shell, and this is what we see on x-rays. However, the inside of our bones look rather like honeycomb, with lots of small holes in them.
These honeycomb-like holes are perfectly healthy. But, when you have osteoporosis, the holes become bigger and bone density reduces – which is why broken bones become more likely. Osteoporosis also causes the outside of our bones to become thinner and more fragile.
The pain of osteoporosis doesn’t come from bones being porous and weak, but from the fractures that the condition can result in. Any bone in the body can be affected by fractures, though they’re most common in the wrists, hips, and spine. Spinal fractures can also cause height loss and a curved spine.
Who’s at risk of osteoporosis?
Anyone can get osteoporosis and, unfortunately, there are no early warning signs. However, being aware of factors that increase the risk of osteoporosis can help you to make suitable lifestyle changes to protect your bones.
Some risk factors for osteoporosis that are out of our control, include…
- Gender. Women are more likely than men to develop osteoporosis. This is because the process of bone loss is accelerated after menopause when the ovaries stop producing oestrogen. Men also tend to have bigger bones, which has been found to reduce the risk of breaks.
- Age. From our late 30s, our bone tissue naturally starts to decrease – though the rate at which this happens can vary from person to person. Bone tissue also loses strength with age, so regardless of how dense it is, our bones can still become more prone to breaks.
- Family history. Having a parent or sibling with osteoporosis means you’re more likely to develop it yourself – especially if either parent fractured a hip.
- A history of broken bones. According to research, you’re three times more likely to break a bone if you’ve broken one before.
Other factors that can increase the chances of developing osteoporosis include…
- Low vitamin D and calcium levels. Vitamin D helps your body absorb calcium, which is an essential nutrient mineral needed for building and maintaining strong bones. So, low levels of these could increase your risk of osteoporosis and broken bones.
- Low body weight. Being underweight weakens bones for both men and women.
- Gastrointestinal surgery. Stomach or intestine surgery can make it more difficult for the body to absorb essential nutrients like calcium.
- Steroids and other medications. Long-term use of corticosteroid medications can affect the bone-rebuilding process. Osteoporosis is also linked with medications used to treat seizures, gastric reflux, and cancer.
- Medical conditions. People who suffer from conditions including coeliac disease, kidney or liver disease, inflammatory bowel syndrome, cancer, or rheumatoid arthritis may be more at risk.
- Sedentary lifestyle. People who don’t do much exercise could be at a greater risk than active people. Exercises like weightlifting, running, walking, and jumping are especially beneficial for maintaining bone health.
- Drinking alcohol. Regularly drinking more than 14 units a week (a 125ml glass of wine is 1.5 units) affects the cells that build and break down bone. It can also make you unsteady on your feet and increase the risk of falling and breaking a bone.
- Smoking. Smoking also slows down the cells that build bone mass in your body and, for women, can also increase your chances of early menopause. Postmenopausal women have an increased risk of osteoporosis and breaking a bone.
If you want to find out more about your risk of developing osteoporosis and get a personalised report on your bone health in under five minutes, you can use the ROS risk checker below.
What are the symptoms of osteoporosis?
Now we’re familiar with what osteoporosis is – as well as who’s most at risk of developing it – how can we spot the early signs of it?
The problem with the early stages of bone loss is that typically there aren’t any symptoms – and most people have no idea that they have osteoporosis until they experience a fracture.
The stage before osteoporosis is known as osteopenia. According to the ROS, this is when bone density scans reveal you have lower bone density than average, but not low enough to be classed as osteoporosis.
It’s important to be aware that osteopenia doesn’t always lead to osteoporosis – and if you have osteopenia, there are steps you can take to maintain your bone health and reduce the risk of developing osteoporosis.
You can find out more about osteopenia on the ROS website.
How can you prevent or reduce your risk of osteoporosis?
So, what’s the best way to prevent osteoporosis from developing in the first place?
As we’ve already seen, there are many risk factors for osteoporosis that are out of our control, like being female, ageing, and having a family history of osteoporosis.
However, there are also some things we can do to help decrease our chances of developing osteoporosis – for example, eating healthily, getting enough exercise, and making lifestyle changes.
Let’s take a closer look at these things below…
Because bone is continually broken down and replaced by new cells, it’s important to consume enough calcium each day to protect your bone’s strength and hardness.
According to the ROS, most adults need 700mg of calcium per day. Though, if you’re taking osteoporosis medication, you might benefit from increasing your daily calcium intake to around 1,000mg.
Many people are able to get all the calcium they need from eating a healthy, balanced diet.
Good sources of calcium include…
- Dark green leafy vegetables
- Low-fat dairy products
- Sardines with bones
- Soya products like tofu or soya milk
- Calcium-fortified cereals and orange juice
If you don’t believe that you’re getting enough calcium from your diet, a calcium supplement could be considered. However, you should always speak to your GP first, as supplements aren’t right for everyone, and taking high doses can also be harmful.
To find out more about calcium-rich foods and calcium supplements, check out our article; Everything you need to know about calcium.
Lead an active lifestyle
Our bones are living tissues that get stronger when we use them, which is why staying active can help to reduce the risk of osteoporosis. Certain exercises are more effective at keeping our bones strong than others; specifically, those that combine muscle strengthening and weight-bearing with ‘impact’.
Muscle strengthening exercises are those that create resistance for your muscles to make them work harder – for example, using dumbbells or using your body weight during a press-up. When your muscles work in this way, they pull on your bones, which respond by renewing themselves and maintaining/improving their strength.
Meanwhile, weight-bearing exercise with ‘impact’ means being on your feet and having an additional force go through your skeleton. This could include anything from walking and star jumps to yoga and Tai Chi. Exercises that combine a variety of movements, directions, and speeds – such as dancing or interval training – are also good for bones.
If you’re not very active, remember that it’s never too late to start improving your health through exercise. One of the best forms of moderate exercise (as well as the most accessible) is walking, and this is a great place to start.
For some quick and easy tips to start increasing your daily step count, such as getting off the bus a stop early or walking to get your groceries, check out our article here.
You can also read more about exercise and physical activity for osteoporosis and bone health on the ROS website.
Make sure you’re getting enough vitamin D
Because it helps our bodies absorb and store calcium, vitamin D is another essential nutrient for bone health.
We can get some of our vitamin D between March and September by exposing our skin to sunlight for around 10 minutes, once or twice a day. But in the UK, the sun isn’t strong enough to provide enough vitamin D all year round.
There’s also a small amount of vitamin D in foods like oily fish, eggs, some pork products, lamb liver, fortified bread and yoghurts, and specially processed mushrooms. However, it’s difficult to get enough vitamin D from food alone.
As a result, the ROS advises that we should consider taking a 10 microgram (sometimes called 400 units) daily supplement of vitamin D between September and April. But, again, you should always speak to your GP before taking any supplements, as vitamin D is a fat-soluble vitamin that can build up to dangerous levels in the body if taken in too high doses.
To find out more about vitamin D, you might like to read our article; What is vitamin D and why do we need it to stay healthy?
Maintain a healthy weight
Being under or overweight can increase your risk of developing osteoporosis, so it’s important to try and keep your weight in a range that’s healthy for you.
If you’re not sure whether your weight is in a healthy range, you can easily calculate your BMI index using this advice from the NHS.
As we’ve already mentioned, smoking can slow down the cells that build bone in your body – meaning it could reduce bone strength and increase your risk of breaking a bone. Stopping smoking isn’t just good for protecting your bones, it’s also one of the best lifestyle changes you can make for your overall health.
The positive news is that it’s never too late, and if you give up smoking, your risk of breaking a bone will start to return to normal.
If you’d like to stop smoking, check out the NHS stop smoking services to find out how you can get support.
Reduce your alcohol intake
Because drinking too much alcohol can impact bone density, cutting down can be a good way to protect yourself against osteoporosis.
You don’t have to give up alcohol entirely, but you should aim to have several alcohol-free days each week. The NHS advises that men and women shouldn’t drink more than 14 units of alcohol a week.
To find out more about alcohol consumption and to calculate your own units each week, have a read of this advice from the NHS.
Work on your balance and coordination
While working on your balance and coordination may not necessarily prevent osteoporosis, it can help to reduce the risk of slips, trips, and falls.
To find out more, check out our article; The importance of building strength and balance in your 50s and 60s.
If you want to start taking greater control of your bone health, it’s important to remember that it’s never too early or too late. To help you on your way, you might want to use this handy bone health checklist from the ROS.
How can you treat osteoporosis?
While there’s no cure for osteoporosis, treatment is available that can help protect and strengthen your bones.
If you’re diagnosed with osteoporosis after fracturing a bone, the first step will be to treat the fracture itself. But after that, you can begin looking at how to reduce the risk of further fractures occurring.
There are steps you can take yourself, like getting more exercise, eating well, and making lifestyle changes. But there are also several treatments that are available, which can help slow the breakdown of bone in your body or even encourage the growth of new bone.
We’ll take a look at these below.
Medications used to treat osteoporosis
The most common drugs used to treat osteoporosis are called bisphosphonates, which can help to prevent the loss of bone mass and make bones stronger.
- Alendronate – a weekly tablet, soluble tablet, or liquid that you drink
- Ibandronate – a monthly tablet or injection every three months
- Risedronate – a daily or weekly tablet
- Zoledronic acid – an IV or ‘drip’ infusion once a year
Other medications that are used to treat osteoporosis include…
- Denosumab. An injected drug that might be offered after a person has tried other more common drug treatments, or if other treatments aren’t suitable for you.
- Hormone replacement therapy (HRT). For women, oestrogen therapy can help stop bone density loss. However, oestrogen therapy has also been linked to an increased risk of blood clots, heart disease, and cancer.
- Raloxifene. This medication can provide the benefits of oestrogen without most of the risks. However, there’s still an increased risk of blood clots.
- Romosozumab. This is a new treatment so it may not be available everywhere and is only licensed for use by women in the UK – usually women who have been through menopause and have a high risk of breaking a bone. It involves giving yourself two injections once a month for a year.
- Strontium ranelate. A drug that’s available as a daily oral solution and may be offered to men and postmenopausal women.
- Teriparatide. Another injected drug that can help to strengthen bones and is available as a daily injection, which you do yourself for up to two years. It’s also often prescribed for men and postmenopausal women.
When your doctor is deciding which treatment is suitable for you they’ll look at a range of different factors, including your risk of breaking a bone, your blood test results, and your wider medical history.
The length of time you have treatment for can vary depending on the type you’re having and how long it takes to wear off. But again, your doctor will be best placed to advise you on this based on your individual circumstances.
Avoiding slips, trips, and falls
There are also steps you can take at home to prevent falls and reduce the risk of fractures. Aside from working on your balance and coordination, you can do things like…
- Wear non-slip shoes and use non-slip mats under rugs
- Keep walkways free from trailing wires
- Mop up spills immediately
- Take care and give yourself time to do things to avoid rushing
- Ask for help changing light bulbs and cleaning windows, rather than standing on chairs
For more tips on avoiding slips, trips, and falls, have a read of this information from the ROS.
Dealing with the emotional impact of osteoporosis
If you feel worried about living with osteoporosis, it’s important to speak to your GP or a health practitioner, as they should be able to answer any questions you have and help alleviate some concerns.
You might want to try speaking to a counsellor or psychologist too, or other people who are living with osteoporosis.
While osteoporosis can lead to broken bones and other painful complications, the good news is that there are things we can do to prevent it from developing in the first place. For example, eating a healthy diet, getting plenty of exercise, and stopping smoking. Plus, these changes can also have many other powerful health benefits.
And even if you’ve been diagnosed with osteoporosis, there are different treatments available that can prevent further bone loss and encourage new bone growth.
If you think you’re at risk of developing osteoporosis, you should speak to your doctor about how you can improve your bone health.
From £2 a month, you might also want to consider joining the Royal Osteoporosis Society (the ROS) to get exclusive member benefits. This includes a free 100-page osteoporosis reference book and magazines full of news, recipes, and tips on diet and exercise – plus, access to a members-only area where you can access a wealth of information and support.
Have you been diagnosed with osteoporosis – or are you concerned you might be at risk of developing it? Or perhaps you have some of your own tips to boost bone health that you’d like to share? We’d be interested to hear from you in the comments below.