Osteoporosis and Bone Health

By Dr Martie Conradie, MBChB (UP)

Bones. Such a neglected part of our bodies!

When younger, you are much more concerned with your skin and muscles, but as age creeps up, you start realising how important bones are.

Osteoporosis is a disorder of bone which commonly affects women. It is estimated that after the age of 50, one in two women and up to one in four men will break a bone due to osteoporosis. You do not want that one to be you…

There is good news however, you can do a lot to prevent and to treat osteoporosis.

What is osteopenia and osteoporosis?

Before looking at these conditions, here are a few facts about bone:

It is living, growing tissue and it changes constantly. While you concentrate on other things in life, old bone is removed (resorption) and new bone is added to your skeleton daily.
It is made up of a soft framework of a protein called collagen, and this framework is hardened by a mineral called calcium phosphate.
Nearly 99% of your body’s calcium is contained in your bones and teeth, with about 1% found in your blood.
Until late in your 20s, the formation of bone takes place faster than its resorption and you reach your maximum bone density and strength. Unfortunately, things slowly change after that.

Osteoporosis occurs when the formation of new bone cannot keep up with the loss of old bone. The term “osteoporosis” comes from Latin, meaning “porous bones”. The small spaces in the bone tissue become larger, resulting in less dense bone which makes it weaker and more fragile.

Osteopenia is the term used when you just have a lower bone density than expected. Your bones are not weakened as much as with osteoporosis and treating it can slow down the progression of bone loss.

Causes and risk factors

The amount of bone mass that you have built up while young, can influence how likely you are to develop osteoporosis. The higher your peak was, the more bone you can lose before it becomes significant.

The risk factors that you cannot change include:

Being female – women reach a lower peak bone mass, and because of menopause along with all the hormone changes, women are more likely to develop osteoporosis.
Being older – although you want to, there is nothing you can do to reverse age. In women, increased bone loss starts from the ages of 45 to 55 years due to menopause. Men also start losing bone at this age, but at a slower rate. By about 65 to 70 years old women and men lose bone at about the same rate.
Having a small-boned frame – you basically have less bone to lose.
Having a family history of osteoporosis – it can be partly hereditary.

The factors that you can do something about, include:

Low calcium and vitamin D intake
Inactive lifestyle or extended bed rest
Cigarette and e-cigarette smoking
Excessive alcohol intake
Certain medical conditions or their medication, such as:
- Hyperthyroidism
- Auto-immune conditions, such as ulcerative colitis
- Eating disorders, such as anorexia nervosa
- Cancer, such as breast cancer
- HIV/AIDS
- Corticosteroids (long-term use and regular use)
- Certain medication for seizures
- Certain medication for gastro-oesophageal reflux disease, such as proton pump inhibitors and aluminium containing antacids

So, those of you who are still young, change the risk factors you can, to increase that peak.

Complications

Osteoporosis can worsen if it is not appropriately treated. Bones will get weaker and thinner which will increase the risk of a fracture. It had even been reported that a strong sneeze had resulted in a fracture in a woman with severe osteoporosis!

Bone fractures are a serious complication, and the hip is commonly affected. Hip fractures can result in disability or death. Up to twenty percent of people with a hip fracture die within the first year (often related to pneumonia or blood clots), and nearly 50% are never able to regain their full functional ability.

Who must go for bone density testing?

To diagnose osteoporosis, your doctor will ask you about your medical history, do a physical exam and run some tests of your blood or urine to check for conditions resulting in bone loss.

Your bone mineral density can also be measured, most commonly by dual energy X-ray absorptiometry (DEXA) of the lower back and femur. DEXA uses X-rays to measure the density of bones.

It should be done on all women who are 65 years or older, all men 70 years or older, and on all people with clinical risk factors, especially if they have had a fracture after the age of 40 years.

Treatment

Osteoporosis and osteopenia can be treated by general practitioners or specialists.

There is no cure, but medications are available to help to slow the breakdown of bone or to stimulate the growth of new bone. Some include: bisphosphonates, oestrogen (which is referred to as hormone therapy) or testosterone (for men). These therapies and their side effects should be discussed in detail before it is started, since many of them increase the risk of cancer, while some cannot be used with other chronic medication.

A comprehensive osteoporosis management program should be followed which includes proper nutrition, exercise and preventing falls.

Prevention

You and every person can benefit from following these tips to ensure good bone health and it is never too late to start protecting your bones.

Increase intake of the following:

Calcium – The amount you need changes during your lifetime with the greatest need in childhood, adolescence, pregnancy and while breastfeeding. Your body also becomes less efficient at absorbing calcium as you age.

Food sources include dairy products (such as milk, yoghurt and cheese), leafy vegetables (such as spinach and broccoli), sardines and certain foods that are fortified with calcium (such as cereals and bread).
If your intake from food sources is low, you can benefit from taking a good quality calcium supplement. These supplements usually contain chelated calcium, which means compounds are added to calcium to improve its absorption. Calcium lactate or calcium gluconate are commonly used.
Your body cannot absorb more than 500mg of calcium at a time and therefore it is advised that you do not take all the tablets at once, but rather spread it throughout the day.
Calcium is often combined with magnesium (CalMag), because they are both good for bone health and magnesium reduces the risk of constipation, which could be a side effect of calcium.

Vitamin D – It is required to ensure that calcium is absorbed and to help maintain good bone health. After the age of 70 the intake should be increased.

There are limited amounts in food, but some sources include liver, saltwater fish and egg yolks.
The source from nature is the sun – spend a few minutes a day in sunlight for your skin to absorb it.
A deficiency can also lead to a depressed mood.

If you are indoors a lot or cannot spend a lot of time in the sun, a supplement is advised, but should preferably be under advisement from your doctor.

Protein – Low protein intake is associated with an increased hip fracture risk. It is important for maintenance of body tissues, including muscles which support your skeleton.

Food sources should include a variety to ensure all the different amino acids, that your body needs as building blocks, are provided.

Vitamin C – It enhances the absorption of calcium and is often advised to be consumed together.
Sources include fresh fruits, vegetables, and good supplements are available.

Magnesium – It is a mineral which is part of the process of forming healthy bones and it helps to keep calcium inside the bones and prevents it from ending up in your blood vessels or other tissue. Your ability to absorb it decreases with age.

Eating a variety of healthy foods, such as nuts, whole grain bread and dark green vegetables, will usually provide enough.

Good supplements are available, and it is often part of a multivitamin or CalMag. Diarrhoea can occur if you take too much magnesium.

Zinc – It helps the bones stay strong and promotes healing of tissues.

Sources include oysters, avocados, blackberries and dairy products. Many types of cereals or breads are fortified with it, and good supplements are available.

Vitamin K – It helps to prevent excess bone loss and is found in food such as spinach, kale, peas and green beans. Supplementation with vitamin K should only be done if advised by a doctor, since it can be dangerous at high levels and interacts with medication such as warfarin.

What to avoid:

Smoking (including e-cigarettes) – The chemicals are toxic to the bone cells and women who smoke can go into menopause earlier, because they tend to have lower oestrogen levels than non-smokers. If you do not stop smoking, there is little that can be done if you have low bone density. It basically counteracts all the improvements brought on by other healthy habits.
Alcohol use – excessive use triggers bone loss, results in poor nutrition and increases the risk of falling. For women, one drink a day is mostly considered safe and men can drink two a day, but after 65 years old, men have the same limit as women.
High-salt foods – sodium chloride is a component in most salt used in food. This increases the amount of calcium you excrete in your urine. The advised limit is 2 300mg, and this might sound like a lot, but go and have a look at the labels on your food…
Wheat bran – It can hinder calcium absorption, including the calcium from other foods consumed at the same time. If you use calcium supplements, try to only use them about 2 hours after eating wheat bran.
Caffeine – It decreases calcium absorption and plays a role in bone loss.
Medications that can cause bone loss

Exercise

You do not have to train for a marathon, but every little bit helps.

Weight-bearing and resistance exercises are what bones really need because it stimulates new bone formation. Your body realises that stronger bones are needed to do these exercises. Combine it with strength training and balance exercises, since these strengthen the muscles which support bones and reduce the risk of falls.

Weight-bearing exercises include jogging, dancing, climbing stairs, stomping your feet
Resistance exercises include lifting weights, leg presses, squats
Balance exercises include standing on one leg

There are exercises that, although healthy for other body systems, will not really strengthen your bones, like swimming.

Fall prevention

For people with osteoporosis, preventing falls are of utmost importance.

Some practical tips are:

Have your vision tested regularly
Wear shoes with rubber soles and avoid slippery floors
Use a cane or walker for extra stability where possible
Keep floors clutter-free
Do not walk in socks or slippers
Install handrails on both sides of stairs and grab bars on the bathroom walls
Keep a flashlight on your bedside table

In your life, you will be exposed to many unhealthy substances, but do whatever possible to avoid those that you are able to. May you all have healthy bones which never fracture, and if they do, may they heal well.

More information

For those interested in reading more about osteoporosis or diets advised for good bone health, the following links can take you to reliable sources:

And for recipes that are good for bone health:

https://www.iofbonehealth.org/recipes