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Osteoporosis risks

Almost three million people in the UK are estimated to have osteoporosis (1) and the combined cost of hospital and social care for patients with a hip fracture amounts to more than £2.3bn per year in the UK – or £6m a day (2).

The lifetime risk of fracture in women at age 50 years is greater than the risk of breast cancer or cardiovascular disease (3).

Osteoporosis causes bones to break following a minor bump or fall. These broken bones, commonly referred to as fragility fractures, are most common in the wrist, hip and spine, although other parts of the body can also be affected.

Compressed bones in the back (spinal fractures) can lead to loss of height and spinal curvature, while a broken hip often results in both loss of confidence and independence.

Having osteoporosis does not automatically mean that your bones will break; it means that you have a ‘greater risk of fracture’. Thin, fragile bones in themselves are not painful but the broken bones that can result can cause pain and lead to other problems.

However, effective drug treatments, physiotherapy and practical support can reduce the risk of further fractures and help speed recovery.

Factors that increase the risk of osteoporosis (4):

Genes – our bone health is largely dependent on the genes we inherit from our parents. If one of your parents has broken a hip, you are more likely to have a fracture yourself.

Age – bone loss increases in later life so by the age of 75 about half of the population will have osteoporosis. As you get older, bones become more fragile and more likely to break generally, whatever your bone density.

Gender – women have smaller bones than men and they also experience the menopause which accelerates the process of bone turnover.

Race – people who are Black Afro-Caribbean are at a lower risk than those of Caucasian or Asian origin because their bones are bigger and stronger.

Low body weight – if you have a low BMI (body mass index) below 19kg/m2 you are at greater risk of developing osteoporosis and fractures.

Falling – older people who are at risk of falling are more likely to have fractures especially of the hip after the age of 75 years.

Previous fractures – If you have already broken bones easily, including in the spine, then you are much more likely to have fractures in the future.

Other factors which may put you at greater risk include:

• Rheumatoid arthritis
• Low levels of the sex hormone oestrogen in women as a result of early menopause, having a hysterectomy with removal of ovaries (before the age of 45), anorexia nervosa or taking drugs such as aromatase inhibitors for breast cancer. Low levels of testosterone in men following surgery or treatment for some cancers can also increase risk
• Conditions that affect the absorption of food such as Crohns or Coeliac disease
• Conditions that cause long periods of immobility
• Taking corticosteroid tablets such as prednisolone for other medical conditions for over three months
• Drinking excessive amounts of alcohol
• Smoking

How can I reduce my risk of osteoporosis?

Our genes are key to deciding the potential size and strength of our skeleton (5,6), but the way we live our life can also play a part in the amount of bone we invest in our ‘bone bank’ during our youth, and how much we retain in later life (7).

Healthy balanced diet

Whatever your age or sex, it is vital to make sure that what you eat today will help to keep your skeleton strong for the future.

Aim to eat meals that incorporate a wide variety of foods from the four main groups, including fruit and vegetables, carbohydrates like bread, potatoes, pasta and cereals, milk and dairy products and protein such as meat, fish, eggs, pulses, nuts and seeds.

A healthy, balanced diet will help provide you with all the vitamins, minerals and energy you need to live life to the full, keep your bones healthy and reduce the risk of other chronic diseases. Calcium is vital for strong teeth and bones because it gives them strength and rigidity (8).

Most people should be able to get enough calcium through healthy eating, without the need for additional supplements. A daily amount of 700 mg is recommended (9) although those with osteoporosis taking drug treatments might benefit from 1000 to 1200 mg a day.

Vitamin D

You need vitamin D to help your body absorb calcium. The best source is sunlight, which your body uses during the summer months to manufacture the vital vitamin in your skin.

The National Osteoporosis Society recommends you should try to get 10 minutes of sun exposure to your bare skin, once or twice a day (depending on skin type), without sunscreen and taking care not to burn. Older, frailer people may benefit from a calcium and vitamin D supplement (10).

Stop smoking

Smoking has a toxic effect on bone by stopping the construction cells from doing their work. It’s another good reason to try to give up (11).

Reduce alcohol intake

Excessive alcohol consumption is a significant risk factor for osteoporosis and fractures (12). The current daily recommended limit, as recommended by the Food Standards Agency, is two to three units for women and three to four units for men. A unit equals one small glass (125ml) of wine or half a pint (300mls) of beer or cider.

Exercise and strong bones

Another way your skeleton can grow stronger is if you do regular weight-bearing exercise (13, 14). This is any kind of physical activity where you are supporting the weight of your own body, for example jogging, aerobics, tennis, dancing and brisk walking.

If you have osteoporosis and are at high risk of breaking bones, you may need to be careful of vigorous, high-impact exercise. After all, broken hips occur in older people when their bones are frail and they fall.

But remember, it’s important to stay active and find something you enjoy. Swimming, gardening, golf and Tai Chi may help to maintain balance and co-ordination and help to reduce your risk of falling.

Infolinks:

• National Osteoporosis Society (NOS)
• National Osteoporosis Foundation (NOF)
• National Institute of Health and Clinical Excellence Guidance on Osteoporosis (NICE)

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