Thursday, 23 March 2017

Preventing Osteoporosis - What you can be doing now

Milk preventing osteoporosis


I've learned a few things during my time as an orthopaedic junior doctor:

1. I seem to have defied the odds by surviving a childhood of gymnastics and horse riding with no more than just a few bumps and bruises.

2. Walking the dog is apparently a far more dangerous activity than I'd ever fully appreciated.

3. I really, really don't want to break my hip when I'm an old lady.

And it's this last one that has got me thinking. Many of the elderly patients I see have broken their bones after fairly low impact falls, but due to osteoporosis, their bones are much weaker. Hip, wrist and spinal fractures are the most common injuries and can significantly impact on quality of life - leading to reduced mobility, chronic pain and sometimes lengthy hospital stays while they're fixed and healing.


What is osteoporosis?

Osteoporosis is essentially weakening of the bone - there is a loss of bone mass and density which can make the bone much more likely to break under lower forces. It's a common condition and is linked to ageing, but there are also a number of other factors involved.

Osteoporosis can affect people of almost any age, but it is typically associated with the elderly population. Despite this though, it's worth thinking about sooner rather than later!

A key factor is "peak bone mass" - the point at which our bones are as dense as they will get in our lifetime. After this, bone mass starts to decline and bone becomes thinner and weaker - and in individuals at risk, this happens faster. The higher your peak bone mass, the more you can afford to lose as you age.

Typically women achieve 90% of their peak bone mass by the age of 18, and men by the age of 20. Even if your teenage days are behind you though, you've still got until roughly age 30 to fully maximise your peak bone mass!

Yoghurt with fruit


How to prevent osteoporosis

So what can we be doing now to reduce the risk of osteoporosis as we age and hopefully avoid any nasty fractures?

Well, there are some things we simply can't change - getting older, being female and a family history of osteoporosis and fragility fractures. But as with all preventative processes, it's about changing the modifiable risks factors. 

Diet

Diet can play a big part in keeping your bones healthy. Key nutrients for bones are calcium and vitamin D. Young people can be at risk of missing out many essential nutrients through restrictive diets - not ideal when you've got a limited window of time to build up bone mass!

Good sources of calcium include dairy products and green leafy vegetables (although apparently not spinach which can interfere with calcium absorption), tofu, soya beans, almonds, dried fruits and any foodstuffs or dairy replacements fortified with calcium. You'll notice from the full list of calcium-rich foods that it's definitely possible to maintain good bone health even with a vegetarian or vegan diet so long as it's varied enough.

Vitamin D can come from oily fish, egg yolk and any foodstuffs fortified with vitamin D. It's also important to get some sunlight - we're just getting to the start of vitamin D season when there's enough UVB in the sunlight and it'll last until September so make the most of it! There are also vitamin D supplements that can be taken during periods when there's not enough sunlight. Vitamin D helps absorb calcium so it's crucial for getting enough calcium in to build good bone mass.

There's also research being carried out to see what impact other nutrients and minerals have on bone strength and osteoporosis, so it's probably wise to be eating a wide and varied diet to make sure you're getting all the goodness you need.

Bowls of porridge

Exercise

Regular exercise is really important in building up and maintaining your bone strength. The best kinds of exercise to prevent osteoporosis are those that are weight bearing and resistance based. Higher impact sports and activities that involve running and jumping are ideal. Up until about the age of thirty, bone is produced faster than it is lost so you've hopefully still got plenty of time to keep building it up!

Running kit

Lifestyle

As if there weren't already enough reasons not to smoke, it's also a risk factor for osteoporosis. It ties in with exercise, but leading an active lifestyle is better than being sedentary, so try to be getting up and about as much as possible!

Combining a balanced, varied diet with regular exercise is also important to maintaining a healthy BMI to reduce the risk of developing osteoporosis - a low BMI is associated with a higher risk.

Excess alcohol intake can also cause weakening of the bones, so keeping your drinking to moderation is good for your bones and avoiding those later life fractures!

Health & Medications

Certain health conditions and medications can put you at higher risk of developing osteoporosis - prolonged use of steroids, inflammatory conditions such as rheumatoid arthritis and inflammatory bowel disease and chronic kidney disease are just a few. If you're at risk, your doctor should be aware of this and prescribing bone-protection medication or be arranging screening as needed - but if you're not sure, then ask.

Where to find out more:

The NHS website is always a good start! - Osteoporosis
The National Osteoporosis Society has plenty of helpful resources and info
It's aimed at doctors, but I like using Patient professional pages for a bit more in-depth information


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3 comments

  1. Doing geriatrics right now I feel the same way! I think I'm on a good path - I love dairy based stuff and I do (well, did and hope to get back into) go for runs (I totally foresee osteoarthritis in my future though unfortunately).

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    Replies
    1. Yes, balancing the osteoporosis/arthritis risks is a bit of a difficulty- I have the same concern!

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  2. This is all kinds of fascinating, thank you! Makes me feel much more motivated to stick with the running lark.

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