Bones affected by osteoporosis are lighter and less dense than normal. They are also more likely to break, even as a result of a minor bump or fall, or even without an injury. Osteoporosis means porous bones.
Osteoporosis is around four times more common in women than men, and most common in women who have been through the menopause.
As well as bones such as the wrist or hip breaking more easily than usual, osteoporosis can result in small fractures of the bones in the spine. This can cause a curved back and a loss of height.
The inside of a bone consists of a strong mesh made of protein and minerals (particularly calcium). This mesh is living tissue that is constantly being renewed by a process called bone turnover. Old, worn out bone is broken down and absorbed by the body while, at the same time, new bone tissue is created from fresh protein and minerals. In children and young people, more new bone is created than is broken down. This makes bones both bigger and denser.
The bones are at their strongest when the peak bone mass is reached, and this usually occurs in a persons mid-twenties. Peak bone mass is then maintained for about ten years, with roughly equal amounts of bone creation and breakdown. After the age of about 35, bone loss begins to overtake creation. This is a natural aging process but with osteoporosis, the process happens much more quickly, leading to premature bone weakness.
Low levels of oestrogen
The female hormone oestrogen reduces the amount of bone that is broken down and so helps to protect against osteoporosis. The ovaries make oestrogen from puberty to the menopause. Any condition that reduces the number of years that a woman produces oestrogen tends to increase the risk of osteoporosis.
These risks include:
- having an early menopause (before the age of 45)
- an early hysterectomy (before theage of 45, especially if both ovaries are removed)
- missing periods for six months or more as a result of over-exercising or over-dieting
Other risk factors
- Men who have low levels of the male hormone, testosterone, are also at a higher risk of osteoporosis. For both men and women, the following factors also increase the risk of developing osteoporosis:
- long-term use of corticosteroid tablets (medicines sometimes used for conditions such as severe allergies)
- a family history of broken hips
- digestive disorders that affect absorption of nutrients, such as Crohns disease or ulcerative colitis
- long-term immobility
- heavy drinking
- very low body weight
Osteoporosis has been called the silent disease. Most people affected are unaware that their bones are thinning until they experience a break, or notice more gradual signs such as height loss, or curvature of the spine (sometimes known as Dowagers Hump).
The bones most likely to break as a result of osteoporosis are the hip, wrist and the vertebrae of the spine.
People who reach a high peak bone density when they are young are less likely to develop osteoporosis. Bone density can be boosted by a healthy diet and regular exercise, particularly in people under 35. This means prevention needs to begin at a young age.
A varied, well-balanced diet is important to build and maintain healthy bones.
A combination of bread and cereals, fruit and vegetables, milk and diary products, and protein (from meat, fish, eggs, pulses, nuts and seeds) should provide the nutrients that your body needs.
Foods rich in calcium are especially valuable for healthy bones. Good sources include milk and diary products, such as cheese and yoghurt.
The body needs vitamin D to absorb calcium properly. About 15-20 minutes of daylight on the face and arms during the summer months will enable the body to store enough vitamin D for the rest of the year; you dont need to sunbathe. Vitamin D is also available in foods such as margarine and oily fish.
Weight-bearing exercise helps to promote bone creation and bone health. Good exercises include running, skipping, aerobics, tennis, weight-training and brisk walking. Ideally, you should try to exercise three times a week for at least 20 minutes.
If you are not used to exercising, build up your exercise routine gradually - increasing frequency before intensity. Talk to your GP before you start if you have a health problem that affects your heart or breathing.
Smoking can have a harmful effect on bone and can also help to induce early menopause. If you smoke, try to give up. You should also be careful not to drink too much alcohol (see the BUPA fact sheet on alcohol).
Treatment for osteoporosis
There are now a number of effective treatments that can help prevent fractures and increase bone density. These include:
- Hormone replacement therapy (HRT). This prescription-only treatment aims to restore oestrogen to a pre-menopausal level. Taking HRT also helps reduce the risk of heart disease and relieves menopausal symptoms such as hot flushes, night sweats, and vaginal dryness. Some women may experience breast tenderness and nausea side-effects of the treatment. HRT can also increase your risk of developing breast cancer and uterine cancer. However, the risk still remains low. There are over 30 forms of HRT available in pills, patches, under-the-skin implants or gels
- Bisphosphonates are non-hormonal treatments that work by blocking the break-down of bone. There are three bisphosphonates available in the UK namely, alendronate (Fosamax), etidronate (Didronel) and risedronate (Actonel)
- A type of medicine called selective oestrogen receptor modulators(SERMS) is a synthetic hormone replacement which works by copying the effects of oestrogen on the bones. They reduce the risk of osteoporosis and heart disease but do not increase the risk of breast or endometriail cancers. The SERM currently available for osteoporosis is raloxifene (Evista)
- Vitamin D and calcium supplements are an effective treatment to reduce bone loss in the elderly
- Calcitriol is an active form of vitamin D given to post-menopausal women who have osteoporosis in the spine. Calcitriol improves the absorption of calcium from the gut
- Calcitonin is a hormone made by the thyroid gland (a hormone-producing gland in the neck), which inhibits the cells that break down bone. It is only available in injection form as Calsynar (salcatonin)
- Testosterone can be used to treat men who are deficient in the hormone and can increase their bone density. It is available in injection or implant form
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
1. I think I may be at risk of osteoporosis. Should I have a bone scan?
Talk to your doctor about what is best for you.
Many people don't know that they have osteoporosis until they break a bone - often a hip, wrist or bones in the spine. However, it's possible to find out if you have osteoporosis before you have a break using dual X-ray absorptiometry (DEXA or DXA) scanning. This is the most common way of diagnosing osteoporosis.
The test is expensive and its availability may be limited. It is usually only recommended for people at high risk of having osteoporosis.
If you're concerned that you're at risk of osteoporosis, talk to your doctor.
2. How much calcium should I be getting to help prevent osteoporosis?
This depends on your age and, if you're a woman, whether you have been through the menopause.
If you think you may be at risk of developing osteoporosis, talk to your GP. If you're a woman who hasn't been through the menopause, try to get 700mg of calcium per day. This is the daily amount of calcium recommended for adults by the Food Standards Agency. It should be possible to get 700mg of calcium a day from your diet. If you find this difficult you may need to take a calcium supplement.
Once you reach the menopause, increase the calcium in your diet to 1,000mg a day. This increased level also applies to people diagnosed with osteoporosis. If you're diagnosed with osteoporosis, you may be given a calcium supplement and your osteoporosis medication.
To give you some idea about how to get enough calcium in your diet, here is the amount of calcium in some everyday foods:
- a 200ml glass of semi-skimmed milk contains 240mg calcium
- a 100g fruit yoghurt contains 122mg calcium
- 100g Cheddar cheese contains 739mg calcium
- four slices of white bread contains 175mg calcium
- four slices wholemeal bread contains 105mg calcium
- 100g tinned sardines (in oil) contain 500mg calcium
- 100g tinned salmon contains 91mg calcium
- 100g baked beans contain 53mg calcium
3. I can't eat dairy food. How do I make sure I get enough calcium?
It should still be possible to get enough calcium in your diet.
Even if you don't eat milk or dairy food there are other options. Good sources of calcium include canned sardines, soya beans and tofu, bread, pulses, green vegetables, dried fruit (especially figs), nuts and seeds (particularly almonds and sesame seeds). If you use soya, rice or oat milk, choose one with added calcium.
If you're concerned about how much calcium you're getting from your diet, talk to your GP or a dietician.
4. My doctor has told me to eat a low-fat diet. How can I get enough calcium if I have to limit cheese and milk?
It's best to eat some dairy foods each day as they are good sources of calcium. There are many low-fat dairy products available.
You can either try switching to lower fat options or try using a little less high-fat foods such as hard cheese. Try switching from:
- whole milk to semi-skimmed or skimmed milk
- Cheddar or Edam cheese to cottage cheese
- cream to yoghurt or low-fat crème fraîche in cooking or with desserts
- butter to low-fat spread
5. I have osteoporosis. How do I deal with the pain from broken bones?
Talk to your GP. It's important to explore all the options until you find something that helps you.
If you break a bone, you will feel immediate pain that can last until the bone and surrounding tissue heals. Everyone's experience of fractures is different. However, a fracture in the spine can cause severe pain. If you go into hospital after a break, your doctors will try and get the best possible pain relief for you.
You can also have chronic pain even after your bone has healed. Ongoing pain after a fracture can affect your quality of life.
Your doctor is likely to suggest trying either over-the-counter or stronger prescription painkillers. But if these don't help control your pain, there are other options to consider. Some examples are listed below.
- Other medicines - such as calcitonin or a low dose antidepressant may help control pain.
- Physiotherapy, hydrotherapy (exercise in water), acupuncture or TENS (transcutaneous electrical nerve stimulation) machine may help control pain.
It's important that your doctor helps you to find an approach that works for you. Sometimes a referral to a specialist pain clinic may be necessary.
6. Why isn't spinach a good source of calcium?
Although spinach has a high calcium content compared with other foods, the calcium is bound to a substance called oxalate, which means that your body can't absorb it. So, although spinach is a good source of other vitamins and minerals it isn't a good source of calcium.
The calcium content of spinach is quite high compared with other foods. For example, 100g of boiled spinach contains around 160mg of calcium compared with 75mg in the same amount of spring greens. But spinach isn't recommended as a calcium-rich source of food because the calcium is bound to a substance called oxalate, which stops your body from absorbing it.
If you're trying to increase the amount of calcium in your diet, you should eat other calcium-rich foods such as:
- milk and dairy products
- canned fish with bones
- fortified breakfast cereal
- soya bean products
- other green leafy vegetables
- dried fruit
7. I read in the newspaper that calcium supplements can increase the risk of having a heart attack. Should I stop taking them?
There is some evidence that calcium supplements increase the risk of heart attacks in women who have gone through the menopause. However, as other studies have reported other findings, more research is needed in this area before conclusions can be drawn. If your GP has recommended that you take calcium supplements because you're at risk of osteoporosis, you should talk to him or her before stopping them.
Calcium supplements are sometimes advised for women who have gone through the menopause to keep their bones healthy. A recent study, however, found that heart attacks were more common in women taking calcium supplements than in women taking a placebo (dummy pills). Scientists don't yet know why calcium supplements could cause this effect, but high calcium levels could lead to a build-up of calcium in the blood vessels. More research is needed to understand the link between calcium supplements and heart attacks.
If your GP has recommended that you take calcium supplements, it may be because he or she thinks that you're at risk of osteoporosis. In the UK, the recommended calcium intake is 700mg a day for adults and up to 1,200mg if you have been diagnosed with osteoporosis and are on prescribed drug treatments. If you get adequate calcium from your diet, you may not need calcium supplements.
You should always talk to your GP before stopping any medicine or supplement that has been recommended for you. It's important to remember that any risks associated with taking calcium supplements must be balanced against the risk of osteoporosis and fractures that may happen if you don't take your calcium supplements.
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