Osteoporosis literally means porous bone. As bones become more porous and fragile, the risk of fracture increases significantly. Surprisingly, while osteoporosis is much more common than other chronic diseases, it tends to receive less public attention, although the effects of certain fractures can lead to disability and death. The situation is aggravated by the fact that bone loss occurs silently and progressively. Often there are no symptoms until the first fracture occurs. Therefore, it is important to understand the reasons for the development and progression of this disease, as well as ways to prevent it.

This article was last reviewed by Svetlana Baloban, Healsens, on June 20, 2020. This article was last modified on 10 June 2020.

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Around the world, 1 in 3 women and 1 in 5 men aged fifty years and over are at risk of an osteoporotic fracture. In fact, an osteoporotic fracture is estimated to occur every 3 seconds. That’s a lot, isn’t it? The most common fractures associated with osteoporosis occur in one’s hip, spine, and wrist. So, hip fracture is associated with serious disability and excess mortality. Women who have sustained a hip fracture have a 10-20% higher mortality than would be expected for their age². The worldwide annual incidence of hip fracture is approximately 1.7 million³.

On the other hand, hip fractures are difficult to overlook, whereas spinal fractures may remain undiagnosed. This is because they might be painless. But even if the pain is present, the person may not know that it is caused by a fracture. And if untreated, the risk of a second fracture is extremely high. So, without treatment as many as one in five women with a spinal fracture will sustain a second fracture within twelve months.

Osteoporosis risk factors

Understanding the risks of developing osteoporosis is very important since there are no external signs of the development of this disease. That is why doctors often recommend an examination, even though you may not have any complaints.

It’s also important to understand that when we talk about risk factors, we mean everything that increases your chance of getting sick. In addition, it is worth remembering that the presence of such risks, even several of them, does not mean that you will definitely have osteoporosis. Only laboratory test results can indicate the development of this disease.

Speaking of risk factors, we are talking about unchanging events (age, gender) and those that you can influence. Let’s take a closer look at each group individually.

Fixed risk factors

Although fixed risk factors cannot be changed, it is better to know about them so that measures can be taken to reduce the loss of minerals in bones. Fixed risk factors also include so called “secondary risk factors” – these are disorders and medications that weaken the bones. These risks include:

• Age > 50 years old
• Female gender
• Family history of osteoporosis
• Previous fracture
• Ethnicity
  • Studies have found osteoporosis is more common in Caucasian and Asian populations, and osteoporosis frequency is lower in black than in white people.
• Menopause/hysterectomy
  • Hysterectomy, if accompanied by removal of the ovaries, may also increase the risk of osteoporosis because of estrogen loss.
• Long term glucocorticoid therapy
  • Long-term corticosteroids use is a very common cause of secondary osteoporosis and is associated with an increased risk of fracture⁴
• Rheumatoid arthritis
• Primary/secondary hypogonadism in men
• Thyroid problems
  • In particular, hyperthyroidism (manifested by an increase in the content of hormones T3 and T4) is linked to osteoporosis. This is because it increases the number of bone-remodelling cycles your body goes through. After the age of 30, the more of these cycles you go through, the more bone density you lose.

If you find yourself having one or more risks, then you should not think that nothing can be done about it. There are currently strategies that can reduce their impact.

Modifiable risks

Most variable risk factors directly affect bone biology and lead to a decrease in bone mineral density. However, there are also risks that increase the risk of fracture, regardless of their effect on the bone itself. So, we will consider all these risks:

• Alcohol
• Smoking
• Low body mass index
• Poor nutrition
• Vitamin D deficiency
• Eating disorders
• Insufficient exercise
• Low dietary calcium intake
• Frequent falls

So, in relation to variable risks, appropriate actions can be taken.

Do you know your personal risk factors for osteoporosis? Take the IOF Osteoporosis Risk Awareness Test in a minute. This risk test is not a diagnostic tool: only a doctor can diagnose osteoporosis.

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What can you do to prevent osteoporosis?

There are many ways that can help maintain healthy bones and avoid premature bone loss. Making simple changes to the diet, enough exercise and giving up bad habits will not only help prevent osteoporosis, but also improve overall well-being. Let’s look at these factors to better understand how they affect the development of the disease.

Diet

A lot of studies⁵⁶ showed that the typical diet does not cover the demand for nutrients, vitamins, and minerals. Firstly, especially important is the deficiency of calcium and vitamin D because it can promote a reduction in bone mineral density. Also talking about a healthy diet, you need to intake a sufficient amount of protein. So, calcium and protein are two key nutrients for bone health.

The amount of calcium you need every day depends on your age and sex. In order to determine whether its consumption complies with the norm, you can use the calcium calculator from the International Osteoporosis Foundation. The calculator takes into account calcium intake from food and supplements. The result is compared with a reference, taking into account your gender and age.

In addition, the ratio of calcium to phosphorus is important for bone health. The presence of phosphates in food products (stabilizers, anticaking agents, emulsifiers and pH stabilizers) increases phosphorus concentrations in the diet. This leads to the acidification of bodily tissues and intensified parathyroid activity. Parathyroid glands produce parathormone which promotes calcium loss from teeth and bones⁷. Our modern diet rarely guarantees the right balance between calcium and phosphorus.

Concerning vitamin D, it is also necessary to maintain the balance of calcium / phosphorus. And besides, its deficiency has a detrimental effect on bone quality and calcium absorption from food. For more information on vitamin D deficiency diagnosis and treatment, feel free to review the article Vitamin D – a general health hormone.

You can boost your vitamin D intake through some foods like oily fish, eggs, mushrooms, and fortified dairy foods or juices.

Food negatively affecting bone health

Whenever possible, avoid foods such as alcoholic and non-alcoholic drinks. Too many soft drinks contain phosphoric acid, which increases the excretion of calcium. It’s also recommended to eschew excessive consumption of caffeine and salt.

Consuming too much salt can lead to loss of calcium. High salt diets may also lead to high blood pressure, heart disease, and even diabetes. So there are many reasons to limit its intake. Experts recommend consuming only 6 grams of salt per day.

Although caffeine is not as harmful as salt, it also has a detrimental effect on bone density. It is recommended you limit its intake to 300 mg per day. And don’t forget to provide sufficient calcium in your diet.

As for alcohol, its increased consumption is also associated with osteoporosis and fractures. Therefore, it is recommended to adhere to the recommended daily allowance.

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Exercises to prevent osteoporosis

Regular exercise is necessary for many reasons and has a beneficial effect on health. As for the prevention of osteoporosis, there are two types of exercises aimed at building and maintaining bone density. These are weight training exercises and muscle strengthening exercises.

Heavyweight exercises help strengthen bones. Examples of high-strength strength exercises are:

• Dancing
• Doing high-impact aerobics
• Hiking
• Jogging/running
• Rope Jumping
• Stair climbing
• Tennis

Low-impact weight-bearing exercises can also help maintain bone strength. In addition, these exercises are a safe alternative if you cannot perform exercises with a high load. For example, if you have a high risk of fracture due to osteoporosis. Examples of such exercises:

• Using elliptical training machines
• Doing low-impact aerobics
• Using stair-step machines
• Fast walking on a treadmill or outside

Adults are encouraged to do moderate-intensity aerobic exercises. For example, you can go brisk walking for at least 2.5 hours every week.

Muscle-strengthening exercises include gravity resistance activities.

• Lifting weights
• Using elastic exercise bands
• Using weight machines
• Lifting your own body weight
• Functional movements, such as standing and rising up on your toes

Furthermore, you should maintain healthy body weight. Too low BMI of up to 19 years old is harmful to bone health.

☝️Forewarned is forearmed.

FURTHER READING

1. The role of healthy diet in the prevention of osteoporosis in perimenopausal period
2. Cummings SR, Melton III JR. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761-7
3. Cooper C, Campion G, melton III LJ. Hip fractures in the elderly: a world-wide projection. Osteoporosis Int 1992;2:285
4. Kanis J A, Johansson H, Odén A, Johnell O, De Laet C, Melton LJ III, Tenenhouse A, Reeve J, Silman AJ, Pols H, Eisman JA, McCliskey EV, Mellström D. A meta-analysis of prior corticosteroid use and fracture risk. J Bone and Miner Res 2004;19.893-99
5. The role of healthy diet in the prevention of osteoporosis in perimenopausal period
6. [Assessment of Intake of Minerals With Daily Diets by Children Aged 10-12 Years From Malopolska Region]
7. The role of healthy diet in the prevention of osteoporosis in perimenopausal period