Today I want to talk about some ideas on how to prevent osteoporosis. According to the NHS, around 3 million people in the UK have osteoporosis – a health condition that weakens bones and makes them more likely to break. Sadly, this is largely a ‘silent disease’ – few people seem know they have it until they have a fall or sudden impact and break a bone. Age UK tell us that about 1 in 2 women and 1 in 5 men over 50 will break a bone (fracture) because of osteoporosis; with breaks in the wrist, hip and spine being the most common. In some cases, a violent cough or sneeze is all it takes to break a rib or damage one of the bones in the spine!
As osteoporosis is largely, silent, you may be sent for a bone density scan (DEXA Scan) if you have some of the risk factors.
Risk factors for osteoporosis include:
- An eating disorder such as anorexia or bulimia
- Family history of osteoporosis or a parent who has had a hip fracture
- Heavy drinking or smoking
- Lack of exercise
- Long term use of certain medications such as anti-oestrogen tablets or steroid medication
- Low Body Mass Index (BMI)
- Other medical conditions such as inflammatory conditions, malabsorption issues or hormone-related conditions
A bone density scan can highlight the stage before osteoporosis, called osteopenia. This is when you have lower bone density than average for your age, but do not have osteoporosis. And it’s important to know that just because you have osteopenia, it does not necessarily mean you will go on to develop osteoporosis.
Like anything, prevention is better than cure, and there are three main steps that conventional medicine recognises to keeping bones healthy. These are exercise, diet (and / or supplements) and lifestyle factors.
Exercise is a key lifestyle choice for keeping bones healthy. After all, bones stay strong when you give them work to do!
While adults should do at least two and a half hours of moderate-intensity aerobic activity, such as brisk walking, every week, it’s weight bearing exercises and resistance exercises that are is key for improving bone density and preventing osteoporosis.
For active people, weight bearing exercises include running, skipping and aerobics.
If you want something more gentle, you can bounce up and down on the spot or dance.
Weight bearing exercises for the over 60s might include brisk walking, tennis or a suitable keep fit class.
Whatever your age, be sure to wear trainers with good support to prevent damage to the joints from impact.
Resistance exercises are when your tendons pull on your bones to increase the bone strength. This includes weightlifting at a gym for more active people or using your own weight such as push ups at home (don’t worry, these can be wall push ups!). Don’t forget the activities you do on a day to day basis – carrying your shopping, digging the garden and walking up and down the stairs all help. You can follow simple dvds at home with light hand weights, resistance bands or even a tin of baked beans!
Here is an excellent video from the Royal Osteoporosis Society:
It’s good to improve balance and flexibility to prevent falls too. Tai Chi, yoga and Qi Gong are all good activities or this. Or the simple exercise of balancing on one foot for as long as you can. Stand near a wall if you’re a bit wobbly. If you’re already good at balancing on one foot, try it with your eyes closed.
Diet and supplements
Standard advice from the NHS and Royal Osteoporosis Society for key supplements for bone health include vitamin D and calcium. In addition, protein is needed for healthy muscles, which support healthy joints, so ensure you are eating adequate protein each day too. In this study, participants showed that those who ate an increased amount of protein saw a significant increase in overall bone density.
Vitamin D helps the body absorb calcium. Wherever possible, get vitamin D from sun exposure. Just twenty minutes a day can provide all the vitamin D you need (depending on skin colour – those with darker skin may need more). Food sources of vitamin D include oily fish and eggs, but Public Health England now recommend that everybody takes a vitamin D supplement of up to 1000ius between October and March. If you don’t go outdoors much, then the recommendation is to take a daily supplement throughout the year.
I like to treat people as individuals, and I think it’s best to have your vitamin D levels checked. You can buy a finger prick test online. Your body stores vitamin D, so if you get enough sun exposure during the summer, you may well have adequate stores. Like most things, everybody is different in their absorption and utilisation. It’s not about how much you take, but how much your body absorbs.
Calcium is the building block of bones and teeth. You can find calcium in dairy foods, leafy green vegetables, sesame seeds, tinned sardines (if you eat the bones) and fortified soy products. Vitamin D and calcium work together to strengthen bones. And magnesium helps activate vitamin D so it can promote calcium absorption, so make sure you’re getting adequate amounts of magnesium too. However, before you go drinking pints of milk every day, this paper in the British Medical Journal, suggests that calcium may not prevent fractures at all. They state “Dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent.”
Which brings me on to something I’ve not seen discussed within the medical profession…
Many vitamin D supplements are combined with vitamin K and there’s good reason for this. Latest research shows that vitamin K plays an important role in keeping bones strong. In fact, vitamin K deficiency is linked to higher hip fracture risk.
In this article, just one or more servings of lettuce (a vitamin K1-rich food) per day was shown to reduce risk of hip fractures by 30 per cent!
There are two types of vitamin K, each found in different sorts of food:
Vitamin K1 (phylloquinone) found in dark green leafy vegetables such as broccoli, cabbage, parsley and spinach.
Vitamin K2 is a family of compounds called menaquinones (MK). Vitamin K2 is synthesised by certain gut bacteria and is found in butter, cows liver, chicken, egg yolks and fermented soy bean products – natto is the superhero here!
Research into the importance of vitamin K on bone health is promising. In Japan, vitamin K2 has been approved for the treatment of osteoporosis since 1995. And this article suggests that vitamin D3 and vitamin K2 – rather than just calcium – appears to be useful in increasing the bone mineral density of the lumbar spine in postmenopausal women with osteoporosis.
Please note: vitamin K contributes to normal blood clotting, so is not suitable for people taking anti-coagulant medication.
How is osteoporosis treated
Are there alternative treatments to treating osteoporosis?
I found the story of a lady called Nina Merer particularly inspiring. She took matters into her own hands when she was diagnosed with osteopenia at the age of 40. Her condition was considered advanced and her bones ‘almost breakable’. Initially, she tried prescription calcium supplements, but finding herself with too many unpleasant side-effects such as intestinal bloating and headaches, she decided to go the holistic route. Her doctor was doubtful but supportive.
Committing to a plan of exercise, acupuncture, herbs, changes to her diet, as well as addressing stress and other emotional and mental aspects, she changed her prognosis. By the age of age 52 Nina’s wrist bone measured over the 100 per cent level for her age group. Her spinal bone density was a bit lower and her hips were low normal-“fragile but not breakable”. She estimates having gained at least 10 per cent in bone density and is now classified as only mildly osteopenic.
You can read her amazing story here.
Keith changes his diet to improve osteoporosis
Former Canadian athlete Keith McCormick broke fifteen bones before taking osteoporosis into his own hands. He learned about the relationship between gut health, the immune system and removed gluten from his diet, as well as adding in several supplements. His supplements included:
- Alpha-lipoic acid
- Fish oil
- NAC (N-acetyl cysteine)
- Trace minerals
- Vitamins D and K
He is now a chiropractor who uses his own experience to specialise in sports injuries and osteoporosis. He’s written a book called The Whole Body Approach to Osteoporosis.
What about mindset and depression?
Proponents of a positive mindset tell us we can achieve amazing progress on all sorts of situations and conditions if we get our mind on board. And far from being woo-woo, doctors are well aware of the power of the placebo effect too – many medical trials are built on it. So maybe our mind has the potential to be the most powerful placebo of all!
Before you switch off, thinking I’ve finally lost the plot, take a moment to consider this fascinating study. During the research, 180 patients with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement (removal of damaged cartilage or bone), arthroscopic lavage (flushing the joint out), or placebo surgery. Patients in the placebo group received skin incisions so that when they came out of ‘surgery’ it looked as if they’d received it.
Researchers measured the outcome over the next two years of the patients ability to walk and climb stairs, as well as pain and function.
The amazing result was that the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure! In his book, “Surgery, The Ultimate Placebo: A surgeon cuts through the evidence” surgeon Ian Harris goes so far to say that “the placebo effect, is the reason why we tend to overestimate the true effectiveness of surgery. ” [my emphasis].
There has been a small amount of study researching the role of depression as a risk factor for low bone mineral density (BMD) and osteoporosis. It seems that overall, depressed individuals display lower BMD than nondepressed subjects. Premenopausal women who are diagnosed with major depression are particularly at high-risk for depression-associated low BMD.
Researchers are unsure as to whether depression itself increases risk for osteoporosis (indicated here and here) or whether certain medications prescribed for depression could be contributing (long term use of SSRIs have been associated with increased odds of falling and lower bone mineral density).
What we can take from this then, is that if you’re predisposed to depression, you might consider getting appropriate treatment to lessen your risk of osteoporosis.
How to prevent osteoporosis
While you might not be able to do anything about your family history or genetics, there are lifestyle factors you can take control of to help you prevent and treat osteoporosis. These centre around exercise and diet, maintaining a healthy weight and quitting habits such as drinking excessive amounts of alcohol or smoking..
As the saying goes “Use it or lose it!” You need to give your bones something to do – low impact exercise such as walking, helps prevent bone loss while high impact exercise such as running or weight training can increase bone density. For people unable to exercise much, whole body vibration training has been shown to be effective in increasing bone density. Twenty five women took part in a whole body vibration training programme three times a week for six months. At the end of the training, the BMD of their hips had significantly increased.
An overly acidic diet – such as one with too much sugar in it – can drain calcium and other minerals from the bones. Too much caffeine can increase loss of calcium and magnesium. Focus on good quality protein, lots of fresh fruit and vegetables, healthy fats, such as oily fish, ensure adequate vitamin D, K2, calcium and magnesium and supplement with high quality supplements if necessary.
Maintain a healthy weight. Carrying too much weight can put a strain on the bones. Carrying too little weight can be a risk factor for bone diseases.
Quit smoking or excessive alcohol consumption. Both these habits are implicated in an increased risk of osteoporosis and have other harmful side effects too.