What is osteoporosis? Causes, symptoms, and how to prevent it

 

Osteoporosis is often referred to as a ‘silent’ disease that often does not present any symptoms. In fact, many people do not realise that they have this condition until they sustain an injury or break a bone. Over time, osteoporosis weakens the bones, decreasing their strength and making them more prone to fractures and breaks. In this guide, we will explore what osteoporosis is, its causes, symptoms, and ways you can help to prevent it.

 

What is osteoporosis?

 

Osteoporosis is a condition that gradually causes bones to become weak and brittle due to a loss of mass and density. It currently affects over 3 million men and women in the UK, although it tends to be more prevalent in women (i). Women are more at risk of developing osteoporosis due to the hormonal changes that occur during menopause, which lead to a decline in oestrogen. Oestrogen is essential for maintaining bone strength and promoting the formation of new bone cells, and low levels can lead to weak and fragile bones (ii). It is estimated that women can lose up to 20% of their bone density in the first 5-7 years after menopause, significantly increasing the risk of fractures (iii). However, you do not have to wait until you get older or have a fracture to worry about your bone health. In fact, taking proactive steps earlier in life can help reduce the risk of osteoporosis later in life.

 

What causes osteoporosis?

 

In addition to the menopause, many other factors can contribute to the development of osteoporosis. It is important to remember that your bones are living tissues that are constantly regenerating, so anything that disrupts this process is going to impact their health. Here are some of the factors that can increase the risk of developing osteoporosis:

 

1. Heavy drinking and smoking

 

Research has shown that heavy alcohol use is significantly linked to osteoporosis. Heavy alcohol consumption can prevent calcium and vitamin D absorption, contribute to hormone deficiencies, and make fractures more likely due to falls (iv). Similarly, studies have shown that smoking disrupts the balance between bone formation and resorption, resulting in decreased bone mass (v). To find out more, check out our guide on how alcohol and smoking can impact your bone health.

 

2. Hormonal changes

 

We know that the decline in oestrogen levels during menopause can lead to bone loss in women, but did you know hormonal changes can also increase men’s chances of developing osteoporosis? Studies have discovered a link between lower testosterone levels and the increased risk of osteoporotic fractures, particularly with hip and nonvertebral (vi).

 

3. Age

 

As we age, our bone mass and density naturally decrease, so this is sadly a factor we do not have much control over. The NHS states that our bones are at their thickest and strongest in our early adult life until our late 20’s. After this, you gradually start losing bone density from the age of 35 (vii). Although age-related bone loss is inevitable, it does not necessarily have to lead to osteoporosis. By focusing on nutrition, lifestyle choices, and exercise, you can help slow down bone loss and ensure that your bones stay healthy and strong for longer.

 

4. Diet and lack of nutrients

 

Diet plays a pivotal role in maintaining and supporting your bone health throughout every stage of your life. Three essential vitamins your bones need to thrive are:

• Calcium. Our bodies cannot produce calcium, so we need to source it from food, drinks, and supplements when needed. Calcium strengthens our bones, keeping them healthy and less prone to breakages. If we do not get enough calcium, our bodies will take this from our bones, weakening them and increasing the risk of osteoporosis (viii).
• Vitamin D. Helps the body to absorb and use calcium, which helps to strengthen your bones (ix). Many people struggle to get enough vitamin D, with 1 in 6 UK adults reporting low levels, and approximately 20% of children having vitamin D levels lower than government recommendations (x).
• Protein. Contributes to bone formation, the remodelling process, and your bone’s overall strength and health. Protein makes up 50% of your bone structure, and like vitamin D, supports calcium absorption (xi). Studies have revealed that a lack of protein is linked to reduced calcium absorption and lower bone mineral density (xii).

 

5. Other medical conditions or medications

 

Just like age, another cause that can increase the risk of bone loss is certain common medical conditions or medications you may be taking. These conditions include (xiii):

• Type 1 diabetes
• Lupus
• Rheumatoid Arthritis
• Hyperthyroidism
• Coeliac disease
• Asthma
• Multiple sclerosis

If you have a condition or are taking medications that may affect your bone health, you should always consult your doctor, who can advise on the best course of action going forward.

 

6. Lack of physical activity

 

Your bones are living tissue, and they get stronger the more you use them, so activity is key the older we get. Studies have highlighted inactivity as a modifiable risk factor for osteoporosis and that increasing your level of physical activity at any point in life can have a positive effect on bone health (xiv). In addition, cross-sectional and longitudinal studies have shown that the skeletal benefits of physical activity during adolescence persist into young adulthood. Likewise, bone loading activities (such as weightlifting or running) during young adulthood were found to increase the bone mineral density in middle age or older adulthood (xiv). The findings from these studies emphasise the importance of maintaining an active lifestyle and the importance of developing strong bones early on in life.

 

What are the symptoms of osteoporosis?

 

Osteoporosis is a progressive condition that weakens the bones over time. It can be difficult to detect, and most people will not be aware of it until they have a fracture. Hence why it is referred to as the ‘silent disease,’ as it does not exhibit any noticeable symptoms. However, one of the early warning signs of osteoporosis is broken bones and how easily these occur. The Royal Osteoporosis Society states that the wrist is one of the most common broken bones caused by osteoporosis. They also state that if you are older, a broken hip after a fall can be a key signifier of bones that have lost their strength (xv). If your bones are strong, they should be able to withstand the impact of a fall or bump from a standing height. However, if you have broken a bone easily, then you should speak to your doctor, especially if you are at a higher risk of osteoporosis.

 

Is osteoporosis hereditary?

 

Yes, genetics can play a significant role in the development of osteoporosis. Research has found that specific gene variations can affect bone mineral density and increase fracture risk (xvi). They looked at the LRP5 gene and found that mutations can lead to weaker and more porous bones, increasing the risk of osteoporosis. In addition, further twin and family studies indicated that 25% to 85% of variations in bone mass and other skeletal traits were capable of being inherited (xvii). However, it is important to note that having a genetic predisposition to osteoporosis does not guarantee that you will develop the condition.

 

How to prevent osteoporosis?

 

Osteoporosis may not be completely unavoidable, but the good news is that there are some ways you can strengthen your bones and reduce the risk of developing this condition. Small changes can make a big difference when it comes to improving your bone health. Here are our top recommendations for keeping your bones strong and healthy throughout the years:

• Stay active. Keep your bones stimulated and strong with regular exercise. The NHS recommends that adults aged 19-64 should do at least 2 hours and 30 minutes of exercise per week (xvii). The best exercises to support bone health include weight-bearing exercises like running and aerobics, and resistance exercises like weightlifting and press-ups. For more bone-friendly workouts, check out our blog on bone health exercises or our guide on improving your posture.
• Ditch the cigarettes. Smoking can disrupt the remodelling process that bones need to break down and reform. It can also negatively affect the absorption of calcium from the diet, so your body will not be getting enough and start to take it from your bones, weakening them further (xix).
• Cut down the tipples. Too much alcohol can also be harmful to your bones, interfering with their growth and remodelling process. NHS guidelines recommend drinking no more than 14 units of alcohol per week (xx).
• Eat a balanced diet. Make sure you are eating a diet that is rich in calcium, vitamin D, and protein, all of which are fantastic for supporting healthy bones. To increase your calcium intake, consume milk, yoghurt, cheese, broccoli, sardines, and almonds. However, if you need more vitamin D, consume oily fish like salmon and mackerel, eggs, and red meats.
• Take supplements if necessary. If you are not getting enough calcium, vitamin D, or protein through diet alone, then you may want to consider taking supplements. If you are taking any medications or have any health conditions, please consult your healthcare provider prior to adding any supplement into your daily routine.

 

Final thoughts

 

Strong bones are your body’s foundation, so it is important to look after them with a healthy and active lifestyle. That does not mean you have to be up at 6am pounding the pavements followed by a green juice if that is not you. It is more about making simple and sustainable choices that will support your bone health long-term and reduce the risk of osteoporosis. By understanding more about this condition, you can effectively prioritise your bone health in a way that works for you. For more practical tips and articles, check out our dedicated health blog, or contact our expert Nutrition Advice team, who are on hand to provide free and confidential advice.

 

References: 

i. NHS Inform. (n.d.). Osteoporosis. Available online: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions-that-can-affect-multiple-parts-of-the-body/osteoporosis

ii. NHS UK. (n.d.). Osteoporosis - Causes. Available online: https://www.nhs.uk/conditions/osteoporosis/causes

iii. WebMD. (n.d.). How to Keep Bones Strong as You Age. Available online: https://www.webmd.com/healthy-aging/features/strong-bones-age

iv. PMC. (2022). Osteoporosis and Fracture Risk. Available online: https://pmc.ncbi.nlm.nih.gov/articles/PMC8835521

v. PMC. (2019). Osteoporosis Treatment and Prevention Strategies. Available online: https://pmc.ncbi.nlm.nih.gov/articles/PMC6304634

vi. PMC. (2021). Testosterone and Fracture Risk in Older Men. Available online: https://pmc.ncbi.nlm.nih.gov/articles/PMC7867125

vii. NHS 111 Wales. (n.d.). Osteoporosis Overview. Available online: https://111.wales.nhs.uk/encyclopaedia/o/article/osteoporosis

viii. NIAMS. (n.d.). Calcium and Vitamin D: Important for Bone Health. Available online: https://www.niams.nih.gov/health-topics/calcium-and-vitamin-d-important-bone-health

ix. Royal Osteoporosis Society. (n.d.). Vitamin D for Bones. Available online: https://theros.org.uk/information-and-support/bone-health/vitamin-d-for-bones

x. GOV.UK. (2022). New Review Launched into Vitamin D Intake to Help Tackle Health Disparities. Available online: https://www.gov.uk/government/news/new-review-launched-into-vitamin-d-intake-to-help-tackle-health-disparities

xi. ScienceDirect. (2022). Protein Composition in Bone Matrix. Available online: https://www.sciencedirect.com/science/article/pii/S0002916522049279

xii. PubMed. (2003). Protein Intake and Bone Health: Epidemiological Evidence. Available online: https://pubmed.ncbi.nlm.nih.gov/12612169

xiii. WebMD. (n.d.). Medical Causes of Osteoporosis. Available online: https://www.webmd.com/osteoporosis/features/medical-causes

xiv. PMC. (2018). Physical Inactivity and Bone Health. Available online: https://pmc.ncbi.nlm.nih.gov/articles/PMC6179512

xv. Royal Osteoporosis Society. (n.d.). Symptoms of Osteoporosis. Available online: https://theros.org.uk/information-and-support/osteoporosis/symptoms

xvi. NIH. (2022). Genes Linked to Abnormal Bone Density and Fracture Risk. Available online: https://www.nih.gov/news-events/nih-research-matters/genes-linked-abnormal-bone-density-fracture

xvii. Genome Medicine. (n.d.). Genetic Factors and Osteoporosis. Available online: https://genomemedicine.biomedcentral.com/articles/10.1186/gm84

xviii. NHS UK. (n.d.). Preventing Osteoporosis. Available online: https://www.nhs.uk/conditions/osteoporosis/prevention

xix. AAOS. (n.d.). Smoking and Musculoskeletal Health. Available online: https://orthoinfo.aaos.org/en/staying-healthy/smoking-and-musculoskeletal-health 

xx. NHS UK. (n.d.). Alcohol and Bone Health. Available online: https://www.nhs.uk/better-health/drink-less