Osteoporosis prevention
Osteoporosis (literally, porous bone) means thinning and weakening of the bones. It is a condition characterised by low bone mass and gradual deterioration of bone structure, leading to fragile bones which are liable to break much more easily than normal bone.
It is often associated with getting older because as people age, their bone mineral density (BMD) level drops, leading to an increased risk of osteoporosis. Bones are made up of minerals, such as calcium, which give them their structural strength and make them thick. When bone mineral density is low it means the bones are thin and not as strong.
Bones reach their maximum density when we are aged about 30, so it is very important before that time to do everything you can to give your bones the best opportunity to be as dense as possible. In the early 30s the bones start to lose density very slowly, until, if you are a woman, you reach menopause. In women, after the menopause, bone mineral density is lost rapidly for the next 5 to 7 years. For this reason, it is very important for women to try to build up a good bone density and then try to maintain it for as long as possible.
Unfortunately, some people have more risk factors for osteoporosis than others and some of these risk factors cannot be changed. These include being female, Caucasian or Asian, small or thin-boned, or having a family history of osteoporosis.
However, other risk factors include having a poor diet that lacks calcium, excess consumption of alcohol, and an inactive lifestyle. By making some simple lifestyle changes now you may be able to reduce your risk and help maintain healthy bones well into old age. Having a healthy lifestyle is equally important for all ages, not just older people. Here are some suggestions for you to think about.
What you can do to help prevent osteoporosis
- Eat lots of calcium-containing foods. Doctors believe, and published studies indicate, that low calcium intakes are consistently associated with low bone mass. Good sources of calcium include milk, yoghurt, cheese, almonds, dark green leafy vegetables such as broccoli, and fish with bones such as sardines and salmon. Men and pre-menopausal women should aim for at least 1000 mg of calcium per day, and post-menopausal women and men over 70 should aim for 1300 mg per day. Most older men and women in Australia are unlikely to achieve these calcium intakes through diet alone, and can benefit from taking calcium supplements.
- Take a calcium supplement (e.g. Caltrate, Cal-Sup, Citracal, Sandocal). If you find it impossible to increase your calcium intake through your food, calcium supplement tablets can help. You can get them without a prescription from a pharmacy or health food shop. Remember, though, that supplements based on calcium carbonate should be taken with food as they need gastric acidity to help increase their absorption, and not to rely on supplements at the expense of a good diet. Calcium supplements may cause constipation.
- Get out in the sun. Vitamin D, which is synthesised in the skin through exposure to sunlight, plays an important role in helping to absorb calcium and also in the general health of bone. Most people have no problems making enough vitamin D, however, elderly people who live in nursing homes, others who cannot get outdoors, and those who cover their skin for cultural reasons, should talk to their doctor about a vitamin D supplement instead.
- Exercise regularly. Bone is living tissue which, like muscles, gets stronger when it is stressed by having to carry more weight than usual. Weight-bearing exercise is one of the best things you can do for your bones. Walking, hiking, running, jogging, weight training and tennis are all beneficial because they force you to work against gravity. Doctors believe that as peak bone mass is reached in your 20s, the earlier you start building an exercise programme into your life, the larger your bank of ‘bone mass’ will be, making you less susceptible to osteoporosis later on. Be aware that very high levels of exercise in young women, such as that done by ballerinas or elite athletes, can lead to their periods stopping which can increase their risk of osteoporosis. It’s never too late for exercise, either, because it will also help you build muscle, and improve your posture and balance, all of which reduce the chance of having a fall if you are elderly, and will lessen your chance of a fracture.
- Maintain a healthy bodyweight. Low bodyweight is a risk factor for osteoporosis. Women such as those with eating disorders, such as anorexia or bulimia, who lose so much weight that their periods stop do not ovulate and don’t get the circulation of oestrogen they need. Oestrogen helps to maintain bone density in women which is why after the menopause, when levels of oestrogen fall, women have a much higher rate of osteoporosis than men. Having your periods stop for more than 6 months before the age of 45, other than during pregnancy, is a risk factor for getting osteoporosis.
- Drink alcohol in moderation. Alcohol is toxic to the molecules that help build bone so it follows that heavy drinkers are more at risk of osteoporosis than those who enjoy the occasional tipple. The National Health and Medical Research Council’s guidelines suggest that women should have no more than 2 standard drinks a day, and men no more than 4 with one or 2 alcohol-free days per week — this amount does not appear to have harmful effects on the skeleton.
- Stop smoking. Smoking may affect your ability to absorb calcium from your diet — it certainly does contribute to weak bones. Smoking in adolescence has a negative impact on peak bone mass.
- Limit your caffeine intake. Caffeine seems to adversely affect calcium absorption in some studies possibly due to its diuretic effect, so limiting your intake of coffee and caffeinated drinks would seem sensible.
- Manage your medications. Long-term use of some medicines, including anticonvulsants, heparin, corticosteroids and some diuretics, can contribute to bone loss. You should talk to your doctor about whether any of your medicines may contribute to your risk of osteoporosis.
Medicines used to prevent osteoporosis
Hormone replacement therapy. HRT is an effective treatment for prevention of osteoporosis in postmenopausal women, however, evidence from recent studies such as the Women's Health Initiative and the Million Women Study has provided doctors with more information on the risks involved in taking HRT. Nowadays, it is usually only recommended for fracture prevention when a woman has menopausal symptoms that need treating. The risks and benefits of taking HRT need to be assessed on an individual basis for each woman and vary depending on age, the type of HRT, and other factors. Your doctor will be able to advise you on whether it is right for you.
Tibolone. Tibolone (e.g. Livial) is a medicine used for preventing postmenopausal bone mineral density loss in women at high risk of fractures as well as for short-term relief of menopausal symptoms. Tibolone aims to replace the body’s natural sex hormones which are reduced after menopause. Tibolone is sometimes given to women who have had their ovaries removed, because it is the ovaries that produce sex hormones in women. Tibolone may improve libido. It takes 3 months of treatment to obtain the full benefit of tibolone. Side effects of tibolone may include: vaginal bleeding or spotting; headache; dizziness; itching; weight gain; nausea; abdominal pain or breast pain; rash; and high blood pressure.
Bisphosphonates. These medicines can slow bone loss, improve bone density and reduce the risk of fractures. They include alendronate (e.g. Fosamax), etidronate (e.g. Didrocal), and risedronate (e.g. Actonel). They can be used to preserve bone mass in people who have to take corticosteroids long term, and alendronate (e.g. Fosamax) can also be used to prevent osteoporosis in postmenopausal women who have low bone mass.
Bisphosphonates can give some people stomach upsets and should be taken on an empty stomach to minimise side effects. Also, people are advised to stay upright for 30 minutes after taking risedronate and alendronate, as they can sometimes irritate the oesophagus (gullet). Once-weekly bisphosphonate formulations are available which reduce the risk of gastrointestinal side effects. Certain people may also be able to take a dose of risedronate (Actonel) once a month, which may be more convenient. Other side effects of bisphosphonates may include musculoskeletal pain and fatigue.
Raloxifene. Raloxifene (e.g. Evista) belongs to the class of drugs called selective oestrogen receptor modulators (SERMs). Raloxifene can improve bone density and has been shown to reduce spine (backbone) fractures. It is only for use by women after the menopause. Raloxifene may make hot flushes worse and may cause leg cramps and increase the risk of blood clots. There is evidence that it may reduce the risk of breast cancer.
There may be other medicines that are available for the prevention of osteoporosis. Talk to your doctor about your options for reducing your risk of osteoporosis.
Other things you can do
Reduce your risk of falling.
If you are older or already have osteoporosis, having a fall and breaking a bone can have a dramatic effect on your quality of life so it is important you try to avoid this at all costs. Weight-bearing exercise will improve your muscle strength and exercises such as Tai Chi or yoga can improve your balance. You should ensure your house is free from loose mats, badly placed power cords and uneven surfaces that could cause you to trip over. Also, check that the lighting in your home is sufficient throughout and that any rails or steps are securely fixed. Make sure too that you minimise the chance of falls by ensuring that your eyesight is OK and that your eye glasses, if you wear them, are adequate.
Some medicines, such as sedatives, antihistamines and blood pressure medicines, can make you dizzy or interfere with your balance, so it is important that your doctor reviews all your medications regularly.
Last Reviewed: 29 August 2007
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