What Is Osteoporosis?
Osteoporosis is a medical condition where bone mineral density and bone mass decrease. This results in bones that are more brittle and fragile which leads to breaks and fractures. Osteopenia, where bone mass is reduced, often precedes osteoporosis.
We hit peak bone mass in our mid-30s. If we want strong and healthy bones as we age, we need to take action as early as possible.
Our bones contain around 95% of our calcium, with only 5% detectable in the blood. This is why DEXA scanning is the gold standard for bone density testing, and not serum calcium measured in blood tests.
More than 1 in 5 women in the UK over 50 have osteoporosis according to the International Osteoporosis Foundation. We lose bone tissue most rapidly in the first 4-8 years after menopause, due to the natural decline in oestrogen.
Our bone tissue is a living organ. It is constantly being broken down and rebuilt over our lifetime. You may be surprised to know that bones are made up mostly of Type 1 collagen which provides a flexible framework, and minerals such as calcium and phosphate which add strength. There are a number of factors that can disrupt healthy bone formation. There are some things we can’t influence, and some that we can. Here’s a summary of these and some simple suggestions on how to support our bone density.
Risk Factors You Can’t Change (1)
1. Being a woman – Caucasian and Asian women have a higher risk of osteoporosis. Afro-Caribbean and Hispanic women have a slightly lower risk.
2. Genetics – If your mother and grandmother have/had osteoporosis, you may be more at risk
3. Ageing – as we age our bone turnover ie the rate at which bone is broken down and rebuilt is slower and less efficient leading to weaker bones
4. Menopause – The natural reduction in sex hormones, and in particular oestrogen is a significant risk factor for osteoporosis. HRT is one effective way of preserving bone mass. Diet and lifestyle factors also support bone health as we go through the change.
Risk Factors That May or May Not Be In Your Control
1. Certain Medications – including steroids and possibly PPIs, some antidepressants and some diabetic medications
2. Certain Medical Conditions – including hyperthyroidism, coeliac, Crohn’s and rheumatoid arthritis
Risk Factors You Can Change
1. A Body Mass Index of less than 19 has been associated with a greater risk of osteoporosis. Maintaining a healthy weight will support bone mass density (2)
2. Nutrient Deficiencies
a) Vitamin D –Vitamin D plays an essential role in bone health. Many of us are deficient as we don’t get sufficient sun exposure. It’s important to ‘test, don’t guess’. If you don’t know what your levels are, you won’t know how much to supplement. I recommend the following test that you can order directly – https://www.vitamindtest.org.uk. Then ask for help on what your optimum level might be, how much to supplement, and for how long.
b) Calcium, Magnesium, Vitamin K2, boron, molybdenum, manganese, phosphorus, strontium etc. – Bone health is not just about calcium. It takes a range of minerals, trace minerals and vitamins to make the processes involved in bone health work optimally. Wholefoods are the best place to get these nutrients, with supplements being used where necessary.
c) Low antioxidant intake – The Framingham Osteoporosis study showed an association between higher antioxidant intake and higher bone mass density. Antioxidants may slow the process that breaks bone down (3)
3. Low Weight Bearing Exercise
Our bones need some amount of stress to remain strong. A review on which type of exercise has been shown to be most effective for bone mass (4) suggests weight bearing exercise around 3 times a week as a general guideline. Vibrating platforms may also be effective. Walking alone may preserve bone mass but may not increase it. Ladies, in my opinion you can’t beat using weights and good body weight exercises such as lunges, squats, press ups, some kind of jumping/running/skipping if possible. It’s why I love Crossfit classes.
4. Smoking – nicotine promotes bone tissue reduction amongst many other hideous things!
5. Too much alcohol interferes with the production of vitamin D and calcium balance. However, there has been an association between small amounts of around 1 glass a day and reduced fracture risk.
6. Too many fizzy drinks – a high intake of drinks containing phosphorous can lead to great bone tissue loss. High sugar and sodium intake (common in fizzy drinks) can also promote bone loss.
7. Too much caffeine – too much caffeine can lead to increased calcium loss. Whilst evidence may not show a direct cause and effect, the recommendations generally are to limit caffeine to moderate levels of no more than 3 cups a day.
What You Can Do
1. Osteoporosis is known as a ‘silent’ disease. You may not be aware you have it until you experience a bone break.
The gold standard for testing bone mineral density (BMD) is a DEXA scan. This can be arranged through your GP, or carried out privately. If you are in your 50s, and you are at risk, consider arranging a scan so that you know your start point and can be proactive and take control of your bone health.
2. Optimise Your Diet
a) The Mediterranean Diet is a good framework to use. It is anti-inflammatory (Inflammation can increase the rate of bone tissue loss) (5)
b) 3 portions of oily fish a week, copious amounts of dark green leafy vegetables (calcium, magnesium, Vitamin K2 etc) and lashings of extra virgin olive oil!
c) Avoid foods that are inflammatory including sugar, refined carbohydrates (the white stuff), poor quality fats and cooking oils (stick to extra virgin olive oil, coconut oil and butter for cooking), processed meats.
d) Limit alcohol, caffeine and fizzy drinks.
e) Identify food sensitivities that can drive inflammation or lead to malabsorption.
f) Consume natural phytoestrogens. These are food that have a mild oestrogenic effect. In other words, they work in a similar way as oestrogen. These include soy, chickpeas, lentils, freshly ground flaxseeds amongst herbs such as black cohosh and red clover.
e) Increase your intake of calcium-rich foods. The average woman needs around 1000mg and for postmenopausal women the recommended level is 1200mg. Ideally, we should get this through food.
Dairy is a great source, but not an option for many people and can be inflammatory and acidifying in large amounts. Focus on other sources of calcium such as dark green leafy vegetables, pulses, sardines, tahini etc.
f) Eat enough protein but not too much. The average women needs around 50g daily (this depends on weight, exercise level etc). We need protein for collagen formation.
However, excessive amounts of protein can promote a loss of bone mineral density, as it is acidifying which causes minerals to be leached from bone tissue to buffer the acidity.
3. Get help if you have digestive problems. You need optimum digestion to digest and absorb the nutrients from your food. You may benefit from digestive enzyme support, and support for your microbiome and gut wall function.
4. Consider Supplements – If you are following a healthy diet but have osteopenia or osteoporosis a bone support supplement may also be helpful. Choose a good quality one that includes a full range of bone supportive minerals and vitamins. You may also need to supplement with Vitamin D3 and K2 throughout the winter.
If you are concerned about bone health and need support with your diet, digestive health or a tailored supplement programme then please do give me a call. To arrange a Free Discovery Call email me here on [email protected] or call 07909 732017