Food for thought
‘Healthy bones need a well-balanced diet, incorporating minerals and vitamins and protein from a range of different food groups including fruit and vegetables, carbohydrates, dairy products, meat, fish, eggs, pulses, nuts and seeds,’ advises Louise Hart of the National Osteoporosis Society (NOS). Government recommendations state that the average adult should eat about 700mg of calcium a day.
Dairy products are the richest source of calcium. ‘Two or three servings per day of dairy products such as a 200ml glass of milk, a 25g piece of hard cheese and a pot of yoghurt will give you the calcium you need,’ says Luci. ‘Skimmed milk is slightly higher in calcium than full fat.’
Those who do not eat dairy products can obtain calcium from bony fish, dried fruit and leafy vegetables but it involves more effort. ‘You would need to eat around 280g of dried apricots or 340g of broccoli to get the calcium you find in a glass of milk,’ says Dr Peter Selby, a consultant physician specialising in bone disease at the Manchester Royal Infirmary. He is dismissive of recent stories suggesting that milk leaches calcium from bones. ‘There is clinical evidence to suggest that this is not the case,’ he says.
Vitamin D is also essential for bone health, as low levels can lead to calcium being released into the bloodstream from the bones. We obtain most of our vitamin D from sunlight. ‘By exposing your face, hands and forearms to the sun – without burning – for 20 minutes, three times a week at times when your shadow is shorter than your height (between 10am and 3pm), you will get enough of the right rays to make sufficient vitamin D to see you through the year,’ advises Dr Selby. Sun protection factors above eight block our ability to make vitamin D.
Some evidence suggests that a high intake of caffeine and salt can increase the amount of calcium lost in urine. There is also concern that phosphoric acid used in fizzy drinks may leach calcium from bones. So if you are at an increased risk of osteoporosis, it may be sensible to limit your intake of these foodstuffs.
Who needs supplements?
Most adults do not need to take vitamin and mineral tablets for their bones unless they have too little calcium in their diet or insufficient exposure to sunlight. However, explains Louise, we absorb minerals less efficiently as we get older and some older people may benefit from a dietary supplement. Patients on osteoporosis medication may be prescribed a calcium and vitamin D supplement but if not, ask your GP for advice.
‘Use it or lose it’ is the message when it comes to building strong bones. Exercise is essential for building bone and the best kind is weight-bearing – where you are supporting the weight of your own body – for example jogging, aerobics, brisk walking, weight-training, skipping, tennis or dancing.
‘Bone is a living tissue which reacts to increases in loads and forces by growing stronger,’ says Louise. ‘Short bursts of varied vigorous activity are most effective.’
According to the NOS, leading an active lifestyle as you age can halve your risk of a fracture and it’s never too late – or too early – to start exercising. ‘It is best to exercise throughout your life but starting appropriate exercise at 60 is better than doing nothing at all,’ advises Dr Selby.
Exercising later in life not only helps to increase bone density but also increases flexibility and stability, reducing the chances of a fall. ‘American studies suggest that older people who walk outside for 20 minutes, three times a week, are less likely to suffer a fracture and this is probably because their stability is much-improved,’ he says.
Bone-building for life
A good way to boost your bones when you are younger is to do brief bouts of high-impact exercise. This could be as simple as jumping up and down on the spot, which provides a useful jolt to the hips and spine, as it’s the impact when your feet hit the ground that strengthens these bones.
Another exercise involves weight-training where the action of the tendons pulling on the bones seems to boost strength. But if the whole idea of weights is a little daunting, the NOS stresses that you shouldn’t be put off, as simply lifting a tin of beans up and down while you’re watching TV may help to strengthen your wrists – a common area for osteoporosis to cause broken bones.
AXA PPP healthcare member case study
Rhiannon Phillips, 56, from Market Drayton in Shropshire, was fit and healthy until she began to suffer from back pain about nine years ago.
‘My GP suggested physiotherapy and painkillers but nobody had mentioned osteoporosis until a few months ago when it was suggested I should have a bone-density scan.
‘I never did get the results but one day I had the most excruciating pain in my upper back. I have never felt anything like it – I thought there was something seriously wrong. I had never before experienced such pain and thought that I would be confined to a wheelchair for the rest of my life.
‘When I visited a specialist he found that I had broken three of my vertebrae because of osteoporosis and admitted me to hospital straight away. He thinks that I developed osteoporosis through taking steroids for prolonged periods for my asthma.
‘It certainly isn’t in the family: my mother is 83 and can still walk 10 miles, while I can only get about very slowly and barely leave the house now.
‘I am now in constant pain, take morphine tablets twice a day and have had to give up my work as a translator. I used to be a chef and now I cannot cook at all because I cannot carry anything.
‘Somebody comes in to help with the household chores every day. Just sitting in the same position causes me pain. It is terrible to think that even if my little dog jumped into my lap it could break one of my bones.
‘My specialist has put now me on teriparatide, a new drug to build up the bone, which I inject once a day. I have been told that within two or three months I should be starting to feel better.’
For osteoporosis sufferers, many drugs have been shown to reduce the risk of a fracture in clinical trials. These include bisphosphonates, which slow bone breakdown; raloxifene and strontium ranelate, which improve bone density; and HRT, which replaces oestrogen lost after the menopause and makes bones less likely to break.
However, Government watchdog the National Institute for Health and Clinical Excellence (NICE) has produced a draft recommendation that no osteoporosis drugs should be available on the NHS to women under 75 who have not had a fracture. NICE will make its final ruling (which will not cover HRT) early next year.
National Osteoporosis Society 0845 130 3076.
Are you at risk?
Many factors influence whether you are likely to develop osteoporosis. You are more at risk if you:
- are female
- have a family history of osteoporosis or fractures
- are of European or Asian descent
- are over 60
- have had irregular periods, an early menopause or a hysterectomy before 45
- have suffered from an eating disorder or are underweight
- have taken long-term steroid medication
- drink to excess
- have a medical condition that affects food absorption such as Crohn’s disease or coeliac disease
- are a man with low levels of testosterone, or
- have reduced mobility.
If you have three or more of the risk factors above – particularly if you are post-menopausal – or if you have suffered a fracture after a minor fall, it's a good idea to talk to your GP about having a scan to measure your bone mineral density and assess whether you have osteoporosis or are at increased risk of developing it.
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