Many people think of osteoporosis as a disease that old people get. Not so lady! Women going through perimenopause and post menopause are at risk (whatever their age). This is due to the lack of or lower levels of oestrogen in the body. Oestrogen is a key factor with regard to bone density. You need this on your radar now and to start looking at ways to improve your bone health.
What is osteoporosis?
Osteoporosis happens when the bone density is reduced which makes the bones at greater risk of fracturing. Many women are unaware they have it until they break a bone relatively easily. This is usually one of the first signs. Osteoporosis causes the bones to become very weak and fragile. So much so that even a bump, sneeze or sudden movement can cause a fracture!
Why is bone health important?
Women are much more affected by bone density loss in the years before, during and after menopause. This is due to the reduced levels of oestrogen in the body. The bone density starts to break down at a rate faster than the body can grow new bone tissue.
The stats are scary. 1 in 3 women will have a hip fracture over the age of 50. This is no straightforward fracture either. Significant numbers of women have difficulties with carrying out their usual day to day activities after recovery. That’s things like washing and dressing and shopping. 40%. Yes 40% of women cannot walk again unaided. It’s no joke ladies.
There are a number of other things that can put you at increased risk of osteoporosis such as a family history, specific medications such as steroids, existing conditions such as diabetes and rheumatoid arthritis, lack of sunlight and lack of physical activity amongst others.
Measuring risk & making a diagnosis of osteoporosis
If your doctor thinks you may have osteoporosis, there are some diagnostic measurements and tools that can confirm it. FRAX is a tool that has been developed for clinicians to evaluate the fracture risk for patients. It bases it on a number of clinical and lifestyle risk factors as well as bone mineral density. Measuring bone mineral density is another useful tool for diagnosis. This can be done with a DEXA scan. The DEXA scan is a very low dose of radiation which basically measures how much radiation enters and exits the bones. The difference in the results indicates how much radiation has been absorbed by the bone and other tissues. This then indicates how “dense” the bones are. It’s essentially measuring the quality of your bone mass rather than the quantity.
You can also measure your own risk of developing osteoporosis with this free risk checking tool developed by the International Osteoporosis Foundation. This is not a replacement for medical advice and diagnosis though. It’s just intended to give you an idea of your level of risk.
What can you do to prevent osteoporosis?
Luckily there are a number of steps you can take to help reduce your risk.
Don’t use it you lose it applies here. Your bones get and stay stronger the more you use them and the more you give them to do. The ideal combo would be to incorporate weight bearing exercise with impact and muscle strengthening exercise.
It’s really important to choose activities that you enjoy otherwise you just won’t do it or it will feel like a chore. Weight bearing exercise is basically any exercise that involves you standing and holding the weight of your body. The impact bit can come in many forms and will depend on your level of ability and what you can manage. For example, low impact activity would be walking or stair climbing. Medium impact would be things like dancing, jogging or skipping and high impact would be sports such as netball, volleyball or some athletic events.
When you add in muscle strengthening exercise, this means the muscle pulls on the bone which makes your bones work more. Strengthening your muscles means giving them some kind of resistance. This could mean activity such as lifting weights, using resistance bands or using your own body weight with exercises such as sit-ups or press-ups.
How much exercise?
The Royal Osteoporosis Society recommends the following:
Weight-bearing exercise with impact with exercise levels appropriate for your health and mobility
- People without osteoporosis, and most people with osteoporosis – About 50 moderate impacts on most days. This could be jumping, skipping, jogging or hopping.
- If you have spinal fractures or are unable to do moderate exercise – 20 minutes of lower impact exercise on most days.
- If you’re not physically strong or unable to do regular exercise – Aim to avoid prolonged sitting. Stand up for a few minutes every hour.
Muscle strengthening exercise
- Exercise two to three days each week, on non-consecutive days.
- Aim for 20 to 30 minutes, working on exercises that target legs, arms and your spine.
- Work gradually with resistance bands and weights – the most you can lift eight to 12 times. Build up to three sets of each exercise.
The 2 well known vitamins and minerals for bone health are vitamin D and calcium. There are also a number of others that impact bone health including B vitamins, vitamin K and magnesium.
If you eat a generally balanced diet, you are likely to be getting enough of these in your diet. This includes:
- fruit and vegetables (at least 5 portions a day)
- carbohydrates, like bread, potatoes, pasta, rice and cereals
- dairy and alternatives
- proteins, like beans, eggs, fish and meat
This factsheet from the Royal Osteoporosis Society has loads of helpful information on specific vitamins and minerals and what foods you can find them in.
Vitamin D helps your body to absorb calcium which strengthens your bones. There are 3 ways you can get vitamin D; through sunlight, foods and supplements.
Since the pandemic started, it is recommended that adults take a supplement of 10 micrograms of vitamin D every day. This is due to many people not getting their recommended amount every day by being outdoors in direct sunlight. Depending on where in the world you live, you may also benefit from this at certain times of the year. For example, in the UK, it is generally accepted that most people do not get enough vitamin D from sunlight from September to March due to the reduced hours of sunlight each day.
When sunlight hits your skin, it reacts with your skin to produce vitamin D. When you are able to access sunlight, it is recommended to expose yourself (without sunscreen) for around 10 minutes once or twice per day. This can be when doing tasks such as putting the washing on the line or walking to the shop.
- If the weather is cloudy, it takes longer to produce the same amount of vitamin D as on a sunny day
- Glass blocks the sun’s rays, so go outside, or open your window
- Darker skin produces vitamin D at a slower rate
- Sunblock and high factor sunscreen stops the sun’s rays reaching your skin and reduces the amount of vitamin D your body makes. If you’re outside for more than 10 minutes though, you should wear sunscreen as the risk to your skin is higher than the benefit to your bones
It is really difficult to get the recommended dose of vitamin D from food alone.
Foods containing vitamin D include:
- oily fish, like herring, salmon and mackerel
- some pork products
- lamb’s liver
- fortified bread
- fortified yoghurts
- specially processed mushrooms
You can get your recommended amount by taking a supplement. 10 micrograms per day is the recommended dose. You don’t need to have a blood test to measure your levels before taking it but I am aware of a lot of my clients being prescribed this after a blood test showed they were deficient. Interestingly, a lot of the symptoms of vitamin D deficiency are similar to perimenopause!
You should only take the recommended dose as it is dangerous to have too much.
Smoking slows down the cells that promote bone growth. This means that smoking can reduce bone strength which increases the risk of fracture. Research also shows that people who smoke are at greater risk of hip fracture as they get older. (Remember the scary stats about hip fractures?? 👆)
It’s never too late either. If you give up smoking, your risk of breaking a bone begins to return to normal.
Excessive alcohol consumption increases your risk of osteoporosis. When you’re under the influence, it also makes you unsteady on your feet, which makes you more likely to trip, fall and break a bone.
The UK government recommends drinking no more than 14 units of alcohol a week.
To help you picture what a unit looks like, the following drinks contain one unit of alcohol:
- A single pub measure (25ml) of whisky, gin or brandy
- Half a pint of beer or cider
- A quarter of a pint of strong beer or cider
One small glass (125ml) of wine is one and a half units. Time to get the measuring jug out 😬
So, as you can see, osteoporosis is something you need to have on your radar. It’s never too late to start looking after your bones. I hope some of this inspires you to make some changes. If you need any help with this and how to generally navigate your menopause more easily, please get in touch for a chat about how I can help. Alternatively you can find out more here.