Last week at Complete we hosted a community seminar all about Bone Health. It was great to welcome an engaged group of people, who were keen to understand more about their bone health and find out how to improve it.
What struck me from the group, and a common theme I have seen among patients recently, is that a diagnosis of osteoporosis or osteopenia has come as a surprise. Many otherwise fit and healthy adults were shocked to discover they had poor bone density, and were left wondering – ‘Why me?’.
If you are one of these people, hopefully this article can bring some context to your diagnosis. Understanding why you may have a higher risk, what factors you can and can’t change, can help you to prevent or manage low bone density. With the right treatment approach, you may even find you can improve your bone density.
Osteopenia (low bone density) and osteoporosis (very low bone density) can affect anyone, and they often present with no symptoms, until a bone fracture occurs.
Before I dive in to explaining the risk factors, let me explain a bit more about how bone – and bone density – is built.
Bone is a living tissue. It is constantly being remodelled by specialised cells that build (osteoblasts) and break down (osteoclasts) bone. These cells are called into action when we load our bones (for example with weight training). With loading, micro-cracks are created, the specialised cells remove the damaged bone, then rebuild with stronger, more resilient bone.
The environment inside our body needs to be optimal for this bone remodelling process to work. Hormones such as oestrogen, testosterone, thyroid, and cortisol, all influence the availability of bone building cells.
If we have low levels of these hormones, the rate of bone breakdown will outpace bone formation, therefore gradually reducing our bone density. Additionally, if we don’t provide our bones with any load, they won’t be stimulated to adapt and strengthen. And if we don’t provide our bodies with the required fuel, in the form of food (and in some cases supplements), strong bones won’t be able to be formed.
Risk factors
When we talk about risk factors, generally we categorise them into ‘modifiable’ (things we can change) and ‘non-modifiable’ (factors that we don’t have control over). They are both important to understand, as even the factors you cannot change help you to know your risk, and you can take the actions needed via the modifiable risk factors.
Non-modifiable
- Older age: peak bone density is reached at around age 25-30, after this bone density will decrease naturally as we age
- Being female:
females tend to have a lower peak bone density than males and experience rapid bone loss during menopause, both of which increase risk - Genetics: if you have a family history of osteoporosis you may be at higher risk
- Early menopause: if you experience menopause earlier (before age 45), the reduction in oestrogen increases your risk
Potentially Modifiable – medical conditions and medications
- Certain medical conditions increase your risk of low bone density
- Some of these are related to lifestyle factors which are within our control, or can be managed with medications to reduce the risk, while others we may not be able to prevent or change
- Examples include: malabsorption disorders (eg. coeliac disease, IBD), diabetes, thyroid conditions, chronic liver or kidney disease, low testosterone
- Certain medications can increase your risk, as they interfere with absorption of nutrients or availability of hormones.
- Some medications are necessary to treat other conditions so should not be avoided, however being aware of the effects on your bones means you can proactively manage this in other ways
- Examples include: certain cancer treatments that block hormones (eg. breast and prostate cancer medications), corticosteroids (eg. certain asthma medications), and some anti-epilepsy treatments (interfere with Vitamin D metabolism)
Modifiable
- Physical inactivity:being inactive greatly increases your risk. However, even active people can develop low bone density. For example, those who do lots of low-impact exercise like swimming, yoga, or even walking, may not be providing enough load to their bones to develop good bone strength.
- Smoking & excessive alcohol intake:
both interfere with bone-building cells and calcium absorption. - Low calcium intake:
calcium is a key building block for bone, so a consistently low intake can increase your risk over time. The recommended daily intake increases in older age, so it is a good idea to track your calcium intake and aim for 1,300 mg daily (for women over 50 and men over 70), preferably through food. - Low vitamin D levels:
Vitamin D is needed to absorb calcium. Lack of sun exposure can lead to low vitamin D levels, so it is a good idea to track your levels especially during winter. - Low body weight:
those with a naturally thin body build, or low body weight due to conditions such as eating disorders, are at higher risk.
Exercise for bone health
For more information on what kind of exercise is best for your bones – check out this blog by James: How to Improve Bone Health Through Exercise: What the Research Says
Our Bone Health Classes at Complete are specifically designed to help you maintain or improve your bone density.
