Bone Health

Why is bone health important?

Bones, like other parts of the body, consist of living tissue that is constantly being broken down and rebuilt. Because bones are living they need constant nourishment, including calcium and vitamin D, to keep them strong.

What factors influence bone health?

The strength of your bones is in part decided at birth and results from the characteristics you inherit from your parents. Women have thinner bones than men and a high amount of calcium is lost from their bones following the menopause. This is caused by the loss of the female hormone, oestrogen, which normally protects bones and helps maintain bone health.

Lifestyle factors also play a part. Smoking, drinking excessive alcohol and high protein or salt intakes can all result in more calcium being lost from your bones.

Who can be at risk of poor bone health?

Women are more at risk than men because of their thinner bones and the loss of calcium associated with the menopause. Young women who lose a lot of weight, or diet repeatedly, or women who exercise excessively, are particularly at risk. Women who have an early menopause (before the age of 45 years) and those on long-term corticosteroid treatment are also more at risk. Men still do suffer from poor bone health although usually later in life than women.

What tests will I need?

One way of finding out how healthy your bones are is to measure your bone density. This gives an indication of how strong your bones are. A type of scan known as a DXA scan is used for this and your doctor should be able to give you more information if this is required. Your doctor may also send you for a blood test to make sure there are no other medical problems causing a low bone density.

How can I maintain bone health?

Prevention is always better than cure. However, if you have not considered your bone health until now, then it is not too late to start. Eating a diet high in calcium is important throughout life. Calcium is contained in foods such as milk, cheese and yoghurt. If you do not like or do not eat sufficient dairy foods, then you may benefit from a calcium supplement. Vitamin D is also important for strong healthy bones because it is needed to absorb calcium from foods.

Taking regular weight-bearing exercise is important to help maintain bone health. Most hip or wrist fractures result from falls. Even gentle exercise can help you maintain your balance and so prevent falls. Take a look around your home and try to sort out any potential safety hazards (see box below).

Smoking can cause the menopause to start several years earlier and is one of the risk factors for poor bone health, as is heavy drinking. So, it makes sense to stop smoking and cut down the amount of alcohol you drink.

Hormone replacement therapy (HRT) helps prevent the rapid loss of bone density after the menopause and your doctor may recommend this form of treatment.

If you already have a low bone density your doctor may prescribe a medicine to help to maintain your bone health and prevent further loss. Examples of such medicines include a group called the bisphosphonates (eg, alendronate, ibandronate and risedronate). Raloxifene (eg, Evista®) is another type of drug used to maintain bone density in postmenopausal women.

Other treatments that may be prescribed include calcitonin (salmon) (Miacalcic® injection), calcitriol (Rocaltrol®), colecalciferol (eg, Desunin®, Fultium-D3®, InVita D3®, Plenachol®, Thorens®), denosumab (Prolia® injection), strontium ranelate (Protelos®) and teriparatide (Forsteo® injection).

Anabolic steroids (eg, nandrolone decanoate) may be used to prevent further bone loss in the elderly and to reduce the risk of hip fracture.

Take action now

  • Take regular exercise - weight-bearing exercise such as cycling, skipping, dancing and brisk walking are most effective in strengthening your bones. Ask your doctor which exercise is most appropriate for you.
  • Eat a calcium-rich diet - the National Osteoporosis Society recommends a daily intake for girls and boys aged 11 to 18 years of 800mg and 1000mg, respectively. The recommended daily intake for men and women over 18 years (including pregnant women)is 700mg. People with osteoporosis may need to take a calcium supplement to boost their intake to 1200mg daily.
  • Stop smoking.
  • Avoid drinking excessively - the recommended limit is 14 units per week (spread over three or more days) with two or more drink-free days each week. One unit = 1/2 pint of average-strength beer (approximately 250mL); 1/2 glass of wine (76mL); 1 standard pub measure of spirits (25mL).
  • Prevent falls by sorting out loose floor coverings, poorly lit steps, trailing cables and uneven floors. Avoid wearing clothes that are too long.

Examples of calcium content of foods

100ml milk (full cream, skimmed or semi-skimmed) = 118mg, 120mg and 122mg, respectively
100g fruit yoghurt  = 122mg
100g cheddar cheese  = 739mg 
100g cottage cheese = 127mg
100g white bread = 177mg
100g wholemeal bread = 106mg 
100g pilchards in tomato sauce = 250mg 
100g sardines in tomato sauce = 430mg

Further information

National Osteoporosis Society
Manor Farm
Skinners Hill 
Bath BA2 0PJ
Tel: 01761 471771
Helpline: 0845 4500 230 (Monday to Friday, 9am-5pm)

Fact sheet provided by MIMS

Date last reviewed: June 2014

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