Eight science-backed steps you can take now to reduce your risk of osteoporosis
The bones of lasting good health are found in being mindful of osteoporosis risks.
How robust are your bones? Even if you think you are fit and healthy in middle age, the reality is that half of women and one-quarter of men over 50 will break a bone because of osteoporosis. According to the Irish Osteoporosis Society (IOS), up to 300,000 people in Ireland have the bone-weakening condition and anyone of any age is at risk.
“We hit peak bone health at about the age of 30,” says Michele O’Brien, CEO of the IOS. “But anyone is at risk of bone loss at any stage of their life with many risk factors such as eating disorders and over-exercising, stress and a lack of vitamin D contributing to bone loss.”
Through early adulthood, our bones are generally kept strong and healthy through the continual turnover of new bone cells and removal of old ones. But into our 40s this process becomes less efficient, with old cells being broken down faster than new ones can be formed. In women, the fragility is accelerated by the decline in bone-protective hormones such as oestrogen around menopause.
Osteoporosis is the often result and the endpoint is a weakened skeleton with bones becoming so brittle that in many cases they are increasingly fracture-prone. However, O’Brien says osteoporosis and broken bones are not an inevitable part of ageing and “is preventable in most people”.
How we exercise is crucial for maximising bone health. In a new paper published in the lead author Dr Katherine Brooke-Wavell - a researcher at Loughborough University’s national centre for sport and exercise medicine - and a panel of experts reviewed evidence to determine what type of activities will best preserve our bones. In the paper, entitled 'Strong, Steady and Straight', Brooke-Wavell describes how strengthening our postural muscles by performing resistance and high-impact, weight-bearing exercises is essential for maintaining healthy bones.
“The more we move and the greater the variety of those movements the better for our bones,” Brooke-Wavell says. “For anyone who has not experienced a vertebral fracture, then jumps and jolts, dancing, jogging and gardening are all good for the bones.”
Diet matters too and O’Brien says that the advice to consume calcium – 700mg a day is enough for most adults - still stands. It is not difficult to get the recommended amount when you consider that 50mg of calcium is supplied in 1tbsp plain yoghurt, a 90g serving of broccoli, or 100g in a small tin of baked beans or salmon.
But what else can we do to boost our bones? Here are the new rules for a stronger skeleton:
They may not be the first thing that comes to mind as a bone-friendly food, but prunes – that’s plain dried plums - contain minerals, vitamin K, phenolic compounds and dietary fibre combine to boost bone health, according to researchers. Findings from a recent review conducted at Penn State University and published in the journal , showed that women who consumed 100g of prunes - about 10 prunes - every day for a year improved bone mineral density in their arms and lower spine. Women who ate five to 10 prunes daily for six months prevented a drop in bone mineral density and had reduced levels of markers for bone loss, including TRAP-5b, compared to women who ate no prunes.
Vitamin D helps your body absorb and use calcium, which gives your bones their strength and hardness. It keeps muscles and bones strong and it’s paramount we get enough as without vitamin D and calcium bones are weakened. “Vitamin D is something we naturally should get from the sunshine when it shines on our skin, but we do not get much sun in Ireland,” O’Brien says. “When it is sunny, we recommend spending 15 minutes outdoors without sunblock, then go inside and put sunblock on to reduce your risk of skin cancer.”
She says vitamin D is found in small amounts in oily fish and in eggs but “it would be next to impossible to get enough vitamin D from any food never mind plant foods” and that a supplement is necessary for most people.
The Food Safety Authority of Ireland recommends 15mcg daily for those who are generally healthy and 20mcg for those who are housebound with limited or no sunlight exposure.
It’s not just bone density that is improved with exercise but the health of bone marrow which produces the cells needed for bone formation. Researchers at Deakin University in Australia were the first to show how weight-bearing exercise prevents spinal bone marrow from turning into fatty tissue as we age. They found running to be the most effective activity for achieving this.
Participants who ran 20km per week, or three miles on four days a week, saw benefits and committed long-distance runners who covered 50km a week (or four miles daily) were shown to have bone marrow equivalent to a person who was eight years younger than those who were sedentary. For every 9km, or 5.5 miles, a person ran each week, their bone marrow was one year 'younger'. “The average person could gain 'younger' bone marrow by small amounts of running", said lead author Daniel Belavy, associate professor at the Institute for Physical Activity and Nutrition.
Dr Gallin Montgomery, formerly a researcher in sport and exercise biomechanics at Manchester Metropolitan University, tested a range of simple high-impact moves - including countermovement jumps, stamps, box-drops and heel-drops - in healthy, early post-menopausal women for a study in the .
Wearing a device that measured the impact on their bones while jumping, the women completed either one jump every four seconds or one jump every 15 seconds. Both durations were found to produce bone health improvements with some exercises faring better than others.
“We found that countermovement jumps were most beneficial as they had the highest muscle activation along with the highest impact,” says Montgomery. “Box-drops and heel-drops were also beneficial but stamp movements were not recommended as the impact was not sufficient.”
Completing 30 varied jumps, three times a week is recommended and that would entail doing just a two-minute circuit if you jump every four seconds. Here’s how to do the moves:
Start standing uptight. Bend at the knees and hips, then immediately extend the knees and hips while simultaneously swinging the arms to jump vertically up off the ground.
Stand on the edge of a knee-height step (or a box of the same height if you have one) around knee height and drop down landing on two feet, bending the knees as you land.
Stand as high as you can on your toes before dropping onto both your heels to create an impact. Keep knees slightly flexed throughout.
In the new guidance paper, Brooke-Wavell says “progressive muscle resistance training” using incrementally heavier weights over weeks and months, should be carried out at least twice a week. “Most research suggests heavy-ish weights that you can lift for a maximum of eight to 12 repetitions are the best to use and that you should try to build up to three sets of each exercise over time,” she says. “Target all major muscle groups in the arms and legs as well as the back muscles to promote strength in the spine.”
Weighted lunges, weighted lunges, hip abduction and adduction, knee extension and flexion, back extension, reverse chest fly, and abdominal exercises should ideally be included each week. It could be that lighter weights with more repetitions is as effective and that is the subject of Brooke-Wavell’s current study.
Non-weight-bearing activities, swimming and cycling are not the best bone builders, but that doesn’t mean you should avoid them. “Because there is no impact, they won’t improve bone mineral density, but they have other benefits such as strengthening muscles around the spine which maintains good posture and prevents falls,” Brooke-Wavell says.
If you prefer to be on the bike or in the pool, then add 50 daily hops on each leg or 50 skips landing on both feet to your routine. In one of her studies published in the , Brooke-Wavell found that post-menopausal women who completed up to 50 hops on the same leg increased bone density in the hopping leg over the course of six months.
A high leafy green vegetables intake is associated with strong, healthy bones in middle-aged and older people. This is partly because they provide calcium, but also because they are a rich source of vitamin K1, known to have benefits for bone metabolism. Consuming 200g a day of leafy greens is enough to increase vitamin K status within a month according to a 2020 study by researchers at Edith Cowan University and other Australian Institutions, and that would pay dividends for your skeleton.
“If you have poor posture, undiagnosed osteoporosis should first be ruled out,” O’Brien says. “Broken bones in a person’s back can cause changes in their posture, such as rounded shoulders, the person's head protruding forward from their body or a dowager's hump developing.” But by maintaining good posture, you can prevent the risk of falling and broken bones.
Brook-Wavell suggests starting with something as simple as sitting in a chair and, keeping shoulders down, pulling and holding your chin back towards your neck for a few seconds. “A next step is to lie on your front and lift head and shoulders off the ground, hold for five seconds and then lower back down, repeating several times daily,” she says. “Activities like Pilates and yoga can also help with alignment and developing muscle strength in the spine.”
