Understanding your Bone Health

Written By Jenni Dowley

Throughout our lives our bones are constantly adapting, replacing old bone tissue with new bone tissue. This process if known as bone remodelling. This natural process results in our bone tissue being broken down and then rebuilt. It allows us to adapt to new mechanical loads and maintains the shape, quality and size of our bones.

We tend to reach peak (maximum) bone mass between 25-30 years old, this then plateaus in our 30s and 40s and then begins to decline. Our peak bone mass is mostly influenced by genetics, gender and ethnicity, however other factors such as diet, physical activity, medical conditions, lifestyle factors can contribute. A 10% increase in our peak bone mass can delay the onset of osteoporosis by 13 years. 

While our bone mass will naturally begin to decline with age, certain factors can speed up the rate at which we lose bone and increase the risk of developing osteoporosis. In women, the decrease in oestrogen (estrogen) during menopause can accelerate bone loss. There are other factors that can contribute to and speed up bone loss.

Osteoporosis occurs when bone mass and bone mineral density (BMD) decrease. As bones become less dense, they weaken and are at a greater risk of fracturing (breaking). Osteoporosis is referred to as a ‘silent disease’ because breaking a bone is often the first symptom. Osteopenia occurs when your BMD has decreased below average levels, but not yet at the level required to diagnose osteoporosis.

Some risk factors include:

·  Ageing

·  Genetics

·  Gender

·  A history of previous broken bones

·  Smoking

·  Excessive alcohol consumption

·  Certain medical conditions ( including rheumatoid arthritis, coeliac disease, hyperthyroidism, Chron’s, Anorexia Nervosa, parathyroid disease)

·  Certain medication (steroids including glucocorticoid tablets).  

For more risk factors see the Royal Osteoporosis Society’s page.

 

What can I do?

Below are some general recommendations for good bone health, advice should be dependent on individuals history and risk factors, and may not be applicable to everyone.

1.    Understand your risks

Understand your risk factors, know your family history – has a parent ever broken their hip or been diagnosed with osteoporosis?

2.   Get tested

If you have risk factors, believe you are at an increased risk, have had a fracture or multiple fractures, or have had a loss of height you should speak to your GP about getting tested

3.    Nutrition

Maintain a healthy, balanced diet that includes good protein intake and covers key nutrients needed for your bone health.

4.    Exercise

Maintain regular physical activity. Certain types of exercise including impact (jumping) and progressive resistance (strength) training have been shown to improve bone density, reduce falls and fracture risk. *Exercise should be tailored to the individual as type and intensity of exercise should be tailored to the individual.

5.    Reduce your alcohol intake

6.    Stop smoking

The Royal Osteoporosis Society offer a risk checker where you can check your risk and receive a report. You can bring this report with you to a GP if required. The risk checker is available here: Link

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Reference list:

  • HADJIDAKIS, D. J. & ANDROULAKIS, II. 2006. Bone remodeling. Ann N Y Acad Sci, 1092, 385-96.

  • LORENTZON, M., MELLSTRÖM, D. & OHLSSON, C. 2005. Age of attainment of peak bone mass is site specific in Swedish men--The GOOD study. J Bone Miner Res, 20, 1223-7.

  • BAXTER-JONES, A. D., FAULKNER, R. A., FORWOOD, M. R., MIRWALD, R. L. & BAILEY, D. A. 2011. Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res, 26, 1729-39.

  • ZHU, X. & ZHENG, H. 2021. Factors influencing peak bone mass gain. Frontiers of Medicine, 15, 53-69.

  • HERNANDEZ, C. J., BEAUPRÉ, G. S. & CARTER, D. R. 2003. A theoretical analysis of the relative influences of peak BMD, age-related bone loss and menopause on the development of osteoporosis. Osteoporos Int, 14, 843-7.

  • KRUGER, M. & NELL, T. 2017. Bone mineral density in people living with HIV: A narrative review of the literature. AIDS Research and Therapy, 14.

  • KHOSLA, S., OURSLER, M. J. & MONROE, D. G. 2012. Estrogen and the skeleton. Trends Endocrinol Metab, 23, 576-81.

  • NHS, osteoporosis prevention. Available at: https://www.nhs.uk/conditions/osteoporosis/prevention/

Jenni Dowley