Your bones are ageing faster than you think. Doctor reveals the best way to protect them

Words by Catherine Renton

Over three and a half million people in the UK live with osteoporosis, a condition that weakens bones and increases the likelihood of fractures and breaks. While osteoporosis is more common as we get older, it isn't an inevitable part of ageing, and there may be ways to help prevent the condition in later life.

‘Positive lifestyle changes, including healthy eating, being physically active and exercising, can help keep bones strong,’ says Sarah Leyland, clinical advisor at Royal Osteoporosis Society. ‘There are many vitamins, minerals and nutrients provided by healthy eating and sensible exposure to sunlight that are vital to help your bones stay strong, including calcium and vitamin D.’

With no national screening programme for osteoporosis and many unaware of the importance of looking after their bones, experts believe midlife women are sitting on a bone health time bomb. We’ve spoken to health, nutrition and fitness experts to get the lowdown on what you need to do to help prevent osteoporosis, and why looking after your bone health is so important.

What is osteoporosis?

Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. By about age 35, people reach their peak bone mass. Women lose bone mass slowly after that point until a few years after menopause, when bone mass is lost more rapidly. 

Why do I need to look after my bones?

Building and strengthening your bones will help reduce the risk of a fracture. The impact of some fractures, such as a hip break, can be huge. Once this type of fracture has occurred, research has found that patients are five times more likely to experience a second fracture within the next two years.

Women are especially vulnerable – half of women over the age of 50 are expected to break a bone because of osteoporosis (compared to one-fifth of men). Research has found that patient survival rates after hip fractures can be very poor, and that women over 65 who suffer hip fractures are more likely to die within five years than patients who develop breast cancer.

Am I at risk of developing osteoporosis?

Dr Deepali Misra-Sharp, GP and women’s health specialist, says osteoporosis is surprisingly common, and some factors make you more likely to develop the condition. ‘Genetics play a role. If one of your parents had osteoporosis or broke a hip, your risk is higher. But it’s not all down to family history and many of the risk factors are things we can influence,’ says Misra-Sharp.

According to Misra-Sharp, some of the lifestyle factors that can affect your chances of developing weak bones include:

• Smoking: Nicotine inhibits bone-forming cells, reduces calcium absorption, and disrupts hormone balance, all contributing to weaker bones
• Heavy drinking: Studies have consistently shown that excessive drinking is linked to decreased bone mineral density and an increased risk of fractures, especially hip fractures.
• Low BMI: A low Body Mass Index (BMI), especially below 19, is a significant risk factor for osteoporosis. Lower body weight means less mechanical loading on bones, which is essential for bone health. Being underweight often means you’re not getting enough bone-building nutrients, and less fat tissue also means less oestrogen, which protects bones.
• Lack of exercise: Regular weight-bearing and resistance exercises - like walking, hiking, dancing, or lifting weights - help stimulate bone formation and slow down loss.

There are also medical conditions that can increase the likelihood of osteoporosis, including:

• Rheumatoid arthritis
• Inflammatory bowel disease
• Coeliac disease
• Thyroid issues

Can menopause cause osteoporosis?

‘Menopause can accelerate bone loss, because the hormone oestrogen that's vital for keeping bone density stable and maintaining bone strength decreases,’ says women’s health expert Dr Shirin Lakhani. She continues, ‘As a result, bone density starts to go down too. With this loss of bone density comes reduced bone strength and a greater risk of breaking bones.’

Changes can happen more rapidly in the decade after your periods stop, and then there will be a steady reduction through old age. This gradual bone density loss affects men, too.

Can HRT help prevent osteoporosis?

Studies have shown that HRT is an effective treatment to prevent and repair bone loss, and it can reduce the risk of fractures by 50%. Oestradiol slows down the rate of bone loss and even promotes new bone growth, which helps keep bones stronger for longer. Research has found that progesterone collaborates with oestradiol, helps bone formation, and prevents bone loss.

What exercises should I be doing to help prevent osteoporosis?

While we have little control over ageing and genetics, there are many ways to help increase bone density in later life. Personal trainer Robyn Drummond says the benefits of exercise on bone health are often overlooked. ‘Many people only think about working out in the context of weight loss, and it’s easy to forget how important exercise is for our overall health from living longer to improving energy, mobility, and especially bone health as we move through different life stages. Once we develop osteoporosis, it's something we cannot reverse but we can prevent it and maintain it, through exercise.’

Drummond continues, ‘Bones stay strong if you give them work to do. The best way to keep bones strong is to do both weight-bearing impact and muscle-strengthening exercises.’

Weight-bearing impact exercises include things like walking, hiking, stair climbing, jumping, or dancing and as Drummond says, ‘It’s about moving to strengthen your muscles, improving your balance, and applying gentle, functional stress on your bones in a way that encourages them to stay strong.’

Personal trainer Tej Patel says progressive muscle resistance training is the best muscle-strengthening exercise for your bones. ‘This involves using weights or resistance bands to build up the work your muscles do over time. You do this by gradually increasing the weight you lift, in a slow and controlled way. As you train, you’ll find the movements get easier as your muscles get stronger.’

Patel continues, ‘The movements you do are called repetitions or reps for short. For example, one rep is each time you pull a band or lift a weight. You should only be able to do 8 to 12 repetitions before your muscles are too tired to do another one with good technique. Your muscles will feel warm, shake or may not want to do the last repetition.’

Patel recommends aiming for 2-3 sessions of strength training per week, focusing on major muscle groups (especially legs, hips, glutes, back, and core) and frequent weight-bearing activity, even brisk walking for 20–30 minutes twice a day.

Helen Davis, who teaches a functional movement programme called Bones for Life, says it’s also important to focus on optimising posture and improving balance as we age. Davis, who began training in Bones for Life after a surprise osteoporosis diagnosis at 56, says, ‘Improving stability reduces our long-term risk of falling, which is the biggest cause of bone fractures. It also actively supports other fitness approaches as poor posture is a major contributor to injuries.’

The Royal Osteoporosis Society recommends tai chi, dance, yoga, and Pilates to help build balance, and this exercise circuit to improve stability and muscle strength.

What to eat to boost bone health

Registered nutritional therapist Helen Ritchie says four main factors underpin a healthy diet that supports bone mineral density: 

• Eating sufficient quality protein, at least 1.2g per kg of body weight at each meal.  Protein is the main structural component of all cells, including bone cells and promotes collagen production.
• Managing blood glucose balance. This means reducing sugars and refined white starches (cakes, biscuits, sweets, white rice, pasta, bread and potatoes), replacing them with wholegrain versions, and managing portion size.
• Eating sufficient anti-inflammatory fats (omega-3 fatty acids) from oily fish such as salmon, mackerel, anchovies, herring & trout 2-3 times a week.  As well as healthy fats in nuts, seeds and their cold-pressed oils.
• Ensuring a wide variety of fibre in the form of different coloured fruits and vegetables supports the gut microbiome and a diverse range of gut microbes. 

At what age do you need to start taking calcium supplements?

The amount of calcium we need changes at different stages in our lives. In our teenage years, more calcium is required because bones are growing rapidly. As we age, the body’s ability to absorb calcium declines, which is why we need higher amounts as we age. 

The NHS advises that adults who do not have osteoporosis need 700mg of calcium a day, which you should be able to get from your daily diet.

Calcium-rich foods include:

• leafy green vegetables
• dried fruit
• tofu and plant milks
• dairy products, such as milk, cheese and yoghurt
• sardines
• eggs

If you get enough calcium from your diet, you shouldn’t need to supplement, regardless of age. And if you think you should take too much calcium to be ‘safe,’ Ritchie has a warning: ‘It’s important not to take too much as high levels of calcium can be laid down in the arteries and become dangerous.

Even if you do have an osteoporosis diagnosis the daily amount required is 1,200 mg – no more, no less. There is a calcium calculator available at the International Osteoporosis Foundation where you can work out how much calcium you’re getting from food and then how much you can supplement the shortfall.’

The importance of vitamin D for bones

‘Vitamin D3 is an important co-factor for calcium to ensure it gets into the blood and not the arteries, says Ritchie. ‘During the winter, we cannot make vitamin D from the sun in the UK, so supplementing is recommended. A higher vitamin D level is recommended to help prevent osteoporosis – ideally above 100 Nmol/Litre. 

For us to produce vitamin D in the summer months, we need to expose bare skin to the sun for a period of time, as long as your skin can stand without burning (10-20 minutes) as often as possible during the summer months.’

How do I know if I am at risk of osteoporosis?

The Royal Osteoporosis Society has developed a Risk Checker tool. This tool asks you questions about your background, family and medical history and offers a personalised report, which you can take to your GP if it indicates you may be at risk of developing the condition. Your GP can then arrange any tests, including a bone scan, if they feel this is necessary. 

If you’re thinking, ‘I’ve left it too late’ when it comes to bone health, there’s never been a better time to start. It is important to understand that osteoporosis can’t be fully reversed, but you can take steps now to help protect your future health, mobility, and independence.

Photos: Getty

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