What is osteoporosis?

Osteoporosis is a systemic disease that gradually weakens the bones, leading to painful and debilitating fragility fractures (broken bones). These fractures can occur after a minor fall from standing height, or as a result of a bump, a sneeze, or even from bending over to tie a shoelace. Any bone can break due to osteoporosis, but some of the most serious and common fractures are those of the spine and hip.

Our bones are living tissue that’s constantly replacing itself. From the moment of birth until young adulthood, bones are developing and strengthening. Our bones are at their most dense in our early to mid-20s. This is called peak bone mass age.

Some of our bone cells (osteoclasts) dissolve old bone tissue, causing cavities to form on the bone surface. This process is called resorption. Once this process is done, the cavities are filled with new bone deposited by bone building cells (osteoblasts) during the remodeling process. This process of resorption and remodeling is a normal part of bone biology through all life stages. It generally takes around 10 years to completely replace your skeleton! As we age, usually from 35 onwards, the osteoblast cells slow down.

For people with osteoporosis, bone loss (resorption) outpaces the growth (remodeling) of new bone. Bones become porous, brittle and prone to fracture.

Who gets osteoporosis?

Osteoporosis is a serious, common, and costly disease. It’s estimated that, worldwide, an osteoporotic fracture occurs every three seconds. One in three women and one in five men over the age of 50 will suffer a fracture in their remaining lifetimes.

In women over 45 years of age, fractures due to osteoporosis result in more days spent in hospital than many other diseases, including diabetes, heart attacks, stroke and breast cancer.

In men, the lifetime risk of fracture is greater than the risk of developing prostate cancer. What’s more, few older men are on the alert for osteoporosis, even though one in five will have a fracture. One-third of all hip fractures worldwide occur in men. Studies also show that 37% of male patients die in the first year following a hip fracture.

In South Africa, with our diverse population groups, we know that osteoporosis can occur in all race groups. Local studies have shown that bone mass is more or less equal in everyone. Hip fractures may occur less in our black population, but osteoporosis in the spine and subsequent spine fractures seems to occur equally in all race groups.

Symptoms of osteoporosis

Osteoporosis is called a “silent disease” because there are usually no symptoms to indicate that your bones are becoming thinner. This makes the diagnosis of the condition difficult because the loss of bone density is usually not noticed until you break a bone.

Fractures due to osteoporosis occur most commonly at sites such as the wrist, upper arm, pelvis, hip and spine, and can result in severe pain, significant disability, and even death.

Most limb fractures (e.g. wrist or hip fractures) are obvious, whereas a spinal fracture can be difficult to diagnose. It’s often overlooked because it may be totally painless or, if there is pain, it’s usually ascribed to other causes of back pain. Only a third of vertebral fractures come to doctors’ attention.

More obvious signs of spine fractures are:

• Loss of more than 3cm height – a result of crush and endplate fractures.
• Developing a curved upper back (Dowager’s hump). This is usually due to a wedge fracture.

Hip fractures, one of the most serious and life-threatening fracture events, often result in the need for assisted care, and loss of physical independence. Fewer than half of those who survive a hip fracture regain their previous level of function, and approximately 20-25% of people who suffer a hip fracture die within a year.

Falls generally lead to fractures and, the more often you fall, the greater the chance of a fracture. How and when you fall usually determines the fracture site. Younger adults still have intact protective mechanisms, which means they usually fall with an outstretched hand, leading to forearm fractures. Older people, who have compromised protective mechanisms, often fall on their side, leading to a hip fracture.

Since there are often no outward symptoms of osteoporosis, your doctor may recommend a bone mineral density (BMD) test (also called a DXA test). This will depend on your age and whether you have risk factors for the disease.

Risk factors for osteoporosis

A risk factor can be defined as anything that increases your chance of getting a disease. Remember: an individual may have one or many of these risk factors and not develop osteoporosis. Conversely, many people may have no apparent risk factors and develop osteoporotic fractures.

Osteoporosis can be divided into two types: primary and secondary osteoporosis. Primary osteoporosis is the more common of the two. Secondary osteoporosis is usually the result of an identifiable agent or disease process that causes the bone loss.

Although the exact cause of primary osteoporosis isn’t always clear, a number of risk factors are known to increase the chances of developing this disease.

Certain risk factors are fixed and can’t be changed. However, you still have to be aware of them so that you can take steps to reduce bone mineral loss.

Fixed (non-modifiable) risk factors

Your overall risk of osteoporosis is influenced by your age, gender and ethnicity.

Generally, the older you get, the greater your risk of osteoporosis.

Women are more susceptible to bone loss than men. However, even though women are more likely to sustain an osteoporotic fracture due to rapid bone loss at menopause, 1 in 5 men also get osteoporosis. In fact, some 20-25% of all hip fractures occur in older men and men are more likely to be disabled and die following a hip fracture (men tend to have more co-morbid diseases, e.g. cardiovascular disease).

Although osteoporosis is still more common in Caucasian, mixed race and Asian people (possibly due to differences in bone structure and peak bone mass), a few local studies have shown that our Black population have exactly the same bone density. Vertebral fractures occur at the same rate in this population group.

Ask your doctor to test you for osteoporosis if any of the following risk factors apply to you:

Family history

Genetics, along with shared lifestyle and dietary factors, will contribute to your peak bone mass and rate of bone loss at an older age. If one of your parents or grandparents has had a broken bone, especially a broken hip, you’re at higher risk of osteoporosis.

Previous fracture

People who have already sustained an osteoporotic fracture are almost twice as likely to have a second fracture compared to people who are fracture free. Anyone who has fractured after the age of 50 years must be assessed for osteoporosis. In most cases treatment should be prescribed to prevent the high likelihood of future fractures.

Primary/secondary hypogonadism in men

Hypogonadal young men with low testosterone levels have low bone density, which can be increased through testosterone replacement therapy. At any age, acute hypogonadism, such as that resulting from orchiectomy for prostate cancer, accelerates bone loss to a similar rate as seen in menopausal women.

The bone loss following orchiectomy is rapid for several years and, in most cases, treatment should be prescribed to prevent it.

Certain medications

Some medications may have side effects that directly weaken bone or increase the risk of fractures due to falls. If you take any of the following medications, you should consult with your doctor about the increased risk to bone health:

• Glucocorticosteroids – oral or inhaled (e.g. for asthma, arthritis)
• Certain immune-suppressants (calmodulin/calcineurin phosphatase inhibitors)
• Excessive thyroid hormone treatment (L-Thyroxine)
• Certain steroid hormones (medroxyprogesterone acetate, luteinising hormone-releasing hormone agonists)
• Aromatase inhibitors (used in breast cancer)
• Certain antipsychotics
• Certain anticonvulsants/anti-epileptic drugs
• Lithium
• Proton-pump inhibitors
• Anti-retroviral therapy (ART)

Menopause/hysterectomy

Postmenopausal women, and those who have had their ovaries removed or who have experienced early menopause before the age of 45 years, must be particularly vigilant about their bone health.

Rapid bone loss begins after menopause when the protective effect of oestrogen is reduced. For some women, hormone replacement therapy (HRT)may help slow down bone loss when initiated before the age of 60 years or within 10 years after menopause.

Certain medical disorders

Some diseases, as well as the medications used to treat the diseases, may weaken bone and increase the risk of fractures. Among the more common diseases and disorders that may place you at risk are:

• Rheumatoid arthritis
• Nutritional/gastrointestinal problems (e.g. Crohn’s and Coeliac disease), other malabsorption diseases
• Chronic kidney disease
• HIV/AIDS
• Haematological disorders/malignancy (including prostate and breast cancer)
• Some inherited disorders
• Hypogonadal states (Turner syndrome, Klinefelter syndrome, amenorrhoea etc.)
• Endocrine disorders (diabetes, Cushing’s syndrome, hyperparathyroidism etc.)
• Immobility

There are many secondary causes for osteoporosis. Your doctor will mostly be able to detect these on the history you provide, or on the initial examination you undergo.

Modifiable risk factors

Here are some of the more common, modifiable risk factors for osteoporosis. This means that you can change them and reduce your risk of osteoporosis and fractures.

Smoking

We all know the dangers of smoking. But many don’t know that, compared to non-smokers, people who smoke or have smoked in the past are at increased risk of any fracture. Smoking increases the risk of a hip fracture by up to 1.8 times.

Excessive alcohol consumption

People who drink more than 2 units of alcohol daily have a 40% increased risk of sustaining any osteoporotic fracture compared to people who drink only moderately, or not at all. Too much alcohol has a direct toxic effect on bone cells. Drinking in moderation will, however, benefit your overall health, not just your bones.

Low Body Mass Index (BMI)

Maintaining a healthy body weight is important too. BMI below 19 is considered underweight and a risk factor for osteoporosis. Low BMI may also result from poor nutrition and low intake of bone-healthy nutrients like calcium, protein and vitamin D.

Vitamin D deficiency

Vitamin D is made in our skin with exposure to the sun’s ultraviolet rays. This vitamin is essential for bone health in that it helps the body to absorb calcium. Few foods contain vitamin D and sunlight isn’t always a reliable source of vitamin D. This is why vitamin D deficiency is common, particularly in the elderly, in those who don’t go outdoors, and in those who endure long, dark winters in northern latitudes.

The National Osteoporosis Foundation of South Africa (NOFSA) and the International Osteoporosis Foundation (IOF) recommend supplements for those at risk and in seniors aged 60 years or over.

Frequent falls

Ninety percent of hip fractures occur as a result of a fall. Poor eye sight, loss of balance, neuromuscular dysfunction, dementia, immobilisation, and use of sleeping pills and anti-hypertensive medication (all relatively common in seniors) significantly increase the risk of falls and fractures. If you’re prone to falls, you should take action by fall-proofing your home and improving your muscle strength and balance through targeted exercises.

Poor nutrition

A nutritious diet rich in calcium, protein, fruit and vegetables benefits bone and muscle health at all ages. Malnutrition in seniors is a special concern, particularly because they’re more susceptible to osteoporosis, falls and fractures.

Insufficient exercise

The saying “move it or lose it” refers to the fact that inactivity results in increased bone loss. That’s why it’s important to get regular weight-bearing and muscle-strengthening exercise.

Adults with a sedentary lifestyle lose bone more rapidly, and studies have shown that sedentary older adults are more likely to have a hip fracture than those who are more active.

Eating disorders

Eating disorders such as anorexia and bulimia that can result in extreme weight loss are dangerous for bone health. In young women this can lead to estrogen deficiency (similar to that experienced at menopause). In these women, there’s often also a very low dietary intake of minerals like calcium, protein and other necessary key elements for bone development. The result is rapid bone mineral loss.

It’s also important to remember that eating disorders are not only limited to women and there has been an increase of both anorexia and bulimia in young males.

How is osteoporosis diagnosed?

Men and women over 60 years of age are at higher risk of osteoporosis than younger people. Nevertheless, it’s possible to have osteopenia (low bone mass) or osteoporosis at a much earlier age. As osteoporosis has no obvious symptoms, it’s important to go to your doctor if any of the risk factors apply to you.

Your doctor will take a thorough medical history that includes information on any recent fractures and your current risk factors. The next step may be to have a bone mineral density (BMD) or DXA test.

What is a BMD test?

Traditional X-rays can’t measure bone density, but they can identify spine/other fractures. Bone mineral density has to be measured by more specialised techniques. A number of different types of BMD tests are available, but the most commonly used is DXA (dual-energy X-ray absorptiometry).

DXA is a low-radiation X-ray capable of detecting quite small percentages of bone loss. It’s used to measure spine and hip bone density, and can also measure bone density of the whole skeleton.

A DXA scan, which is used to measure spine and hip bone density, is the most common technique for assessing the risk of osteoporosis as well as follow-up treatment.

There are also a number of other tests:

• DPA (dual photon absorptiometry) measures the spine, hip or total body.
• SPA (single photon absorptiometry) measures the wrist.
• QCT (quantitative computed tomography) measures the spine or hip.
• PQCT (peripheral QCT) measures the forearm.
• QUS (quantitative ultrasound) uses sound waves to measure the heel, tibia or finger.

What do my test results mean?

The World Health Organization has defined a number of threshold values (measurements) for osteoporosis. The reference measurement is derived from bone density measurements in a population of healthy young adults (called a T-score). Osteoporosis is diagnosed when a person’s BMD is equal to or more than 2.5 standard deviations below this reference measurement.

Osteopenia (low bone mass) is diagnosed when the measurement is between 1 and 2.5 standard deviations below the young adult reference measurement.

The test results can be summarised as follows:

Status	Bone mineral density (BMD) score
Normal	T-score of -1 or above
Osteopenia	T-score lower than -1 and greater than -2.5
Osteoporosis	T-score of -2.5 or lower
Severe Osteoporosis	T-score of -2.5 or lower, and presence of at least one fragility fracture

If the results of your BMD test show osteopenia or osteoporosis, it doesn’t automatically mean that you will have a fracture. Your doctor might prescribe lifestyle changes and other therapies to slow down bone loss and help prevent fractures.

TAKE NOTE: A bone density test is one of the methods used to determine your future risk for fracture. A vast majority of osteoporotic fractures occur in the normal to osteopenic bone-density range.

Other methods for diagnosing osteoporosis

A number of other methods have been used extensively in clinical trials and epidemiological studies to diagnose osteoporosis. These include radiological assessments and certain blood and urine tests that look for Bone Turnover Markers (BTM). These tests reveal whether there’s an increased rate of bone turnover, which may suggest osteoporosis.

How is osteoporosis treated?

If you’ve been diagnosed with osteoporosis, never accept the incorrect and uninformed advice that osteoporosis is a normal part of ageing or that nothing can be done.

There are several treatment options available to reduce bone loss. Many of these potent drugs are capable of reducing the rate of osteoporotic fractures by 70% or more.

The aim of medication used in the treatment of established osteoporosis is to stop further bone loss, to replace or repair bone, and to prevent further fractures. These drugs can be divided into two broad groups: those that inhibit bone resorption (chewing away of bone) and those that stimulate bone formation (building new bone).

A number of effective medications are approved for the prevention and treatment of osteoporosis. These medications must be tailored to each individual’s specific needs and used in conjunction with recommended lifestyle changes.

Commonly available treatments include:

• Bisphosphonates
• Calcitonin
• Denosumab
• Selective Oestrogen Receptor Modulators (SORM)
• Teriparatide
• Hormone Replacement Therapy (HRT)
• Vertebroplasty and kyphoplasty

How effective are the treatments?

In postmenopausal women with osteoporosis, the primary outcome investigated in pharmaceutical trials is the reduction of fracture. Risk reductions of between 30-70% have been demonstrated for vertebral fractures, while reductions of around 15-20% for non-vertebral fractures and up to 40% for hip fracture have been noted. However, of the currently approved treatments, only alendronate, risedronate, zoledronic acid and strontium ranelate have been shown to reduce vertebral, non-vertebral and hip fractures.

In men and in glucocorticoid-treated populations, regulatory approval has been obtained on the basis of bridging studies in which similar BMD changes to those seen in postmenopausal women with osteoporosis have been demonstrated.

Staying on treatment

Treatment can only work if medication is taken as recommended. It’s common for people with osteoporosis to find taking medication challenging. As a result, up to half of all people stop their treatment after only one year.

Be sure to take your medication exactly as prescribed and to talk to your doctor if you find it difficult to comply.

Are there risks involved?

As with any medication, there are risks and side effects involved with osteoporosis treatment. Talk to your doctor about possible risks and side effects, and how to manage them.

Preventing osteoporosis

Preventive measures aim to ensure maximum accumulation of bone tissue during skeletal growth and maturation, as well as reducing bone loss after the skeleton matures.

The approaches therefore differ during each life stage. Adolescence and young adulthood are the times to build skeletal reserve, while midlife provides the opportunity to preserve bone mass and assure bone health in future years. In later life, those who may already have developed osteoporosis can take measures to prevent further bone loss and fractures.

Certain risk factors that predispose to the developing of osteoporosis can’t be altered: you can’t change your gender, race or age. However, you do much to prevent further bone loss.

Lifestyle changes

Diet

A balanced diet that contains adequate kilojoules, vitamins and minerals is required to maintain bone health. Sufficient kilojoules, protein and vitamin C will ensure normal collagen synthesis.

Calcium is probably the most important bone-building mineral. It’s a well-known fact that the diet of most individuals in western countries contain insufficient calcium to maintain a positive calcium balance.

Reasons for limited consumption include a distaste for dairy products, fear of kilojoules and fats (although skim milk actually contains slightly more calcium than full cream milk), true milk allergy (this is rare in adults) and lactose intolerance, which occurs frequently in the elderly, as well as the black and Asian populations. Fermented lactose products like cheese and yoghurt are, however, tolerated by most.

Whereas calcium is an essential mineral required to build bone mass and slow age-related bone loss, calcium alone won’t protect against bone loss resulting from estrogen deficiency in post-menopausal women. It also won’t provide protection against the bone loss caused by physical inactivity, smoking, alcohol abuse or the use of bone-toxic drugs. Sufficient calcium is just one of the many steps you need to take to ensure a healthy skeleton.

Debunking milk and dairy myths

When it comes to this important food group, myths abound. Brush up on the facts:

The benefits of dairy:

• Dairy is an excellent source of calcium, phosphorus, protein and other nutrients that are important for both bone and overall health.
• Calcium is vital for strong bones and is a major building block of the skeleton – 99% of the kilogram of calcium in our bodies are found in our bones and teeth.
• Milk and other dairy products are the cheapest and most readily available sources of calcium.
• Scientific evidence strongly supports the benefits of dairy products for bone and muscle health – bone loss is reduced and muscle mass improved with adequate dairy intake.
• In some countries, including South Africa, certain milks are fortified with vitamin D – an added benefit to bone health.

Dairy vs other calcium sources:

• Dairy foods are rich sources of calcium with the added advantage of providing protein and potassium.
• Non-dairy foods containing calcium include green vegetables like kale and broccoli, whole canned fish with soft edible bones such as sardines, some nuts (e.g. almonds), and calcium-set soy products (tofu, soy milk).
• You’d have to eat numerous servings of these non-dairy foods to get the equivalent amount of calcium provided by just one serving of yoghurt, cheese or milk.
• For children who often avoid green vegetables, dairy products are often the preferred source of calcium (it provides up to 80% of dietary calcium intake) and protein. Both nutrients are essential for growing bones.

A few other myths and facts

MYTH: Milk and other dairy foods aren’t good for bone health because they’re “acid-forming”. As a result, calcium is leached from the bones to prevent the body from becoming too acidic.

FACT: Milk and yoghurt are not “acid-forming” foods. They produce a neutral residue when digested. In contrast, hard cheeses such as parmesan and cheddar are acid-forming. The acid produced from consuming hard cheeses can be neutralised by the ingestion of more fruits and vegetables.

As long as you’re getting a reasonable amount of calcium from your diet, your body will ensure that you have the right amounts of calcium circulating in your body.

If your calcium intake is too low to maintain adequate calcium blood levels, calcium will be released from your bones. This can weaken them.

MYTH: Western countries, where people tend to consume more dairy foods compared to other cultures, are more prone to osteoporosis and broken bones.

FACT: Many factors determine whether a person will develop osteoporosis and be at increased fracture risk (see our article on “risk factors”).

Dairy foods aren’t responsible for higher fracture rates, nor does dairy consumption alone guarantee strong, healthy bones.

MYTH: People with lactose intolerance or sensitivity can’t consume any dairy products

FACT: Very few people in western countries are completely lactose intolerant, although a large number of the South Africa black population may be lactose sensitive. Most lactose-intolerant people can, however, enjoy the fermented dairy products like cheese and yoghurt, and even small quantities of milk. Some people may also take lactase tablets, if required.

Vitamin D

Vitamin D plays two major roles in the development and maintenance of healthy bones. It aids in calcium absorption from the intestine and also ensures correct renewal and mineralisation of bone. It’s also essential for muscle health.

Vitamin D is made in the body when the skin is exposed to UV-B rays in sunlight. Due to increasing time spent indoors and other factors such as pollution, the use of sunscreen, skin pigmentation and advanced age, low levels of vitamin D have become a global problem jeopardising bone and muscle health in populations everywhere.

Generally speaking, you should try to get 10 – 20 minutes of sun exposure to your bare skin (face, hands and arms) outside peak sunlight hours (before 10am and after 2pm) daily, without sunblock. Darker skins need longer exposure time – 20 – 30 minutes a day.

We all need about 600 International Units (IU) of vitamin D per day.

Those at higher risk for vitamin D deficiency (older adults, obese people, people who get no sun exposure, people with absorption diseases like Chrohn’s disease), need to be supplemented after consultation with their doctor. Seniors 60 years and older need to be supplemented with approximately 800IU/day vitamin D. Supplementation at these levels has been shown to reduce the risk of falls and fracture by about 20%.

Up your vitamin D intake with the following foods:

Food	Vitamin D content
Wild salmon	600-1000 IU
Farmed salmon	100-250 IU
Sardines, canned	300-600 IU
Tuna, canned	236 IU
Shiitake mushrooms, fresh	100 IU
Shiitake mushrooms, sun-dried	1600 IU
Egg yolk	20 IU per yolk

*per 100g unless otherwise stated

IU: International Units

Protein

Protein provides the body with a source of essential amino acids necessary for health. A low protein intake during childhood and adolescence can affect skeletal growth and also affect skeletal and muscle health in the aged. This leads to an increased risk of falling.

Many people have been scared by claims that a high protein intake (including drinking milk) can lead to an increased calcium loss via the kidneys and is therefore bad for bones. This claim has been disproved by many studies.

The current recommended daily allowance for healthy adults is 0.8g of protein per kilogram of body weight per day. Protein-rich foods include dairy products, eggs, meat, fish, lentils, beans and nuts.

Micronutrients that support bone health

Vitamin K: Found in leafy green vegetables like spinach, broccoli, kale and cabbage. It’s also found in liver, some fermented cheeses and dried fruit (especially prunes).

Magnesium: Found in green vegetables, legumes, nuts, seeds, unrefined grains, fish and dried fruit. Fifty grams of almonds yield about 40% of your daily need.

Zinc: Found in lean red meat, poultry, whole-grain cereals, pulse legumes and dried fruit. Beans and chickpeas are good sources.

Carotenoids: These precursors to vitamin A are found in many vegetables, including leafy green vegetables, carrots and red peppers. Just 50g of raw carrots meet your daily needs.

Calcium supplements should be considered if your dietary intake is insufficient. Calcium isn’t found free in nature and is usually bound to a salt (e.g. calcium carbonate, calcium citrate, calcium lactate). Since these salts all yield different amounts of elemental calcium (the calcium that gets absorbed), it’s important to know what the elemental calcium content of your supplement is to know how much of it you should take per day.

The National Osteoporosis Foundation of South Africa (NOFSA) recommends a total daily intake (diet and/or supplements) of approximately 1000mg per day. One supplement of approximately 500-600mg per day should be sufficient if you have a diet that’s deficient in calcium.

Remember to take calcium carbonate supplements with a low-fibre meal (e.g. supper) as it needs stomach acid to be absorbed. Also keep the following in mind when taking calcium supplementation:

If you need to take an iron supplement as well, take your calcium supplement either two hours before or after the iron supplement to ensure proper absorption of both.

Calcium may interfere with your body’s ability to use certain antibiotics like tetracycline. Take your calcium two hours before or after taking the tetracycline.

If you’re using a bisphosphonate drug for osteoporosis, don’t take the calcium supplement in the morning as it will interfere with the absorption of the medication.

Calcium absorption is inhibited to a certain degree by fibre in the diet. Try taking your calcium when you’re having a low-fibre meal.

Special care should be taken when considering supplements that contain oyster shells, dolomite or bone meal as these may contain high doses of lead. This can be harmful in the long run.

Exercise

Regular exercise is important at all ages as it’s the only physiological way to stimulate bone formation. People who exercise regularly tend to have higher peak bone mass. Exercise also seems to slow down age-related bone loss.

The exact mechanism of how exercise influences bone turnover isn’t known, but we do know the following:

• The muscle pull on bone generates piezoelectrical charges on bone surfaces. This stimulates osteoblast activity and bone formation.
• Exercise causes the release of hormones that promotes bone formation.
• Exercise stimulates blood flow within the bone.
• Exercise improves balance, co-ordination and confidence, thereby helping to prevent falls. It also strengthens muscles and flexibility, and protects against fractures in the event of a fall.
• Weight-bearing exercise like brisk walking, stair climbing, jogging and dancing is better than non-weight bearing exercise like swimming or cycling. It is, however, excellent to start with these exercise if you haven’t exercised in a while.
• A brisk 45-minute walk at least 3 times per week is recommended. Wear comfortable shoes with good arch and heel support.
• Exercises that help to improve your posture and strengthen the pelvic floor, back and stomach muscles are also very important (e.g. Pilates, yoga).

Exercise recommendations

Exercise plays an important role in building and maintaining bone strength. Just like muscles, bones respond when they’re stressed. In other words, when they are forced to bear more weight than they’re used to. This can be achieved by weight-bearing or impact exercises.

The International Osteoporosis Foundation (IOF) offers excellent information on specific exercise programmes that have been shown in scientific studies to improve or maintain bone health in men, women and children at various life stages.

Note that many of the regimens and images on the IOF website are not appropriate for everyone, and should only be carried out under professional supervision.

Stop smoking, limit your alcohol intake and be aware of bone toxic drugs

Tobacco and alcohol’s detrimental effect on bone tissue have already been discussed. If you’re serious about your health, and want to prevent osteoporosis, it’s important not to abuse these bone-toxic substances.

If you need to take other drugs that is detrimental to bone health e.g. cortisone, ARV’s, anti-epileptic drugs, cancer medications (as previously discussed under risk factors), be extra vigilant with your diet and exercise regimen and have a regular BMD done to monitor your bone health.

Shall we mention something about the bone-toxic drugs again?

Adopting a bone-healthy lifestyle (whether you have osteoporosis or not) is of critical importance throughout life. This needs to start during childhood and adolescence, and be maintained as you age.

Controlling your osteoporosis risk factors, and complying with treatment regimens if prescribed, will help you to live a mobile, independent, fracture-free life for longer.

Information compiled by Teréza Hough, CEO of the National Osteoporosis Foundation of South Africa. www.osteoporosis.org.za