BREAKING BAD!

One in two women over 50 will break a bone, but it is possible to stack the odds against that happening to you, Tessa Hilton discovers

Optimise bone health and lower the risk of osteoporosis

Twaistbands nag us about weight and a walk up a steep hill is a sharp reminder of the health of our heart and lungs. But we seldom think about our bones – unless we break one, and then suddenly we’re in A&E looking at X-rays and scans. ‘People often take the strength of their bones for granted because they’re hidden, which is why it’s vital to increase awareness of how to enhance and prolong good bone health and also recognise warning signs if a problem develops,’ says Professor Nick Harvey, vice chair of the Osteoporosis & Bone Research Academy, set up by the Royal Osteoporosis Society (ROS) to find a cure for osteoporosis.

Osteoporosis literally means ‘porous bones’ and is a condition that develops slowly, as bones become less dense and more likely to break. It causes fractures in half of all women (and one in five men) over 50, and affects 3.5m people in the UK. Fractures caused by osteoporosis can be life-threatening and cause long-term disability and pain.

Despite this, research by the ROS shows that only one in four people under 55 take action to prevent it, and the disease costs the NHS £4.5bn a year, a figure set to rise as the population ages. The ROS has warned this may climb even higher following the effects of lockdown, as the research shows that, worryingly, over a third of people (35%) have exercised less since the pandemic began.

So, what can we do to stack the odds against breaking a bone?

High-impact exercise can keep bones strong

JUMP TO IT!

While the strength of our bones is partly determined by our genes, plus a host of environmental factors, lifestyle plays a huge part, too. The proven essentials for healthy bones are regular activity, a good balanced diet, adequate vitamin D and not smoking or drinking excessive amounts of alcohol.

Our bone mineral density reaches its peak by our late 20s and from that point some bone loss is inevitable. But latest research shows that impact and resistance exercise can keep bones strong and may even improve bone strength, explains Sarah Leyland, clinical advisor at the ROS.

We need to push ourselves, though:

‘Brisk walking, while great for health generally, isn’t enough to make a difference to bones. Instead, aim to build up safely to 50 jumps or jogging steps daily,’ advises Sarah.

A qualified fitness instructor or physio can advise, and the ROS has excellent videos showing modified versions for exercising safely with osteoporosis. If a hop, skip or a jump is too much, don’t be discouraged. Simply getting out of your chair, so your bones take the weight of your body, or going up and down stairs will help.

Muscle strengthening using resistance bands or free weights is equally important. Aim for 20 to 30 minutes two to three times a week on non-consecutive days. ‘People diagnosed with osteoporosis or low bone density can lose confidence, but, in fact, they need to do more exercise, not less,’ says Sarah.

If you need convincing that all this effort will yield results, be inspired by an exciting Australian study, the LIFTMOR Trial, led by Professor Belinda

Beck of Griffith University, Brisbane. Women aged 58-plus with osteoporosis who followed a supervised eight-week programme of 30-minute, twice-weekly high-intensity and high-impact training sessions showed enhanced bone strength in both hips and spine, compared with a control group who followed a low-intensity programme. ‘Building up muscle strength also reduces back pain and cuts the risk of falling, the cause of nearly all breaks and one in five spinal fractures,’ says Sarah.

Balance not so good? When you next put the kettle on, practise standing on one leg. Easy? Now close your eyes or try heel-toe walking (as on a tightrope). Yoga, t’ai chi and Pilates are also all excellent, both for balance and strengthening, but join a guided group pitched at entry level if you have a tendency to fall.

HOW STRONG ARE YOUR BONES?

The point at which low bone density is classified as osteoporosis is a T-score of -2.5, a World Health Organisation measurement determined by a DXA scan. Osteopenia is when bone density is lower than average, but not low enough to be classified as osteoporosis.

‘I often speak to people who are concerned because they have very low bone density but who haven’t broken bones,’ says Julia Thomson, a senior osteoporosis nurse at the ROS. ‘Bone-density scanning is useful, but it’s not the only factor. There may be other things going on within their bones, influenced by diet and exercise, which we can’t measure.’

A fracture risk assessment by your GP, using a tool called FRAX, looks at many factors, including height, weight, family history, medications, smoking and alcohol intake, plus a scan. This generates a percentage risk of fracture in the next 10 years and is a guide as to whether treatment is needed to reduce that risk (see box overleaf).

NEW TREATMENT

For those newly diagnosed with osteoporosis, the first line of treatment is most commonly alendronate, part of a group of medications called bisphosphonates that slow down the cells that break down bone.

For those with more advanced osteoporosis, a new drug, romosozumab (also known by the brand name Evenity), which patients self-inject, is awaiting approval by the National Institute for Health and Care Excellence (NICE) and many hope it will come into use by the end of the year. Researchers found a year of treatment, followed by a year’s course of alendronate, reduced the risk of fracture by up to 48%.

‘The biggest problem is simply that many of us don’t take the medication we’ve been prescribed,’ says Professor Harvey. ‘It’s the same with other chronic conditions where medication is used to prevent something that hasn’t happened yet. That’s why it’s so vital to help people understand the risk and why it’s important to keep on taking their medication.’

DO YOU NEED SUPPLEMENTS?

Calcium is crucial for healthy bones. Most 18- to 64-year-olds can get the recommended 700mg a day from a healthy diet, but the British Dietetic Association recommends 1,200mg a day for women past the menopause. Your GP may recommend a supplement if you’re at high risk of breaking a bone and your intake is inadequate. Your body also needs sufficient vitamin D to absorb calcium and diet only provides us with a small amount; we obtain most through the action of sunlight on our skin. Current advice is to take 10 micrograms (mcg) a day of vitamin D between October and March, while those who don’t expose their skin to the sun much in summer should consider taking it all year round. For those with osteoporosis, 20-25mcg of vitamin D a day is usually recommended.

Meanwhile, probiotic supplements might be an additional sensible measure. New research into the gut microbiome – the friendly bugs in our intestine – shows probiotics may help bone health. A group of 90 women aged 75 to 80 who took the probiotic Lactobacillus reuteri 6475 for a year, lost less bone density than the control group, according to a study by a team from the University of Gothenburg.

So how can a probiotic affect our bones? ‘It’s not fully understood yet, but bacteria produce chemicals that may alter the metabolism of other agents. For example, by perhaps improving absorption of calcium and vitamin D,’ says Professor Harvey.

While science continues to seek a cure, make no bones about it, we already have it in our power to make some small changes to stay stronger for longer – a reason to jump for joy. Visit theros.org.uk or call the free helpline on 0808 800 0035

Small changes can make us stay stronger, longer

KNOW YOUR RISK

Warning signs of fragile bones:

● Losing over 4cm in height, particularly if sudden or progressive, or increasing curvature of the spine. A spinal fracture, where the vertebrae compress, can cause back pain and be mistaken for arthritis.

● Breaking a bone very easily, a low-impact fracture, also needs investigating.

● After one broken bone, you’re two to three times more likely to suffer another. You’re also more likely to break a bone if one of your parents broke their hip.

● Both a very low body weight and being obese are risk factors. ● The size of your bones matters. If you’ve ever been described as ‘big boned’ now is the time to be glad. People with Afro-caribbean heritage are less vulnerable than those with an Asian and Caucasian heritage, because their bones are bigger; men are less likely to have osteoporosis for the same reason.

● Post-menopause bone density can greatly reduce due to the drop in oestrogen, which protects bone strength.

● Medications such as steroids can reduce bone density – so discuss this with your doctor.