Arthritis Ireland, making a BIG difference everyday.
Osteoporosis is a disease that thins and
Little things can make a big difference to a person with arthritis.
weakens the bones to the point that they
Difficulty with the little things like making a cup of tea, getting
become fragile and break easily. It occurs
dressed or opening the front door can all add up to have a big
impact on a person’s quality of life.
At Arthritis Ireland we understand this. That is why we are working
single-mindedly to transform the experience of people living with
arthritis and those who care for them.
Every day, we work in communities across the country providing
community based education programmes to help people
effectively manage and control this devastating disease. We
when bones lose minerals, such as calcium,
more quickly than the body can replace
them, leading to a loss of bone thickness
(bone density or mass).
This booklet outlines the symptoms, causes,
diagnosis and treatment of osteoporosis.
actively drive grassroots advocacy so that the voice of people
It also highlights what you can do to help
with arthritis is heard and understood and we work with the
manage your condition and make day-to-
medical community to control and cure arthritis.
day life easier.
If arthritis is affecting your life or the life of someone you love, call
us and talk to someone who understands, someone who will
listen, chat and point you towards the people, resources and
programmes that can make a big difference to your life.
If you would like to volunteer, help raise funds or make a donation,
call us on 01 661 8188, log on to arthritisireland.ie or find us on
facebook!
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Contents
What is osteoporosis?
4
What are the symptoms of osteoporosis? 9
Who gets osteoporosis
What causes osteoporosis
How is osteoporosis diagnosed
What treatments are there for osteoporosis? 17
Medications for osteoporosis
Self-management and daily living
for osteoporosis 23
Preventing osteoporosis
Healthy balanced eating
Healthy eating tips
Exercise and strong bones
Exercise with osteoporosis
Exercise for people over 70 or after fragility fractures
What else can I do for my bones?
37
Stop smoking
Reduce alcohol intake
Support from Arthritis Ireland 3
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What is
Osteoporosis?
Osteoporosis is a disease of the bones. It occurs when
your body loses too much bone, makes too little bone
or both. As a result, bones become weak and can break
from a minor fall or, in serious cases, even from simple
actions, like sneezing or bumping into furniture.
Osteoporosis means “porous bone”. If you look at healthy
bone under a microscope, you will see that parts of it
look like a honeycomb. If you have osteoporosis, the
holes and spaces in the honeycomb are much bigger
than they are in healthy bone. This means your bones
“When I broke my wrist, I asked my
doctor about having a bone density
test. I was glad I did as it revealed
that I did have osteoporosis and I was
able to begin treatment.”
have lost density or mass and the structure of your bone
tissue has become abnormal. As your bones become
less dense, they also become weaker and more likely
to break. If you’re aged 50 or older and have broken a
bone, talk to your doctor or other healthcare provider
and ask if you need to have a bone density test. We
all have some degree of bone loss as we get older, but
the term osteoporosis is used only when the bones
become significantly more fragile. When bone is affected
by osteoporosis, the holes in the spongy bone become
larger, which is why the bone is more prone to fracture.
Osteoporosis affects both men and women and its
prevalence increases with age, being especially common
in postmenopausal women. One in three women and
one in five men over the age of 50 will experience an
osteoporotic fracture in their lifetime.
4
osteoporosis and an increased risk of broken bones,
especially in later life. Women are particularly susceptible
because bone loss becomes more rapid for several years
following the menopause.
Osteoporosis is serious
Bones contain collagen (protein), calcium salts and
other minerals. Each bone is made up of a thick outer
shell known as cortical bone and a strong inner mesh of
trabecular bone which looks like a honeycomb. Bone is
alive and constantly changing throughout life. Old, worn
out bone is broken down by cells called osteoclasts and
Healthy bone
Osteoporotic bone
replaced by bone building cells called osteoblasts, a
process of renewal called bone turnover. In childhood,
osteoblasts work faster, enabling the skeleton to increase
in size, density and strength. During this period of rapid
bone growth, it takes the skeleton just two years to
completely renew itself. In adults this process takes seven
to ten years.
Bones stop growing in length between the ages of 16 and
18, but bone density continues to increase slowly until a
person’s late 20s. At this point the balance between bone
demolition and bone construction becomes stable. After
the age of around 35, bone loss increases very gradually
as part of the natural ageing process. This can lead to
6
Breaking a bone is a serious complication of
osteoporosis, especially when you’re older. Broken bones
due to osteoporosis are most likely to occur in the hip,
spine and wrist, but other bones can break too. Broken
bones can cause severe pain that may not go away.
With osteoporosis some people lose height and become
shorter. It can also affect your posture, causing you to
become stooped or hunched. This happens when the
bones of the spine, called vertebrae, begin to break or
collapse.
Osteoporosis may even keep you from getting around
easily and doing the things you enjoy. This can make
you feel isolated and depressed. It can also lead to other
health problems. Twenty percent of older people who
break a hip die within one year from problems related
to the broken bone itself or surgery to repair it. Many of
those who survive need long-term nursing home care.
Osteoporosis can sneak
up on you
Osteoporosis is often called the “silent disease”, because
you could have it now or be at-risk without even realising
it. You can’t feel your bones becoming weaker. Breaking
a bone is often the first clue that you have osteoporosis or
“I’d never heard it called the silent disease
before but now I know why; one day my
life was going along as normal, the next
I had a broken arm and was diagnosed
with fully-fledged osteoporosis.”
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What are the
symptoms of
osteoporosis?
If you’ve broken a bone in a relatively minor fall or
accident, it’s quite often the first sign of osteoporosis.
You’re most likely to fracture your hip, spine or wrist.
you may notice that you are getting shorter or your upper
back is curving forward. If you are experiencing height
loss or your spine is curving, talk to a doctor or healthcare
professional right away as the disease may be advanced.
Osteoporosis and Arthritis
Although osteoporosis is not a form of arthritis, the two
conditions are closely connected, for several reasons.
You may have back pain, which is caused by your
vertebrae becoming weak and damaged. These are
known as vertebral crush fractures, and they can cause
your vertebrae to lose height. It usually happens at chest
level (the area known as the thoracic spine). If several
vertebrae lose height, your spine will start to curve and
you may look shorter.
Vertebral crush fractures can make breathing difficult
because there’s less space under your ribs. If you have
a vertebral crush fracture you have a greater risk of
fracturing your hips or wrists.
1. Both osteoporosis and osteoarthritis (OA), the most
common form of arthritis, occur frequently in older
people, so many older people have both conditions.
2. Some types of inflammatory arthritis, such as
rheumatoid arthritis (RA), can increase the risk of
osteoporosis.
3. Corticosteroid drugs, often taken
to treat RA and other types of
inflammatory arthritis, put people
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at increased risk of osteoporosis
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4. Like arthritis, osteoporosis
is often treated by
rheumatologists, doctors who
specialise in arthritis and arthritisrelated conditions.
8
“The first time I broke a bone I was out
with friends when I fell. Then over the
next year I broke two more bones and
I knew something was up. My doctor
ran some tests and diagnosed me with
osteoporosis.”
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Who gets osteoporosis?
The risk of osteoporosis increases with age. Anyone can
get osteoporosis but women are about 4 times more likely
than men to develop it. There are 2 main reasons for this:
■■
The process of bone loss speeds up for several
years after the menopause, when the ovaries stop
producing oestrogen.
■■
Men generally reach a higher level of bone density
before the process of bone loss begins. Bone loss
still occurs in men but it may never reach a point
where the bone is significantly weakened.
A number of other risk factors can affect our individual
chances of developing osteoporosis and of breaking a
bone in a relatively minor accident.
What causes
osteoporosis?
There are a variety of factors that can put you at risk for
developing osteoporosis. These risk factors include:
Steroids: Taking steroids can affect the production of
bone partly by reducing the amount of calcium absorbed
from the gut and increasing calcium loss through your
kidneys.
Oestrogen deficiency: Women who’ve had an early
menopause (before the age of 45) or a hysterectomy
where one or both ovaries have been removed are at
greater risk. Removal of the ovaries only (ovariectomy or
oophorectomy) is relatively rare but is also associated with
an increased risk of osteoporosis.
“I knew I fit the profile for osteoporosis:
female, white and heading towards
60. But it was still a big shock when
the diagnosis was made.”
Lack of exercise: Moderate exercise encourages bone
development. Anyone who doesn’t exercise, or who has
an illness or disability that makes exercise difficult, will be
more prone to losing calcium from the bones and more
likely to be diagnosed with osteoporosis. Women who
exercise so intensively that their periods stop are also at a
higher risk.
Poor diet: People whose diet doesn’t include enough
calcium or vitamin D or who are significantly underweight
are at greater risk of osteoporosis.
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How is osteoporosis
diagnosed?
A medical evaluation to diagnose osteoporosis and
estimate your risk of breaking a bone may involve one or
more of the following steps:
Heavy smoking: Tobacco lowers the oestrogen level
in women and may cause early menopause. In men,
smoking lowers testosterone activity and this can also
weaken the bones.
Heavy drinking: Drinking a lot of alcohol reduces
the ability of your body’s cells to make bone. It also
increases the risk of breaking a bone as a result of a fall.
Family history: Osteoporosis runs in families. This is
probably because there are inherited factors that affect
the development of bone. If a close relative has suffered
a fracture linked to osteoporosis then your own risk of a
fracture is likely to be greater than normal. We don’t yet
know if a genetic defect causes osteoporosis, although
we do know that people with a very rare genetic disorder
called osteogenesis imperfecta are more likely to develop
osteoporosis.
“Looking back I wish I’d thought more
about how I ate and how much I
exercised. I should’ve quit smoking a
lot earlier. I’m much more careful about
those things now. With osteoporosis
you have to be.”
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■■
Medical history
■■
Physical examination
■■
Bone density test
■■
FRAX® score
■■
Laboratory tests
Other tests that may be used to get information
about your bone health, but are not used to diagnose
osteoporosis include biochemical marker tests, x-rays,
vertebral fracture assessments (VFAs), and bone scans.
Medical History
Your healthcare provider will ask questions to better
understand your risk. Factors he or she may consider
include:
■■
Your age
■■
Your gender
■■
Whether you have reached menopause (women)
■■
Your personal history of broken bones as an adult
■■
Your family history of broken bones and osteoporosis
■■
Your smoking or drinking habits
■■
Your diet, including how much calcium and vitamin
D you get
■■
Your exercise and physical activity
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■■
Whether you have had an eating disorder such as
anorexia nervosa
■■
Whether you have had regular periods
(premenopausal women)
■■
Your testosterone levels (men)
■■
Whether you take any medicines or have any medical
conditions that may cause bone loss
Physical Examination
Your healthcare provider may measure you to see if you
have lost height and examine your spine. After age 50,
you should have your height checked without shoes every
year at the same healthcare provider’s office.
The FRAX® tool can be used to guide treatment decisions
in people who meet the following three conditions:
■■
Postmenopausal women or men aged 40 and older
Bone Density Test
■■
People with low bone density (osteopenia)
■■
People who have not taken an osteoporosis
medicine
A bone density test is the only test that can diagnose
osteoporosis before a broken bone occurs. This test helps
to estimate the density of your bones and your chance of
breaking a bone and is undertaken using a DXA machine.
“It was only when I had a DXA scan
that my doctor discovered severe
osteoporosis in my spine and hips.”
FRAX® - The WHO Fracture Risk
Assessment Tool
The FRAX® tool uses information about your bone density
and other risk factors for breaking a bone to estimate
your 10-year fracture risk. Your FRAX® score estimates
your chance of breaking a hip as well as your combined
chance of breaking a hip or other major bones over the
next ten years. Other major bones include the spine, hip,
forearm and shoulder.
14
If you have low bone density (osteopenia), your DXA
report may include your FRAX® score along with your
bone density. If it doesn’t, your healthcare provider can
find out your FRAX® score using a web-based version.
Laboratory Tests
Blood and urine tests can be used to identify possible
causes of bone loss. Some of these tests include:
■■
Blood calcium levels
■■
24-hour urine calcium measurement
■■
Thyroid function tests
■■
Parathyroid hormone levels
■■
Testosterone levels in men
■■
25-hydroxyvitamin D test to determine whether the
body has enough vitamin D
■■
Biochemical marker tests, such as NTX and CTX
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What treatments
are there for
osteoporosis?
There are many treatments available for osteoporosis.
The aim is to reduce the risk of broken bones occurring.
Some of the tests listed above can help to identify if you
have another medical condition that is causing bone
loss. This is called secondary osteoporosis. Depending
on your symptoms and other risk factors, your healthcare
provider may want to test you for other conditions that
can cause bone loss. If you have another condition
that is causing bone loss, treating that condition will
usually help your bone health. But, for many people,
there is often no known cause for their bone loss or
osteoporosis.
Other Tests to Evaluate Bone Health
Biochemical marker tests of the blood and/or urine may
help to estimate how fast you’re losing or making bone.
X-Rays and Vertebral Fracture Assessments (VFAs) can
show breaks in the spine.
Nuclear bone scans, CT Scans or MRIs can show
changes that may be caused by cancer, bone lesions,
inflammation, new broken bones or other conditions.
They are often used to help find the cause of back pain
or to follow up on abnormalities seen on an x-ray.
16
Factors which determine
which medication to treat
osteoporosis
There are many things to think about when choosing the
right osteoporosis medicine. You and your healthcare
provider may want to look at:
Your sex: Some medications are only approved for
women whilst some are approved for both men and
women.
Your age: Some medicines may be more appropriate for
younger postmenopausal women while others are more
appropriate for older women. In general, osteoporosis
medicines are not recommended for premenopausal
women. Some osteoporosis medicines are approved
for the prevention and treatment of osteoporosis in
premenopausal women as a result of the long-term use
of steroid medicines.
How severe your osteoporosis is: Osteoporosis
medicines work in different ways. A person with more
severe bone loss or a broken bone may take a different
medicine than a person with less bone loss. Your
doctor will consider other health problems you have
when recommending a medicine. If you have had breast
cancer or blood clots, for example, you should not take
oestrogen.
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Personal preference: Do you prefer a pill, liquid or
IV medicine or one that is given as a nasal spray or
an injection? Does it work better for you to take your
medicine every day, once a week, once a month,
several times a year or even once a year? Do you have
negative feelings about a particular drug? Any of these
factors could influence your treatment decision. It’s also
important to keep in mind that no two people are the
same. How well a medicine works, or what side effects
it will have, can vary from one person to the next. It is
a good idea to keep track of how you are finding your
medicines and write down any physical or emotional
symptoms that you experience with a type of drug or the
way or time you take the drug.
Medications for
osteoporosis
There are many drugs used to treat osteoporosis. Most
of these drugs aim to reduce the risk of you having
bone fractures. As well as drug therapy, treatment for
osteoporosis involves attention to lifestyle risk factors,
such as smoking, drinking alcohol, diet and exercise.
Together these can prevent further bone deterioration
and can often improve its strength, reducing the risk of
fractures.
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thereby stimulating bone formation and making bones
stronger. They come in a ‘pen’ syringe and are injected
under your skin, daily for up to two years.
Denosumab (Prolia®): This belongs to a group of
treatments called monoclonal human antibodies. It works
by blocking a substance involved in bone development
known as RANK ligand®. RANK ligand stimulates the
production and activity of bone cells called osteoclasts
which increase bone breakdown. By blocking RANK
ligand, denosumab aims to increase bone density and
strength thereby reducing the risk of broken bones. It’s
given as an injection under the skin twice a year.
The following drugs are used to treat osteoporosis:
Calcium and vitamin D: An adequate calcium intake is
important to build and maintain strong bones. Vitamin D
works in a number of ways to keep bones strong and is
essential to help the body absorb calcium. Not getting
enough calcium and vitamin D can increase your risk of
fractures. You may be given supplements to help reduce
your risk and to promote better responses to other
treatments for osteoporosis.
Bisphosphonates: These are a widely used family of
drugs used to reduce the risk of broken bones in people
with osteoporosis.Bisphosphonates slow the bone
breakdown process. Healthy bones are in a state of
continuous breakdown and rebuilding. As you get older,
and especially after menopause in women when your
oestrogen levels decrease, the bone breakdown process
accelerates. When bone rebuilding fails to keep pace,
bones deteriorate and become weaker. These drugs
basically put a brake on that. There are several different
kinds of bisphosphonate. Some are taken by mouth,
while others are given by intravenous injection (a slow
injection into a vein). Alendronate (Fosamax®), risedronate
(Actonel®), ibandronate (Bonviva®) and zoledronate
(Aclasta®) are all types of bisphosphonates.
Strontium ranelate (Protelos®): It appears to have
an effect on both the cells that build bone and those
that break it down. This is taken daily at least 2 hours
before or after food. It comes as a powder which you mix
with water. Due to a slight increase in the risk of blood
clots associated with this drug, it is now not considered
appropriate for people who have had a blood clot or who
are immobile or likely to be e.g. after an operation.
SERMs (Selective Oestrogen Receptor Modulators):
This group of medications mimic the action of the hormone
oestrogen on certain organs or tissues in the body while at
the same time blocking the effect of oestrogen in others.
Raloxifene (Evista®) mimics the positive effects of oestrogen
on bone tissues helping to keep bone strong but does
not affect breast or womb tissue. This means that longterm use of raloxifene does not carry the increased risk of
cancer of the lining of the womb (endometrial cancer) or
breast cancer that is associated with the long-term use of
of oestrogen-based hormone replacement therapy (HRT).
Teriparatide and parathyroid hormone (Forsteo®,
Preotact®): These are synthetic versions of human
parathyroid hormone, which plays a role in calcium
regulation. They increase absorption of calcium and
increase the action of the bone-forming cells, osteoblasts,
“When I began my treatment my doctor
advised me it could take up to a year
before I noticed any improvement.
Thankfully it worked a lot quicker than
that. After 6 months I’ve a lot more
hope for the future.”
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How long do treatments
take to work?
Treatments for osteoporosis take time to work because
bone renewal is a slow process. However, reduction
in fracture risk is often evident after 6–12 months. It’s
important that you continue treatment for as long as your
doctor tells you to – the aim is to prevent fractures rather
than to make you feel better in the short-term.
It’s becoming more common to review and assess
treatment after 3–5 years to minimise the rare
complications sometimes seen in those having longer
treatment. Your doctor or specialist will discuss whether
this is appropriate for you. You may have what’s called
a ‘treatment holiday’ while your progress is monitored.
Many treatments last a very long time and their effects
continue, perhaps for years, so you shouldn’t worry that
their benefits will rapidly be lost during this time.
Will I need any special
checks while having
treatment?
You may have a bone density scan before you start
treatment, although this isn’t necessary for everyone.
After treatment you may be monitored by one of the
following:
■■
bone density scans, usually of the spine and/or hips
■■
blood and urine tests for special markers of bone
turnover (these show a response to treatment earlier
than a bone density scan, often within 3–6 months;
however, they’re not yet widely available).
If you’re taking HRT, you’ll have regular checks of blood
pressure and mammographies (breast x-rays).
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Self-management
and daily living
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Preventing osteoporosis
During childhood, adolescence and early adulthood,
when the skeleton is growing, it is vitally important to
maximise bone strength. By ‘banking’ plenty of bone
in these years, it puts the skeleton in a better position
to withstand the bone loss that occurs with advancing
age. You can do this by taking plenty of weight bearing
exercise and eating a well balanced, calcium-rich diet.
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As we get older our bones start to lose strength and
density as the work of the bone demolition cells starts to
slowly overtake the work of the bone construction cells.
The older we get, the greater our risk of breaking a bone.
Fragility fractures become more common as the density of
bone decreases and bones become generally less strong
and more fragile.
Although there is a lot you can do to help keep bones
strong, there are lots of other factors which can increase
the risk of breaking a bone. For older people one of
the most common causes of fracture is falling. This
is common in later life because of poor balance and
co-ordination, leading to a higher risk of breaking a hip,
something which could have a significant impact on
quality of life. Reducing risk of falling may be a way of
reducing risk of fracture.
Healthy balanced eating
Whatever your age or sex, it is vital to remember that what
you eat today will have a big impact on the strength of
your skeleton in the future. Eating for your bones needn’t
be boring – there are lots of delicious meals and snacks
packed full of the vitamins and minerals you need and
they don’t have to be fattening. Low fat or fat free dairy
products usually have as much or more calcium as the full
fat versions.
Aim to eat meals that incorporate a wide variety of foods
from the four main groups. These are;
■■
fruit and vegetables
■■
carbohydrates like bread, potatoes, pasta and
cereals
■■
milk and dairy products
■■
protein such as meat, fish, eggs, pulses, nuts and
seeds
This will also help provide you with all the vitamins,
minerals and energy you need to live life to the full and
reduce the risk of other chronic diseases.
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Healthy eating tips:
■■
Eat plenty of starchy foods but try to make them the
whole grain variety such as brown rice and pasta.
■■
Eat more fruit and vegetables, at least five portions
a day.
■■
Eat more fish, try for two portions a week and
remember oily fish, such as mackerel, are also a
good source of vitamin D.
■■
Cut down on saturated fats and sugar, check out the
food labels. 5g or more of saturated fat per 100g and
10g or more of sugars per 100g is a lot.
■■
Try to cut down on the amount of salt you eat, again,
check out the food labels and remember that 0.5g or
more of sodium per 100g is high.
■■
Get active and try to maintain a healthy weight.
■■
Don’t skip breakfast, it kick-starts the day!
“On the advice of my doctor I’ve kissed
goodbye to the chippers and Chinese
takeaways. I missed them at first but to
be honest I’m feeling a lot better allround.”
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Examples of calcium rich foods
Calcium
Calcium is vital for strong teeth and bones because it
gives them strength and rigidity. Most people should
be able to get enough calcium through healthy eating.
The following table lists recommended intake levels for
calcium. The EAR is the estimated average requirement;
the RDA is the recommended daily allowance that meets
the requirements of 97.5 % of the population; and the UL
in the upper tolerable intake level (or the upper safe level).
An individual should try and achieve the EAR.
AGE
YEARS
EAR
MG/D
RDA
MG/D
UL
MG/D
1-3
500
700
2,500
4-8
800
1,000
2,500
9-18
1,100
1,300
3,000
19-50
800
1,000
2,500
51-70 men
800
1,000
2,500
51-70 women
1,000
1,200
2,500
>70
1,000
1,200
2,000
Source: Report on Dietary Reference Intakes for Calcium
and Vitamin D, Institute of Medicine Report, 2011
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WEIGHT
FOOD
CALCIUM
CONTENT (mg)
190ml (1/3 pint)
Whole milk
224
190ml (1/3 pint)
Semi-skimmed milk
231
190ml (1/3 pint)
Skimmed milk
235
150g (5oz)
Low-fat yoghurt
225
112g (4oz)
Ice cream
134
28g (1oz)
Cheddar cheese
202
112g (4oz)
Curly kale
168
112g (4oz)
Baked beans
59
100g (3.5 oz)
Tofu
480
56g (2oz)
Whitebait (fried)
482
Vitamin D
You need vitamin D to help your body absorb calcium.
The best source is sunlight, which your body uses during
the summer months to manufacture the vital vitamin
in your skin. Try to get ten minutes of sun exposure to
your bare skin, once or twice a day, without sunscreen
and taking care not to burn. Get outside between May
and September so that your body can produce enough
Vitamin D to help see you through the winter months. You
can also find vitamin D in margarine, egg yolks, cod liver
oil and oily fish such as herrings and sardines.
You should be able to get enough vitamin D through
diet and by enjoying an active, outdoors lifestyle during
the summer months. However, some people might be
deficient in vitamin D and might benefit from a dietary
supplement of vitamin D.
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Do you need more vitamin D?
If you fall into one or more of these categories you may
want to think about taking a vitamin D dietary supplement:
■■
The housebound, especially frail, older people.
■■
Those with a poor diet.
■■
Asian women and children. This group may be
deficient in vitamin D because of decreased skin
production due to skin pigmentation, dress code
and, sometimes, poor dietary vitamin D.
■■
Those who wear total sun block all the time when
outdoors.
■■
Pregnant women. This is because a baby’s stores of
vitamin D are laid down during pregnancy and are
affected by the mother’s vitamin D levels.
■■
Breast feeding women.
■■
Infants and children under three.
■■
Those using long term anti-epileptic drugs because
this alters the take-up of vitamin D by the body and
can affect the absorption of calcium.
■■
People with severe liver, kidney disease or
malabsorption problems.
The following table lists intake requirements for vitamin D
in those with minimal or no sunlight exposure.
AGE
YEARS
EAR
IU/d
RDA
IU/d
UL
IU/d
1-3
400
600
2,500
4-8
400
600
3,000
9-70
400
600
4,000
>70
400
800
4,500
Source: Report on Dietary Reference Intakes for Calcium
and Vitamin D, Institute of Medicine Report, 2011
28
Get the most from your food
■■
Breakfast cereals are an easy calcium rich start
to the day. Add milk and it bumps up the calcium
content even more.
■■
Instead of snacking on crisps or sweets, eat nuts or
dried fruit like apricots and figs, both
excellent sources of calcium.
■■
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Whitebait is also rich in calcium.
■■
Tofu (a vegetable protein made from
soya beans) is high in calcium.
■■
Bring water to the boil before putting in the
vegetables (including potatoes).
■■
Steam vegetables or use a microwave to help to
maintain their vitamin content.
■■
Green leafy vegetables, like watercress, broccoli and
curly kale, are good sources of calcium.
■■
Eat fresh or frozen fruit and vegetables because
vitamin levels drop the longer they are kept.
ation
29
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Exercise and strong
bones
Exercise is important for everyone at all stages of
their lives, but is especially important for people with
osteoporosis and at risk of fracture. Finding out the right
kind of exercise for you will help you to gain confidence
and help to reduce your risk of breaking a bone.
■■
Weight-bearing exercise such as jogging can help
maintain and increase bone density in the spine
and hips, and arm loading exercises such as weight
training can increase bone density in the wrist.
Weight-bearing exercise means any exercise where
you are supporting the weight of your own body.
■■
Do not leave cut vegetables in the air, heat or light.
Instead keep them covered in a cool, dark place, eat
them raw or cook them in small amounts of water.
■■
Use the cooking water in a soup or sauce to get
back some of the lost vitamins and minerals.
■■
When taking up bone-boosting exercise choose an
enjoyable activity which fits in with your life.
■■
Fat soluble vitamins (vitamins A and K) are more
readily absorbed if foods are stir fried in oil, for
example, stir fried broccoli.
■■
Make sure you avoid excessive exercise and
unnecessary weight loss.
■■
Stir frying food is also a good way to conserve
nutrients.
■■
One of the most effective ways of loading your bones
is by doing brief bouts of high impact exercise. High
impact is created by a large force which rises rapidly.
For example, the heel strike when your leading foot
hits the ground during jogging provides a useful jolt
to the skeleton, including the hip and spine. A few
jolts are enough.
“At first, changing my eating habits
was hard but with more thought and
planning around my diet, I was able
to shed a lot of excess weight. As
well as helping my bones, it has also
improved my overall health and wellbeing.”
30
Running up an average flight of stairs provides 10
jolts each time you go up and 10 jolts each time you
come down. Five flights a day provides 100 jolts
which are likely to produce a positive effect on bone
density, whereas half an hour jogging provides about
2,000 jolts.
31
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and young people because it adds some impact to
bones. Aim for 50 jumps a day or skipping for five
minutes each day.
If you ‘bank’ enough bone when you are young, you
will be in a better position to withstand the natural bone
loss we all experience later in life. Try to incorporate 30
minutes of some form of physical activity five times a
week into your life. Not only will it be good for your bones
but also for your general well being.
■■
■■
Team sports like football, as well as participation
classes like dancing, are a great way of getting
children involved in fitness from a young age. Key
bone-building years are those up to about your
mid 20s, so plenty of weight-bearing exercise and
a healthy well balanced, calcium rich diet will build
strength into young bones.
Jumping on the spot or skipping is good for children
“On the advice of my doctor I joined my
local gym to work on strengthening my
bones. It was a new experience for me
and I was a little anxious at first but the
staff have been so helpful and tailored a
programme especially for me.”
32
■■
A 20 minute jog three times a week is good for
building bone in both the hip and spine in younger
people. Intermittent jogging is also good, especially
for people who find continuous jogging too
strenuous. Walk then jog every 20 metres or so.
Even a very brisk walk can be good for your bones.
■■
The slow, controlled lifting of weights, best done
in a proper gym with advice from an instructor, will
increase bone density and makes
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■■
Tennis is another high impact
but enjoyable sport that
builds bone density. Research
has shown that professional
tennis players have much higher
bone density in their serving arm than
their non-serving arm!
■■
Exercise to music classes, like aerobics, circuit
training and boxercise. Anything that involves high
impact exercise will boost both your bones and your
heart when you are young.
Exercise with osteoporosis – for the fitter
person without fractures
If you have had a bone density scan and osteoporosis
has been diagnosed, you will want to know which
exercises are safe for you and how exercise can build up
your bone density or at least reduce further bone loss.
You may not be old and frail or have broken any bones; in
fact, you could be fit and healthy except for the finding of
low bone density.
Recommending exercise for you is not straightforward
and a referral to a physiotherapist may be helpful. It will
be important to discuss how high your risk of fracture
33
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is at this point. If you are at risk for other reasons and
especially if you have already had a fragility fracture
then you will need to be cautious and avoid high impact
exercise.
If you are already jogging without pain or problems then
your immediate risk of fracture may not be high and you
may decide to continue. The dilemma here is that it is high
impact exercise that builds strong bones most effectively
but for some people, at high risk of fracture, these types
of exercise might risk breaking bones.
Exercise to keep fit, keep bones strong
and prevent falls – for people over 70 or
after fragility fractures
Although you may not want to do all the things you did
when you were younger and fitter or before you had
fragility fractures, if you stop using your muscles they
will lose strength which will affect your sense of mobility
and balance, and this makes you more prone to falls
and fracture. Leading an active lifestyle can halve your
risk of breaking a bone, particularly in your hip. The term
‘active lifestyle’ means enjoying a variety of physical
activities throughout the day that keep you on the move.
These may include sport or leisure activities like ballroom
dancing or gardening as well as necessary activities like
housework and shopping. It can be as simple as climbing
the stairs regularly or taking short, brisk walks.
34
You can adopt a more
active lifestyle at any age,
provided you begin with
familiar activities that
you enjoy and progress
at an appropriate pace –
research has shown that
you are never too old to start
reaping the rewards of being
more active! As we get older, our
risk of falling increases which puts us in greater danger of
breaking a bone, particularly the hip. So we often need
to improve our muscle strength and sense of balance
and there are many exercises which can help. If you like
to swim, try walking about in the water, sideways and
backwards as well as forwards.
However, it is important that you exercise safely. Warm
up, begin gradually and then increase intensity over time.
■■
Enjoying a brisk walk every day is great for older
people. It’s an easy and free way to a fitter, healthier
older age.
■■
Dancing of all varieties provides enjoyable exercise
which is especially good for balance as well as your
bones.
■■
Tai Chi is an ancient form of Chinese martial arts
which is good for improving posture and balance
in older people. Good balance, co-ordination and
muscle strength are vital for lessening your risk of
falling and therefore breaking a bone if you have
osteoporosis. (Tai Chi and other balance improving
activities, such as dance, require a fair sense of
balance to begin with, so choose a class that is
suitable for your age group or is aimed at beginners.)
■■
Golf and croquet are all sports that people can enjoy
into older age. Golf provides a good walk and also
develops flexibility for the shoulders and spine.
■■
Swimming provides excellent opportunities to
improve the stamina and strength of all the major
muscles. It can also help to improve the flexibility of
many joints.
35
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■■
Gardening can also be a useful activity. Long handled
tools and raised flower beds will allow you to avoid
bending if you have had compression fractures in
your spine.
What else can I do
for my bones?
■■
Simple exercises can also strengthen your bones
and can be done from the comfort of your own
home. Gentle press ups against a wall or lifting tins
of food while you watch TV can help strengthen your
wrists.
Stop smoking
Smoking is well known to have an adverse effect on
general health. It has been shown to slow down the work
of the bone building cells, osteoblasts. Smoking may also
result in an earlier menopause in women and can also
increase your risk of a broken hip later in life.
Reduce alcohol intake
“With a bit of planning I began to
incorporate more physical activity
into my daily life. I’m now reaping the
benefits”.
36
Excessive alcohol consumption appears to be a
significant risk factor for osteoporosis and fractures. Even
minor alcohol intoxication is associated with an increase
in falls, which can result in breaking a bone. Try not to
exceed the recommended limit of up to 11 standard
drinks a week for women and up to 17 standard drinks a
week for men, which is considered low risk. It is important
that they are spread out over the week and not saved
for one session or big night out, and that no more than 5
standard drinks are consumed in one sitting.
37
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Notes
Support from
Arthritis Ireland
You can learn more of the skills that will help you deal with
osteoporosis on one of Arthritis Ireland’s self-management
programmes.
Living Well with Arthritis, our most popular course,
focuses on what you can do for your self, how to get
the most from your health professionals, handling pain,
fatigue and depression, relaxing and keeping active. It is
a great chance to meet and share tips with other people
who know what you are going through.
Looking for somebody to speak to about
living with osteoporosis? Why not give
the Arthritis Ireland Helpline a call. All our
volunteers are living with arthritis and as
such have a strong understanding of what
it is like to live with a lifelong condition
like osteoporosis. They would be happy
to hear from you if you are in need of a
listening ear. Call 1890 252 846.
38
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