NHS Choices - Live Well
Judi Paxton, 62, talks about her shock at being diagnosed with osteoporosis.
Judi Paxton, 62, talks about her shock at being diagnosed with osteoporosis.
"Four years ago I was working as an HR Director. I was stuck in the office day in, day out from eight in the morning till six or seven at night. I never saw daylight and I never took any exercise because I was so busy working all the time.
"But never in a million years did I think my lifestyle might be affecting my bone health.First signs
"Then one day I was walking down the road with my husband when I twisted my ankle. I felt a snap and fell over. My husband took me to A&E and it turned out to be broken.
"I was referred to the local fracture liaison service for a DEXA (or DXA) scan, which measures the density of your bones. In our area, they do that for everyone over 50 who has a fracture. I thought it was a sensible thing to do, but I didn’t for a minute think there anything wrong with my bones.
"It took ages to get the appointment because the service was very busy. But finally, eight months after I broke my ankle, they did the scan. It was a bit like an X-ray really. I just lay there while they scanned different parts of my body.Shock diagnosis
"Once they had finished they told me there and then that I had osteoporosis (when the bones become weak and fragile). When I heard that I was in shock.
"It never occurred to me that it was something that could happen to me. No one in my family had had osteoporosis, and I didn’t know that women are more at risk following the menopause.
"The staff at the clinic were very kind. They gave me some leaflets about osteoporosis and referred me to the physiotherapists.
"I really thought it was the end of my life as I knew it. I thought, “My bones are all fragile so I can’t do anything anymore. If I fall over I will break something.” It was a horrible feeling.
"When I went along to see the physios they measured me, checked my balance and generally looked me over. They also referred me for a series of 12 strengthening and balance exercise classes.Reassuring news
"When I told one of the physios how worried I felt, she said, “You don’t need to be – if you do all the things we tell you, you can improve your bone density.”
"Once I heard that, I perked up no end. I hadn’t realised till then that you can actually improve your bone health. I thought, “Yes, I can do this.” From then on I felt very positive and started doing everything the physios told me.
"In the classes we did press ups against the wall to strengthen our wrists, shoulders and back. We used light weights and stretchy bands to strengthen our muscles, as well as stepping on and off a low step and some brisk walking.
"We also did balances while holding on to the back of a chair. All the time two physios watched over us all and took great care with us.
"Once the classes ended I was referred on to Vitality classes, which are run by the local authority with help from the NHS. These are special exercise classes for people who are a bit more fragile for some reason. That could be due to osteoporosis, arthritis, asthma or following a heart attack. Again, they were very good.Healthy diet
"I started to eat as healthy a diet as possible. I had more milk and yoghurts to provide calcium for my bones. Instead of crisps I’d have handfuls of flavoured almonds, which are good for calcium too. I ate plenty of eggs and oily fish for vitamin D and got out into the daylight whenever I could. I also took tablets containing calcium and vitamin D twice a day.
"A year after my fall decided to give up work. I realised I needed to put my health first. It meant I could get on with taking exercise, being out in fresh air and generally getting fitter.
"Two years after being diagnosed with osteoporosis, I had another DEXA scan. My bone density had improved by 14 per cent. I was so pleased and excited.
"It just shows that it is totally possible to improve your bone health. I have done what I was told by the physios and have improved my bone health so much. I am not actually classed as having osteoporosis any more although I still have osteopaenia (lower bone density) in my spine.Staying strong
"Now that I’m not working I spend a lot of time in the garden. It’s good because it gets you out into the daylight and it involves weight-bearing exercise.
I also go to three exercise classes a week – two Pilates classes and an easy circuit class. I make a point of talking to the instructors and asking for different exercises, particularly ones for my spine.
"As funny as it sounds, I was so fortunate to break my ankle. If I hadn’t gone for that DEXA scan my bones would just have got worse and worse. Thank goodness for the fracture liaison service.
"To anyone who finds themselves in my situation, I would say don’t despair. As long as you put the effort in – eating the right things, taking some exercise and getting out in daylight – you can improve matters. Being diagnosed with osteoporosis doesn’t have to be the end of the world."
It’s normal for women to gradually lose bone density from the age of about 35. But after the menopause bone loss speeds up.
Women can lose up to 20% of their bone density in the five to seven years after the menopause. This makes post-menopausal women more at risk of osteoporosis (weak bones) and fractures.Why does bone loss speed up after the menopause?
The rapid dip in bone density after the menopause is caused by falling levels of the female hormone oestrogen. Oestrogen helps to protect bone strength.
“While we still have oestrogen on board it’s very useful for keeping our bones healthy,” says Dr Heather Currie, managing director of Menopause Matters. “By the time we have the menopause, we are producing fewer hormones and it has a detrimental effect on our bones.”
“When someone loses oestrogen at a younger age than normal and has an early or premature menopause it has a worsening effect later on,” says Dr Currie. “The longer we have oestrogen, the better it is for our bones.”Keeping bones strong after the menopause
Osteoporosis is more common after the menopause, but women often aren’t aware that they have it. “Osteoporosis doesn’t cause any symptoms. A fracture is often the first sign, and osteoporotic fractures are increasing,” says Dr Currie.
While you can’t halt bone loss entirely after the menopause, there is plenty you can do to slow it down. “I encourage women to see the menopause as a wake-up call,” says Dr Currie. “It’s a great time to review your diet and lifestyle.”
Here are some simple steps you can take before or after the menopause to protect your bone health.Stay active
Even if you haven’t been physically active before, adopting an active lifestyle after the menopause will help to protect your bones.
It’s recommended that adults aged 19 to 64 do at least 150 minutes of moderate-intensity activity in bouts of 10 minutes or more each week. This could include activities such as cycling or brisk walking. You should also try to avoid sitting for long periods, for example, watching TV, playing video games or sitting at a computer.
Weight-bearing exercises and resistance exercises are particularly important for improving bone strength and helping to prevent osteoporosis. This is because they place stress on the muscles and bones, which helps to strengthen them.
Weight-bearing exercises are ones where your legs and feet support your weight. High-impact weight-bearing exercises, such as running, skipping, dancing and aerobics are all great for strengthening muscles, bones and joints, and can be part of your 150 minutes of moderate intensity activity.
With resistance exercises you use your muscle strength to work against resistance. Government guidelines recommend this type of activity twice a week. Examples include press-ups, exercising with weights or using weight equipment at a gym. The action of muscles pulling on the bones boosts your bone strength.
See more on exercises for strong bones.Eat a balanced diet
A healthy, balanced diet that includes calcium and vitamin D will help slow down bone loss after the menopause. Good sources of calcium include green, leafy vegetables (but not spinach), nuts, seeds, dried fruit, tinned fish with the bones in, and dairy products like milk, yoghurt and cheese. Lower-fat dairy products contains just as much calcium as full-fat ones.
Useful food sources of vitamin D include oily fish, eggs, and spreads fortified with vitamin D, although most of our vitamin D comes from sunlight.
If you feel your diet isn’t up to scratch for some reason, you may like to talk to your GP or pharmacist about dietary supplements.
See more on eating for bone health.Get some sun
Sunlight on your skin between May and September triggers the production of vitamin D. One or two 10-minute spells outside without sunblock on sunny summer days should be enough to keep your vitamin D level healthy. Take care not to let skin redden or burn.
Read more on vitamin D and sunlight.Drink sensibly and don’t smoke
The recommended daily limit for alcohol is 2-3 units for women.
See how to keep track of your alcohol units.Hormone replacement therapy (HRT) and bone health
HRT can be an effective treatment for common menopausal symptoms like hot flushes, night sweats, sleep disturbance, and achy joints. It works by replacing oestrogen, which naturally begins to drop before the menopause. HRT can also help to maintain bone density and reduce the risk of osteoporosis.
HRT isn’t suitable for all women and some women prefer not to take it, but it is recommended for certain groups.
The average age for women to have their menopause is 52. If your periods stop before the age of 45 it’s considered an early menopause. If they stop before the age of 40 it’s considered a premature menopause.
“Women who have a strong family history of osteoporosis should also consider taking HRT for bone health as well as the control of menopause symptoms,” says Dr Currie.
For more information about the risks and benefits of HRT see your GP.
Read more about HRT and the menopause.
How children’s bones grow
Children’s bones keep growing throughout childhood. They grow fastest of all when children go through puberty in the early years of secondary school.
The bones keep getting denser and stronger until they reach what’s known as ‘peak bone mass’. This usually happens between the ages of 18 and 25.
The stronger your child’s bones are at the time of peak bone mass, the less likely they are to develop the fragile bone disease osteoporosis and suffer fractures later in life.
“The reserve of bone you establish during childhood and the teenage years is with you throughout adulthood,” explains Dr Paul Arundel, a consultant in paediatric metabolic bone disease at Sheffield Children’s Hospital. “We all start to lose bone mass later in life. If you are starting from a low baseline you are more likely to develop osteoporosis earlier on.”
The good news is that you can protect your child’s bone health with some simple lifestyle measures.Your child’s bone-friendly diet
Building strong bones in childhood requires a range of vitamins and minerals. A healthy, balanced diet will provide this. That means a diet that includes:
• fruit and vegetables – at least five portions every day (but no more than one 150ml glass of fruit juice)
• carbohydrates – such as potatoes, pasta, rice and bread (preferably wholegrain)
• protein – such as meat, fish, eggs, beans, nuts and seeds
• dairy products – such as milk, cheese and yoghurts
There are a couple of nutrients that are particularly important for building strong healthy bones.Calcium for healthy bones
Our bodies contain about 1kg of calcium. About 99% of this is found in our bones and teeth – it’s what makes them strong and hard. Most of this calcium is laid down during childhood and the teenage years.
Calcium is particularly vital during puberty when the bones grow quicker than at any other time. On average puberty lasts from 11 to 15 for girls and 12 to 16 for boys.
The recommended calcium intake for children and young people aged from 11 to 18 is 800-1,000mg compared with 700mg for adults. But research shows that, on average, children and young people in this age group don’t get enough.
“Teens need more calcium because they’re growing,” says Dr Arundel. “People don’t relate bone health to teenagers like they do with toddlers, but teenagers grow loads.”
Foods that contain lots of calcium include dairy foods such as milk, cheese and yoghurt, but also tinned sardines (with the bones in), green, leafy vegetables (but not spinach), peas, dried figs, nuts, seeds and anything that’s fortified with calcium, including some soya milks.Vitamin D for kids' bone health
Vitamin D is important for bones because it helps our bodies to absorb calcium. There are only a few foods that contain useful amounts of vitamin D. These include oily fish, eggs and foods that have been fortified with vitamin D, such as spreads and cereals.
Our main source of vitamin D is sunlight. This is made by our skin when it’s exposed to sun during the summer months. The problem is that, here in the rainy UK, more than one in five of us lack vitamin D, and this may affect the health of our bones.
Children under five are one of the groups that are more likely to have low levels of vitamin D. Because of this it’s recommended that children aged from six months to five years take a daily vitamin D supplement.
If you breastfeed your baby it’s recommended that you give them vitamin D drops from soon after birth. Formula milk contains enough vitamin D to support babies’ bone health in the first six months.
For under-fives it’s best to choose a vitamin D supplement that’s formulated specially for children. The supplement you choose should contain 7-8.5 mcg (about 300 units).
Other supplements may not contain the right amount.
If you receive benefits, you may be eligible for free Healthy Start vitamins, which contain vitamin D. Your health visitor can tell you more, or visit the Healthy Start website.Sunlight and children’s bone health
Sunlight is our main natural source of vitamin D. Short, regular periods of sun exposure without sunscreen from May to September is enough for most people to get the vitamin D they need. About 10 to 15 minutes is enough for lighter-skinned children. Children with darker skin will need to spend a little longer in the sun to produce the same amount of vitamin D.
It’s important never to let your child’s skin go red or start to burn. Babies under six months should never go in direct sunlight.Bone-strengthening exercises for children
Daily physical activity is important for children’s health and development, including their bone health.
Try not to let your child be sedentary for long periods. You can do this by reducing the amount of time they spend sitting down, for example, watching TV or playing video games.
Children under five who aren’t yet walking should be encouraged to play actively on the floor. Children who can walk on their own should be physically active daily for at least 180 minutes (three hours) spread throughout the day. This should include some bone-strengthening activities, such as climbing and jumping.
Children aged five to 18 need at least 60 minutes (one hour) of physical activity every day, which should include moderate-intensity activity, such as cycling and playground games.
In order to strengthen muscles and bones, vigorous-intensity activities should be included at least three times a week. This could be swinging on playground equipment, sports such as gymnastics or tennis, or hopping and skipping.
Eating disorders affect people of all ages, both male and female. But girls and women are more likely to be affected and, on average, anorexia first develops around the age of 16 to 17.
The bones are still growing and strengthening at this time and eating disorders like anorexia can affect their development. Low body weight can lower oestrogen levels, which may reduce bone density. Poor nutrition and reduced muscle strength caused by eating disorders can also lower bone density.
If your teenage child has anorexia or another eating disorder, it’s important to seek medical advice about their bone health.
It’s true that our bones tend to lose strength as we get older. But even in later years there is plenty we can do to slow down bone loss and avoid the bone-thinning disease osteoporosis.
“Fractures related to osteoporosis mainly occur later in life and we’re all living longer – men and women,” says Sarah Leyland, senior osteoporosis nurse at the National Osteoporosis Society. “But even when you are over 65 there are still things you can do to strengthen your bones as well as reduce your risk of falling, to prevent fractures.”Stay active over 65 for healthy bones
In general our activity levels tend to drop as we get older. You may feel you don’t have the energy to exercise or that you may harm yourself in some way. Physical problems like stiff, painful joints can also make us less inclined to be active.
The problem is that being inactive makes your muscles and bones lose strength. This increases your risk of osteoporosis, falls and fractures. By staying active you can significantly lower your risk of breaking a bone.
Doing something is always better than doing nothing. But for optimum health, it’s recommended that people over 65 get 150 minutes of moderate-intensity exercise, in bouts of 10 minutes or more, every week.
With moderate intensity activities you will get warmer, breathe harder and your heart will beat faster, but you should still be able to carry on a conversation. Examples include a round of golf with friends, doing the garden or taking the dog for a walk.
Muscle strength is vital for improving your balance and staying independent and mobile in later years. It’s recommended that people over the age of 65 do activities to improve muscle strength at least twice a week. This could include dancing, carrying groceries, going up and down stairs or exercising to music – in fact, anything that challenges your muscles.
It’s also a good idea to do activities to improve balance and co-ordination twice a week as this can reduce your risk of falling. Things such as yoga or tai chi are best for this. These types of activity can also ease stiffness and unsteadiness associated with painful joints.
Another important tip for over 65s is to avoid sitting around for long periods. As well as reducing muscle and bone strength, this can make joints feel stiffer and so increase the risk of falls. If you find you have been sitting for more than about 20-30 minutes, get up and go for a stroll.
See more on the risks of sitting for long periods.
Physical problems, such as painful joints, needn’t prevent you from being active. Classes are available for people who are older or who have underlying health conditions, such as heart disease or arthritis. Ask your GP or practice nurse, or make enquiries at your local leisure centre.
If you have a high fracture risk or spinal fractures caused by osteoporosis, you need to look after your back. It’s especially important to bend your knees when lifting objects. Avoid movements that involve awkward bending and lifting movements. You may need to be cautious about some types of high-impact exercises. Your GP can advise you about this.Eating for healthy bones over 65
Some people find their appetite starts to drop as they get older. Eating less can make it more difficult to get the nutrients you need to keep muscles and bones strong and healthy.
Staying active will help to keep your appetite up. But if you don’t feel like eating much some days, it’s still important to try and stick to a balanced diet, says Sarah Leyland. “Don’t just have tea and biscuits,” she says. “Try to keep to a balanced diet with fruit and veg, dairy, carbohydrates and protein.”
Maintaining a balanced diet will ensure you are getting all the nutrients you need. Healthy muscles and bones especially need calcium, vitamin D and protein. Calcium is what makes our bones (and teeth) strong and rigid, and vitamin D helps our bodies to absorb calcium.
Protein, meanwhile, is important for muscle strength. “Low protein has been linked with a higher risk of hip fracture in older people,” says Sarah Leyland.
Another reason to eat a balanced diet is that it will help you to maintain a healthy body weight. Being underweight is linked to a higher risk of fractures.
If your diet isn’t as good as it should be you may want to consider taking a dietary supplement. Go for one that contains calcium and vitamin D. Your GP or pharmacist can help you choose one that’s suitable for you.
Some medicines can affect your appetite. If you think a medicine you are taking may be affecting your appetite, perhaps because it makes you feel nauseous, talk with your pharmacist or GP. They may be able to suggest an alternative.
See more about food and diet for strong bones.Vitamin D and older people
Vitamin D is important for both strong muscles and healthy bones. People aged over 65 are more likely to lack vitamin D. For this reason it’s recommended that people in this age group take a daily supplement containing 10mcg of vitamin D. “You can buy this cheaply over the counter or your GP can prescribe it,” says Sarah Leyland.
Some foods contain vitamin D. These include oily fish like mackerel and salmon, eggs, and spreads fortified with vitamin D. However, it’s difficult to get enough vitamin D from food alone and as we get older our bodies' ability to absorb vitamins and minerals from food decreases.
The best natural source of vitamin D is summer sunlight. The action of sunlight on bare skin provides us with vitamin D. However, in the UK the sun is only strong enough to make vitamin D from May to September. About 10 minutes’ sun exposure once or twice a day without sunscreen on sunny summer days will help to keep your vitamin D levels topped up.
Taking a vitamin D supplement is particularly important if your diet is poor, you have darker skin, or you don’t get outside much. If you have osteoporosis, your GP may prescribe a calcium supplement too.
See more about vitamin D.Other ways to protect bones in over-65s
The older we get the more likely we are to experience broken bones, particularly fractures of the hip or spine. Each year there are about 300,000 fractures in the UK and most of these are in older people.
This is partly because older people are more likely to have osteoporosis but also because they are more likely to have falls.
To help prevent falls and fractures:
Get your eyesight and hearing checked – sight plays a vital role in balance and mobility so make sure you get your eyes tested at least every two years. Eye tests are free for everybody over the age of 60 in the UK.
Look after your feet – foot pain can make it difficult to stay active and can increase your risk of falls. See your GP promptly if you have painful feet.
Manage your medicines – some medicines, including some used to control blood pressure, can make you feel faint or dizzy. Regular medication reviews with your GP or pharmacist will ensure that the drugs you take are effective without causing unwelcome side effects.
Find out your risk of having a fall.