A Women's Health Doctor's Guide to Preventing Osteoporosis

Today I’m talking about something crucial for women as they age: osteoporosis prevention.

Osteoporosis, a condition that weakens bones, affects 1 in 3 women, compared to 1 in 5 men. It’s a silent disease, often without symptoms until a fracture occurs. These fractures, particularly of the wrist, hip, and vertebrae, can dramatically impact quality of life and lead to significant health issues. But here's the good news: there's a lot we can do to prevent it.

Understanding the Basics Osteoporosis is a skeletal disorder characterized by compromised bone strength, predisposing you to an increased risk of fracture1. It’s especially important to address bone health around the time of menopause, when oestrogen levels decline, affecting bone density.

What Can You Do?

Let's break down the key strategies for keeping your bones strong:

Embrace Exercise:

Resistance training, like lifting weights or using resistance bands, is essential for building bone and muscle strength3.

Impact exercises, such as jogging, jumping, or dancing, also help to stimulate bone growth4.

Aim for a combination of both types of exercise most days of the week.

If you have vertebral fractures or multiple low trauma fractures, stick to activities such as brisk walking or consult with a physiotherapist for personalized exercise advice.

Don't be afraid to move! Inactivity can be more detrimental than exercise, so avoid unnecessarily restricting physical activity based on bone mineral density (BMD) or fracture thresholds.

Nutrition is Key:

Calcium: Aim for around 1000 mg of calcium daily. This can be achieved through a balanced diet or supplements, but consult with your doctor to determine your specific needs.

Vitamin D: Adequate vitamin D is crucial for calcium absorption and bone health. The Royal Osteoporosis Society recommends considering treatment for those with levels below 50 nmol/L.

Testing is not always needed: Routine testing for vitamin D is often unnecessary if you are being treated for osteoporosis.

Hormone Replacement Therapy (HRT):

For younger women going through menopause, HRT can be a highly effective option for preventing fractures.

It’s especially important to consider HRT for women with premature ovarian insufficiency.

The starting dose of HRT for women over 60 should be tailored to their specific needs.

Mind Your Posture:

Incorporate exercises that strengthen your back muscles to improve posture and reduce the risk of falls.

Avoid excessive spinal flexion or loaded forward bending in both your exercise and daily activities.

Balance is Crucial:

Include activities such as Tai Chi, dance, yoga, or Pilates to improve balance and reduce the risk of falls.

It is important to strengthen postural muscles and maintain balance in order to reduce the risk of falls, because falls are a major risk factor for fractures.

Safe Lifting: Be mindful of your lifting techniques. Keep your spine straight, and use your leg and core muscles instead of your back when lifting.

Work with Professionals: Don't hesitate to seek personalized advice from a healthcare professional or physiotherapist for specific recommendations on exercise and treatment options.

Be Aware of Medications: Certain medications, such as oral glucocorticoids, may increase the risk of osteoporosis, so be sure to discuss all of your medications with your healthcare provider.

What to Avoid

Here are some "don'ts" to keep in mind for osteoporosis prevention:

Don't Overdo Spinal Flexion: Be careful to avoid postures or exercises that involve excessive forward bending of the spine, especially with added weight.

Don't Rely Only on Supplements: While calcium and vitamin D supplements are helpful, they are not a substitute for a healthy lifestyle and exercise.

Don't Ignore Vitamin D Deficiency Symptoms: If you experience chronic pain or muscle weakness, it might indicate a vitamin D deficiency that needs attention.

Avoid Annual Vitamin D Depot Injections: These are not recommended for treatment.

Don't Fear Movement: Avoid restricting activity unnecessarily because fear of movement can actually increase the risk of falls.

Don't Start Treatment Without Addressing Vitamin D: It's important to correct any vitamin D deficiencies first before starting treatment with anti-resorptive medications.

The Role of DEXA Scans

DEXA scans are an important tool to measure bone mineral density and assess fracture risk1. They are recommended for individuals with risk factors for osteoporosis, such as a history of fragility fractures, rheumatoid arthritis, or those taking medications that affect bone density. However, routine DEXA scans aren't always necessary, especially if you're already being treated for osteoporosis with medication and vitamin D .

Moving Forward

Your bone health is a lifelong journey that requires a holistic approach. By incorporating regular exercise, a balanced diet rich in calcium and vitamin D, and working with your healthcare provider, you can take proactive steps to protect your bones and live a full, active life. Remember, you are your best health advocate.