On World Osteoporosis Day, we ask experts about how to deal with the condition, including medication that can be taken and vitamin deficiencies to be aware of. Five lifestyle changes to consider include more weight-bearing exercise, sleeping well and taking care of your gut microbiome.

The global burden of osteoporosis has doubled in the last 30 years, while hip fractures, almost always a consequence of osteoporosis, are also expected to double over the next 30 years, according to two recent studies.

Why? What’s happening given our better advice on bone care as we age?

It’s partly because as we live longer, we exhibit more of the problems that manifest in old age, says Cheung Ching-Lung, associate professor at the University of Hong Kong’s department of pharmacology and pharmacy.

It’s also party because osteoporosis – commonly perceived as a woman’s disease – has been widely neglected in men by both physicians and patients themselves, Cheung adds.

For men with hip fractures, roughly 20 per cent are treated for osteoporosis a year after hip fracture, compared with 30 per cent for women, Cheung says. This is also part of the reason why the projected increase in hip fractures by 2050 is higher in men than in women.

Post-menopausal women are also prioritised for osteoporosis treatment over men on account of limited resources, Cheung adds.
Hip fracture patients should be treated with anti-osteoporosis medications.

According to Dr Edith Lau, a world expert in osteoporosis at the Hong Kong Centre for Clinical Research, one-third of menopausal women live with the condition, but so do 20 per cent of elderly men.

Osteoporosis is a degenerative disease caused by a loss of bone density. It can be measured using a Dexa scan, which uses low-dose X-rays to check bone strength. Cheung helped me understand my own recent result.

Bone density is measured at the spine and hip. Osteoporosis is diagnosed if either site has a T-score lower or equal to -2.5. If the T-score is between -2.5 and -1, this is classified as osteopenia, when your bones are weaker than normal. So, my -1.6 score indicates osteopenia, which may precede osteoporosis.

Whether that happens depends on the cause of the condition and a patient’s age. It can be stopped or reversed with lifestyle modifications.

Osteoporosis is especially dangerous in age as it makes hip fractures far more likely when an elderly person falls, Cheung says.

“Osteoporotic hip fracture is known to be associated with increased immobility, morbidity and mortality. 

For example, more than half of the patients will have deterioration in mobility, approximately one-fourth of the patients will be institutionalised after hip fracture, and the one-year mortality in hip fracture patients is 17.3 per cent in Hong Kong.”

Loss of bone mass isn’t just a risk factor for fractures – it might also compromise heart health, says one study that found that thin, brittle bones presented as red flags for heart attacks and strokes in women.

The reason for this is unclear, but research suggests it might be because weaker bones means stiffer arteries.

Osteoporosis isn’t inevitable: if one-third of post-menopausal women have it, two-thirds don’t. So what causes it – apart from declining oestrogen in the case of women?

Being underweight is a risk factor, as is insufficient calcium and vitamin D. A drop in sex hormones affects men too, though, Cheung says. The age-related decline in testosterone predisposes them to osteoporosis.

Common risk factors shared by both sexes include smoking, drinking, use of oral steroids and having other health problems.

But there are ways to prevent it, Lau says. “Maintain calcium and vitamin D intake, make sure we do load-bearing exercises regularly, and maintain an ideal BMI [body mass index].”

Load-bearing exercise sends signals to bones to keep up their metabolism, which keeps them strong. Walking is an excellent load-bearing exercise, as is dancing, jogging, stair climbing, playing ballgames and tai chi.

The theme for this year’s World Osteoporosis Day is “Step Up for Bone Health”, which speaks to both action and awareness. Be aware of the risks, which include taking certain prescription medications and having some diseases, and know what you can do minimise them.

Remaining active and on your feet is key – 30 minutes a day if you can. And while swimming is wonderful for cardio and muscle strength, it’s no good for bones.

If we do nothing to change the incidence of hip fractures, the total direct medical cost in treating hip fractures will also double by 2050, Cheung says. In Hong Kong, the direct medical cost is approximately HKD$100,000 (US$12,700) per case already.

Hip fracture patients usually need to stay in hospital for weeks, which brings further financial, physical and psychological costs. 

And a hip fracture often leads to another fracture, or imminent risk of one.

How can we arrest, or even reverse, the situation if we have been diagnosed with a loss of bone strength?

While adequate vitamin D and calcium are important, and hormone replacement therapy (HRT) can help protect women’s bones in the face of declining oestrogen, simply using calcium and vitamin D supplements is not effective in preventing fractures, Cheung says.
“These are not drugs. The same applies to HRT. It can help improve bone mass but is not so effective in preventing fractures.”

That’s where more potent bone-mass-building agents come into play if osteoporosis has been diagnosed. These include bisphosphonates, and the drugs denosumab, teriparatide and romosozumab.

Not only can these stop further bone loss, they can even lead to significant bone gain. Most patients should have improved bone mass after taking these agents, so the condition can be reversed if treated and managed properly.

Timely treatment and management are important, Cheung says. But anti-osteoporosis treatment is only indicated for those with diagnosed osteoporosis or with a high risk of fracture.

In my case, I need to address my lifestyle to improve my bone mass and reduce further bone loss.

5 lifestyle changes to help build ageing bones and avoid fractures

1. Walk if you don’t, run if you do
Walking is good. Running is better if you’re already a walker; the key is to put more weight on your frame than it’s used to.
Weight-bearing exercise strengthens bones in two ways: it prompts muscle to pull on the bone and it makes the bone react to high-impact force. Both of these actions encourage bone building.
Studies have also found that maintaining bone marrow health keeps bones healthy. With age our bone marrow is inclined to turn to fat, rather like the rest of us. And fat has a negative impact on bone metabolism.

2. Hop (skip and jump)
Just five minutes of high-impact exercise a day could have a profoundly positive effect on bone health.
In one study, subjects hopped on the same leg every day for six months. At the end of that time, scans revealed that bone density has improved in that leg and decreased in the non-hopping one.

3. Add resistance if you cycle or swim
If your body weight is supported by a bike or water, you’re going to miss out on the “weight-bearing” advantage of fast walking or running. You don’t have to add weights to the mix; you could work against resistance bands.

4. Look after your gut microbiome
The microbiome is the new buzzword in good health – that is, looking after our gut’s health flora and fauna.
Eating a gut-friendly, high-fibre diet is obviously good for all-round better health, but one study indicates that taking a probiotic supplement might be especially good for bone health.

5. Get enough sleep
Good sleep helps to build bones.
While you’re sleeping your body goes into repair mode, replenishing old cells with new ones and boosting your immune system. That means it is also building bone, so make sure you get enough shut-eye, at least seven hours a night.

*Anthea Rowansc

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