Bone health and Osteoporosis: an update

Healthy foods from the food groups image


By Dr. Rivkeh Haryono, Nutrition Scientist at Dairy Australia

What is osteoporosis and who does it affect?

Osteoporosis is a common condition where bone loses important minerals, such as calcium, more quickly than the body can replace them. This results in the loss of bone structure and strength, often leading to a fracture, or a break in the bone. Osteoporosis is often referred to as the ‘silent disease’, as symptoms are often not present until a fracture occurs. 

In 2014-15, 3.5% (801,800) of Australians had osteoporosis 1; a number which is projected to grow due to the ageing population 2. Both men and women can develop osteoporosis, with prevalence higher in the female population. 

Poor bone health is often regarded as an issue that only affects the elderly, however this is not the case. While osteoporosis is most common at older ages, it is important that bone health is thought of as a lifelong condition. An estimated 6.3 million Australians have osteopenia (thin bones) which is a precursor to osteoporosis 2

To see if your patients are at risk of osteoporosis or osteopenia, use this bone fracture risk calculator

What’s the impact of osteoporosis?

The burden of osteoporosis is high; fractures can cause a significant loss of independence to life, for example, it has previously been reported that 11% of those with a hip fracture end up in aged care (or similar residence)3. Furthermore, fractures lead to increased disability, with evidence highlighting hip and vertebrae fractures can also lead to increased risk of morbidity, while vertebrae fractures are associated with increased mortality 4,5

Factors leading to the development of osteoporosis

The development of osteopenia and osteoporosis is complex and there are many factors involved in bone density. Some factors that increase the risk of osteoporosis cannot be changed; these non-modifiable factors include being female (women develop thin bones sooner than men), menopause, age, certain medical conditions, and a genetic predisposition. 

The good news is there are lifestyle factors that are recommended for optimising bone health, which are thought to account for 20-40% of adult peak bone mass 6. Adequate consumption of calcium rich foods, such as milk, cheese and yoghurt, weight bearing exercise, adequate vitamin D, decreasing smoking and limiting alcohol and healthy weight also play a role in healthy bones 7

For many, taking simple, preventative measures throughout the lifespan can help reduce the risk of osteoporosis. Peak bone mass achieved during young adulthood, and optimizing bone accrual during critical periods of growth, such as childhood, and the teenage years is crucial for preventing fractures. During adulthood and beyond, the focus should be on minimising bone loss, and maintaining strong, healthy bones.  

Tips for better bone health

It’s never too late to start looking after your bones and health professionals have a critical role to play in helping individuals build and maintain strong, healthy bones throughout life. Evaluating potential risk factors for bone disease and promoting bone-healthy behaviours is important. To help build and maintain strong bones, here are some tips for patients: 

1. Have adequate dietary calcium. Milk, cheese and yoghurt are the top three sources of calcium in the Australian diet9, with a serve (250mL milk, 40g (2 slices) cheese or 200g yoghurt) supplying around 300mg calcium. There are also other foods in the diet which provide calcium. The following alternatives contain about the same amount of calcium as a serve of milk, yoghurt or cheese.

• 100g almonds with skin
• 60g sardines, canned in water
• ½ cup (100g) canned pink salmon with bones
• 100g firm tofu (check the label as calcium levels vary) 
• Calcium fortified milks with calcium levels at 100mg/100mL. 

It is important to remember that some of these foods may not provide the same package of nutrients as dairy foods, with research identifying other nutrients within the dairy food matrix also play an important role in bone health, for example protein, magnesium and potassium 8.  

Despite the importance of calcium in the diet, Australians are alarmingly low on this critical nutrient with 73% of women and 51% of men not meeting their requirements 9 and putting their bone health at risk.

Further information on dairy foods and bone health can be found here

2. Have adequate vitamin D. Maintaining adequate vitamin D is important for bone health and muscle function, and adequate levels help the body to more efficiently absorb calcium. Only a small amount of vitamin D comes from the diet, so the best way to prevent a deficiency is through regular, and safe sun exposure. 

3. Exercise regularly. Regular exercise, particularly weight bearing exercises such as basketball, soccer or netball helps to maintain and improve muscle strength, leading to skeletal benefits.  

For more on prevention of osteoporosis, read the latest evidence-based Australian position statement here

References 

1. Australian Bureau of Statistics. 4364.0.55.012 - Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines, 2011-12. 2016.
2. Watts J, Abimanyi-Ochom J, Sanders K. Osteoporosis costing all Australians. A new burden of disease analysis – 2012 to 2022. 2016.
3. Australian Institute of Health and Welfare. The problem of osteoporotic hip fracture in Australia 2011.
4. Lips P, van Schoor N. Quality of life in patients with osteoporosis. Osteoporos Int. 2005;16(5):447-55.
5. Center J, Nguyen T, Schneider D, Sambrook P, Eisman J. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353(9156):878–82.
6. Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, et al. The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. 2016;27(4):1281-386.
7. Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. Med J Aust. 2013;199(7 Suppl):S1.
8. Heaney RP, Abrams S, Dawson-Hughes B, Looker A, Marcus R, Matkovic V, et al. Peak bone mass. Osteoporos Int. 2000;11(12):985-1009.
9. Australian Bureau of Statistics. 4364.0.55.007 - Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12. 2015