What are our bones? 

Our bones are the framework for our bodies: keeping our organs in place and providing support for our muscles, tendons and ligaments. Bones are predominantly made of collagen, which in itself is a growing, living connective tissue and protein. Our bones are composed of collagen, providing a soft framework, and calcium, a mineral that strengthens and hardens the frame. With this combination, our bones are made to be flexible and hardy enough to withstand injuries and stress. We also have two layers of bone; the outer layer is referred to as cortical and is dense and compact, whilst the inner layer consists of trabecular bones, and has a sponge-like consistency.  

As we age, they become heavier and larger, with bone formation occurring up until your thirties. After this, bone loss begins to occur – and while a slow, steady rate of this is normal as we become older, excessive bone loss or weakening can lead to conditions such as osteoporosis. Women are considerably more likely to develop this condition, particularly in the first decade following menopause.   

Hormones and the bones 

Our sex hormones play a big role in the density of bones as we age, particularly in the harder, mineral calcium component. In some studies, women over the age of 65 and with relatively higher estrogen levels actually had higher bone mineral densities than those with lower estrogen levels. Women with lower levels of estrogen instead had a greater risk of fractures, further increased by the presence of another sex hormone called globulin.  

At our bones, estrogen works to regulate the interactions and responses of cells to chemicals and stimulation. Research in mice has shown that when we lose these functions, there can be a reduction in bone growth and increased bone loss that’s accompanied by increased bone formation in a feedback loop to try correct the imbalance. During menopause estrogen levels drop, and you guessed it: so does bone density. While having a higher bone density prior to menopause can prevent any serious impacts of this reduction, those without optimal bone health at this stage of life can open themselves up to bone fractures and osteoporosis.  

Even younger women are at risk of developing disorders and injuries associated with low bone density. Losing your period at any stage – known as amenorrhea – is a big risk factor for young women developing osteoporosis. The condition affects 3-5% of young women, and is further confounded by poor nutrition or malnutrition, excessive exercise and chemotherapy, among others.  

But what exactly happens when osteoporosis creeps up? And can it be reversed? 

Osteoporosis: the slow wasting away of bones.  

Osteoporosis is a result of low bone mass and the gradual, insidious deterioration of bone tissue. This leads to incredibly fragile bones and, as a result, a greater chance of fractures occurring. It is often called a silent disease due to its slow progression and it may not be noticed until a bone break occurs. With no symptoms, osteoporosis fractures occur in situations where normally a healthy person would not break a bone. These fractures can be a cause of acute and chronic pain – leading to further disability, early mortality and reduced quality of life. Most commonly, fractures occur at the wrist, the hip, the shoulder and the spine. Compression factors are common at the spine, leading to the collapse of vertebra, stooped posture and reduced mobility.  

Osteoporosis doesn’t just lead to more breaks and fractures; the impact of this condition can trigger a range of other conditions that further compound a reduced quality of life. Depression is a common complication of osteoporosis, with reduced mobility leading to isolation and less physical activity. Osteoporosis is also associated with reduced lung capacity, with the collapse of the spine making it harder to move air through the lungs.  

It’s not all doom and gloom: while some risk factors for osteoporosis are non-modifiable, there are many more that can be modified to protect bones and even improve bone health. The factors that we cannot modify include:  

• Age is the single most impactful factor in developing osteoporosis and experiencing poor bone health. Being over 50 years of age increases the loss of bone density, and as a result, increases the chance of disorders associated with bone weakness. 
• Being female is another risk factor for osteoporosis. As discussed above, our sex hormones can wreak havoc even on the hard frame of our skeleton, and the loss of estrogen during and after menopause is a primary culprit. 
• Family history plays another large role in the risk of bone weakness. Low bone density and chances of a fracture occurring can be hereditary, with over 30 genes identified as being part of these events.  
• Ethnicity can also influence osteoporosis – people of any ethnicity can develop the disease, but being European or Asian can predispose you to disease development. 
• Various medical disorders come part and parcel with poor bone strength. These include hormonal disorders, where female sex hormones are repressed or reduced; endocrine disorders, including those of the thyroid; and gastrointestinal disorders, such as Crohn’s disease.   

Controllable risk factors: working towards healthy bones

Lifestyle plays a huge part in the health of our bones. In unsurprising news, much of this comes down to overall diet and exercise. Still, there are certain aspects of diet and exercise that are especially beneficial for our bones, and activities that we would do well to avoid or moderate.   

Excessive alcohol affects the absorption of minerals by bones, particularly that of calcium and vitamin D – critical for bone health. Alcohol intake further decreases estrogen and suppresses the cells responsible for building our bones. Smoking impacts the absorption of calcium, with nicotine in particular slowing the formation of cells responsible for bone formation. Smoking also breaks down estrogen; again, impacting the ability of bones to form and remain strong.  

Decreased vitamin D levels are common for many, particularly in this day and age where we spend an ever-increasing amount of time inside. Insufficient hormone levels can increase the activity of other hormones in our body that subsequently lead to bone loss.  

The role of nutrition in maintaining bone health is both complex and critical. Having a diet low in nutrients including calcium; magnesium; zinc; iron; fluoride; copper; and vitamins A, K, E and C can lead to bone weakness and subsequent fractures and osteoporosis. Conversely, too much sodium can result in lower bone density, with sodium increasing the loss of calcium from the body. High protein diets can increase the ability of the body to use calcium, and may even increase the density of bone in the spine in particular. Being underweight can negatively impact all of the above factors, with the incidence of osteoporosis being lower in overweight people.  

Striking the right balance of exercise is another key to bone health. Physical inactivity can lead to bone loss, whereas bone formation occurs in response to healthy amounts of physical stress. Weight bearing exercise are especially crucial for maintaining bone mass, with clear links between the strength of our muscles and the strength of our bones. Yet exercise can also lead to decreased bone density, particularly in women. Endurance exercise is characterized by prolonged periods of moderate-intense physical activity, and female athletes who take part in sports such as triathlon, marathon runner or endurance cycling have an increased risk of both osteoporosis and the loss of the menstrual cycle.  

Having poor bone health can also be present as a side-effect or co-morbidity of many other disorders and diseases. Often to manage the primary condition, certain medications will be used to halt or slow symptoms. While more research is needed into the impact of medications on bone health, we do know that there are associations between our bone health and the use of glucocorticosteroids and of anti-convulsants. If you recognize any of the risk factors mentioned in this article, discuss this with your general practitioner or specialist before undertaking any medication regimen.   

Outlook 

Treating osteoporosis can only happen when bone loss is halted. A healthy lifestyle, following the steps below, provides you with a protective reservoir of bone health, and can even return your levels of bone strength and density to normal. But sometimes even that is not enough: making sure your home is safe and not likely to cause a fall is crucial for preventing breaks as a result of bone weakness, and certain medications can also treat disorders of poor bone health. It’s never too late to start focusing on your bones, a mantra especially true for women – regardless of your bone strength and health, adopting a fun and effective exercise regime in conjunction with a healthy diet will only ever be beneficial. Get some sunshine, eat some leafy greens, and enjoy moving your body.