The world’s population is undergoing an enormous shift as we are, on average, living longer. According to the World Health Organization, in 2020, the number of people worldwide aged 60 years and older outnumbered children younger than five years old.
In the UK, there are over 11 million people aged 65 or older, and in 10 years this will have increased to 13 million people, or 22 per cent of the population. Due to this shift, an often-ignored health condition – especially in women – is gaining attention: osteoporosis and bone fractures.
Worldwide, osteoporosis causes more than 8.9 million fractures annually, which means there is an osteoporotic fracture somewhere in the world every three seconds.
It affects more than 200 million women worldwide, and it is estimated that 1 in 3 women over 50 will have an osteoporosis-related bone fracture at some point. Studies have shown that this is a significant cause of morbidity and mortality in women in this age group.
But why does bone health deteriorate as we age? There are special cells in our bones known as osteoblasts that form new bone tissue. At the other end of our skeleton’s lifecycle, there are cells known as osteoclasts, which dissolve old and damaged bone tissue so it can be replaced with new, healthier tissue.
A key factor in bone health is the ratio between the activity of these two types of cells. If the activity is balanced, then overall there won’t be any net change to bone tissue – the new replaces the old in equal measure.
Up until the age of 30, there is generally more osteoblast activity. This means that we are building more bone than we are losing. However, this doesn’t mean we’re forming additional bones in our bodies. Instead, our osteoblasts are building new bone tissue, remodelling existing bones and healing damaged ones by laying down the structure to be filled by bone matrix – the calcium, collagen and other substances that form the mass of our bones.
But when we hit 35, our bone quality and density begin to decrease as osteoclast activity starts to take over. This results in a small, approximately less than 1 per cent, loss of bone tissue each year.
However, this significantly increases in women post-menopause, when the level of oestrogen produced by the body has dramatically decreased. This is thought to result in a reduction in the number of osteoblasts and an increase in osteoclast lifespan so they remain active for longer.
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A condition called osteopaenia can arise when a certain level of bone density has been lost. And if this worsens where the density of bones is so reduced that the bones easily break, it can progress to osteoporosis.
Often, people will refer to this as ‘thinning bones’. In fact, it is the change in bone density, microarchitecture and quality that reduces bone strength.
Unfortunately, neither of these conditions show any signs or symptoms. Currently, osteoporosis is commonly diagnosed as an ‘incidental’ finding when a woman has already sustained a bone fracture, and the condition shows up in scans.
Not all women with osteopenia will go on to develop osteoporosis, although the risk is increased. Other risk factors for developing osteoporosis include smoking and health conditions such as thyroid disease and diabetes. Some medications – such as steroids – can also affect bone density.
Like all preventative measures, it is never too early to look after your bones. As ever with health and well-being, a significant way to protect your bones is by eating a well-balanced, varied and calcium-rich diet.
If you eat dairy – milk, eggs, cheese – you will likely get a sufficient dose. However, if you are vegan or don’t consume dairy you may need to take supplements to top calcium levels up.
But the calcium alone is an insufficient building block for the bone matrix – our bodies also need to produce vitamin D through safe sunlight exposure. However, most people living in countries with low levels of sunlight, such as the UK, have low levels of vitamin D and would benefit from taking a supplement.
Calcium and vitamin D may be the building blocks for healthy bone growth, but exercise, especially activity which puts ‘strain’ on the bones such as progressive resistance training, can prevent and delay the progression of osteoporosis by stimulating osteoblast activity.
This increases the rate of new bone formation, and changes bones’ microarchitecture, including the arrangement of collagen, all of which increases skeletal strength.
In addition, studies show that resistance training helps to build muscle strength and improves balance, so helps us to maintain a healthy posture and reduces the overall risk of falls and fractures.
However, it should be noted that post-menopause, the effectiveness of exercise in increasing bone minerals depends heavily on the adequate availability of calcium and vitamin D, so supplementation is strongly advised.
Additionally, there are also various types of medication available that can treat or delay the progression of osteoporosis. Oestrogen, taken as part of hormone replacement therapy, is the recommended treatment of choice for osteoporosis prevention in menopausal women, especially those with premature ovarian insufficiency.
While bone health can be an issue for many, with awareness and education, prevention and the correct treatments we can reduce it. This is sorely needed as we look into the future of an ageing population.