What is osteoporosis and what affects bone density?

What are the symptoms of osteoporosis?

Unlike most health conditions osteoporosis is silent and painless unless you experience a fracture, consequently you may not realise you have the condition. However, there are some warning signs that may suggest you might be at risk, for example:

If, over time, you have lost an inch or more in height

• You find yourself stooping or bending forward, more often
• You have lower back pain, possibly caused by a broken or collapsed bone in the spine
• You experience shortness of breath, because changes in posture mean you have less room for your lungs to fully expand.

How do we lose bone?

There are two types of bone cells that grow and maintain our bone. Osteoblasts are the cells that build new, and heal existing bone, whereas osteoclasts are bone-resorbing cells, they break down bone to initiate normal bone remodelling. After the age of about 35 years, the difference between the amount of bone that is removed by osteoclasts and the amount of bone that is laid down by osteoblasts starts to get slightly out of balance.

As a result, the total amount of bone tissue starts to decrease. This is often described as ‘bone loss’ or ‘bone thinning’. It doesn’t mean your bones look any different from the outside. However, inside, the cortical ‘shell’ thins and the struts that make up the inner structure become thinner and sometimes break down. This results in the holes in the honeycomb structure of your bone becoming larger – hence the word ‘osteoporosis’, literally meaning ‘porous bone’.

This change in the quality of your bones is much more likely and more significant as you move into later life, which explains why bones become more fragile and fractures become more common as we enter our senior years.

Who is more at risk of osteoporosis?

Many factors increase your risk of osteoporosis and broken bones, these include:

• Your genes: Bone health is dependent on inherited genes from our parents.
• Age: As we get older, the natural aging process means our bones become more fragile and are more likely to break.
• Race: People who are of Caucasian or Asian origin are more at risk than those of Afro-Caribbean origin.
• Gender: Women are at greater risk than men because they have smaller bones and experience a higher rate of bone loss around the time of the menopause.
• Low body weight: If you have a low BMI (body mass weight index) below 19kg/m2 you are at greater risk of developing osteoporosis and fractures.
• Smoking: Current smokers are more likely to break bones.
• Alcohol: Excessive alcohol consumption appears to be a significant risk factor for osteoporosis and fractures.
• Some medical conditions: These include rheumatoid arthritis, low levels of oestrogen in women (e.g. due to anorexia, excessive exercise or hysterectomy, as well as early menopause), low levels of testosterone in men, thyroid conditions, digestive issues that affect the absorption of food such as Crohn’s or coeliac disease and conditions that cause long periods of immobility such as stroke.
• Some medicines may also increase your risk. You can find out more by visiting the ROS website or by asking your GP.

When are the crucial times for bone formation?

It is vitally important to maximise bone strength during childhood, adolescence and early adulthood, when your skeleton is still growing. ‘Banking’ plenty of bone in these formative years puts the skeleton in a stronger position to withstand the bone loss that occurs with advancing age. Most people are thought to reach their peak bone mass between the ages of 20 and 25, depending on their gender.

Children can build strong bones by getting plenty of weight-bearing play and activity and eating a well-balanced, calcium-rich diet.

Which dietary factors can affect bone health?

Although getting enough calcium is important, it is not the only nutrient we need to consider. A healthy, balanced diet is essential to provide all the vitamins, minerals and other nutrients that your bones need. People should aim to eat meals that incorporate a wide variety of foods from the four main food groups, including fruit and vegetables; carbohydrates like bread, potatoes, pasta and cereals; dairy and fortified plant-based alternatives; beans, pulses, fish, eggs, meat and other proteins.

1. Calcium

Calcium is vital for strong teeth and bones because it gives them strength and rigidity, but we also need it to help our muscles, heart and nerves work properly too. Most people should be able to get enough calcium through a varied and balanced diet. However, if you don’t achieve adequate amounts your body will draw calcium from your bones, and over time this will make your bones weaker.

Read our guide on the best calcium-rich foods.

If you are advised by your GP or healthcare practitioner to supplement, check out our review of the best calcium supplements.

2. Vitamin D

Vitamin D helps the body absorb calcium and keeps muscles strong, which helps prevent falls in older people. You can get vitamin D through sunlight exposure, from certain foods or from dietary supplements. Try to get short periods (about 10 minutes) of sun exposure to your bare skin, once or twice a day, between late March and the end of September (but take care not to burn). In the UK, in addition to sensible sunlight exposure, everyone over 4years of age are advised to consider a supplement providing10 micrograms of vitamin D every day, during the autumn and winter months.

Talk to your doctor if you are concerned that you aren’t getting enough vitamin D or if you are considering taking a supplement.

Check out our review of the best vitamin D supplements.

3. Vitamin K

Vitamin K works synergistically with vitamin D to support bone density by regulating your use of calcium, so it is important for strong, healthy bones. The good news is, most of us get all we need either through eating a varied, balanced diet, or from the production of vitamin K2 in our gut – in fact, a healthy gut microbiome produces enough vitamin K to cover all your daily needs.

4. Protein

Adequate protein from lean meat, fish, dairy, nuts, seeds, beans and pulses is important to optimise bone mass as we grow but it is also key to preserving bone strength as we age. Studies suggest more than half of older adults don’t eat enough protein to remain healthy. If this sounds familiar look to increase your protein intake, especially in the morning, when we tend to eat more carb-based foods.

Check out our high-protein breakfast recipes.

5. Alcohol

Excessive alcohol consumption appears to be a significant risk factor for osteoporosis and fractures. If you are older, even minor alcohol intoxication is associated with an increase in falls, which can result in fractures. Long-term alcohol consumption may also interfere with bone growth and remodelling and result in weaker bone density.

Try not to exceed the government’s guidelines of no more than 14 units of alcohol in a week, spread over at least three or four days, making sure you also have alcohol free days.

For more practical tips check out our guide on how to drink responsibly.

Read more about dietary ‘do’s and don’ts’ for your bones.

Which lifestyle factors can affect bone health?

1. Exercise

Exercise is important for bone health as it helps your skeleton to grow stronger. Weight-bearing exercise is particularly helpful and includes physical activity where you are supporting the weight of your own body. Walking is the most common weight-bearing activity that we most of us do every day, and as a result, regardless of our age, it increases bone strength. Other examples include jogging, yoga, tennis and dancing. Staying active as you age through activities like swimming, gardening, golf and Tai Chi may help improve muscle strength, balance and co-ordination, all of which can reduce the risk of a fall.

People who have been diagnosed with osteoporosis may need to be careful of high-impact exercise and certain stretches. Your doctor will be able to advise you if this is the case.

2. Smoking

Smoking is well known to have an adverse effect on general health and has been shown to slow down the work of the bone-building cells, osteoblasts. Smoking may also result in an earlier menopause in women and increase your risk of a broken hip later in life. The good news is that fracture risk is reduced in those who give up smoking.

3. Body weight

Aim to maintain a healthy body weight, as being underweight or overweight can increase the risk of osteoporosis and fractures. Talk to your doctor if you are concerned about your weight.

Even after menopause, women who are a healthy weight can continue to produce small amounts of bone-protecting oestrogen in the fatty layers under the skin. Ensuring that you aren’t too thin also helps to provide some protection to the bones in the form of ‘padding’ should you fall. However, being overweight isn’t helpful to bones either – it increases your fracture risk as well as your risk of developing many other medical conditions.

4. Certain medications

A number of prescribed medications may affect bone density, these may include anticoagulants, steroids, thyroid hormone and others. Long term use of these medications may weaken bones, increasing your risk of osteoporosis. It is important to remember that all medicines offer benefits and possible side effects so if this is relevant to you speak to your doctor for advice and guidance, never stop taking your medication without seeking the advice of your doctor.

What is a bone density scan (DXA)?

A bone density scan, using a densitometry X-ray (DXA), measures how much ‘bone mineral’ is in the area being measured – usually, one hip and the lower part of your spine. Research has shown that the lower your bone density is, the greater your risk of having a fracture.

Find out more about DXA.

What is osteopenia?

The DXA scan results are commonly given as a ‘standard deviation’ (SD) – the number of units above or below an average. If your bone density is 2.5 SD below average, this is described as ‘osteoporosis’. If your bone density is between the lower end of the normal range and the ‘osteoporosis’ range, you are said to have ‘osteopenia’. This means the protein and mineral content of your bone is reduced but not as severely as that seen in someone with osteoporosis. Being diagnosed with osteopenia means there is a greater risk, that as time passes, you may develop osteoporosis.

So, what’s most important when it comes to bone health?

Make the lifestyle changes described above, including exercising and staying active, enjoy a healthy, balanced diet with enough calcium, vitamin D and protein, getting enough sunlight exposure to top up vitamin D levels, stop smoking and avoid excessive alcohol intake.

You can find out more about risk factors on the ROS website. Talk to your doctor if you are concerned or have further questions.

Now read…

The best calcium-rich foods
Am I at risk of calcium deficiency?
Am I getting enough vitamin D?
10 health benefits of walking
How much protein do I need?

This article was reviewed on 18 January 2025 by Kerry Torrens.

The information was supplied by Sarah Leyland, Osteoporosis Nurse Consultant at the Royal Osteoporosis Society in collaboration with the ROS’s expert clinical and scientific advisors. It has been reviewed by Professor Susan Lanham New, Professor of Nutrition at the University of Surrey.

The Royal Osteoporosis Society are a UK-wide charity dedicated to ending the pain and suffering caused by osteoporosis. You can find out more information by visiting their website.

All health content on goodfood.com is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other healthcare professional. If you have any concerns about your general health, you should contact your local healthcare provider. See our website terms and conditions for more information.