8 Tips to Prevent Bone Loss and Fractures

Losing bone density may be a part of normal aging, but osteoporosis and the bone fractures it can cause is certainly not. Knowing that you have osteoporosis following a bone fracture often means it's getting too late. But, osteoporosis is preventable, and you're never too young or too old to improve your bone health. Read on as Beijing United Family Hospital's (BJU's) Dietitian Jackie Gao shares with us the lifestyle measures to prevent what's so-called a "silent disease", osteoporosis.

Our bones are not forever strong as we think they are. Bone mass reaches their peak at about 30 years of age, after which they begin to lose steadily. Osteoporosis occurs when bone density decreases to the degree that is too thin and weak and leads to fractures. 

Osteoporosis happens more in women than men, and osteoporosis-related fractures can increase pain, disability, and mortality. Most women lose bone mass after menopause, partly due to a sharp drop in estrogen levels. It's recommended that all postmenopausal women aged over 50 years are evaluated for osteoporosis risk.

The good news is that osteoporosis and fractures are preventable. While we can't control our genetics, race, and age, we can be in reasonable control over lifestyle factors. Below are eight tips that can help prevent bone loss and fractures.

1. Ensure adequate calcium intake

About 99% of the calcium in our bodies is in our bones and teeth, and our bodies can't produce its calcium. Adequate calcium intake is essential for bone health, with no questions asked. What is enough, though? The table below shows the calcium intake recommended for each age group (including diet and calcium supplements).

Dietary sources of calcium are dairy products, including milk, yogurt, cheese, canned fish with bones, and calcium-fortified foods. For those who are lactose intolerant or don't consume sufficient dairy products, lactose-free milk, calcium-enriched foods (such as soy milk, oat milk, and rice milk), beans, and tofu are excellent alternative options. 

Whether you need calcium supplements depends on whether you can get adequate calcium from your diet. Also be aware that taking more calcium than you need does not provide any extra benefits and may cause harm to your kidneys. Existing evidence suggests that calcium intake (including diet and supplements) should not exceed 1500mg/day.

2. Ensure adequate vitamin D intake

Vitamin D enhances calcium absorption and helps with muscle performance, balance, and the risk of falling. You will need a blood test to evaluate whether you are vitamin D insufficient or deficient (serum 25(OH)D 20-29 or <20 ng/mL, respectively). If the vitamin D level is low, you are at a higher risk for osteoporosis and will mostly need a supplement.

The majority of vitamin D comes from the skin's reaction to sunlight and is available only in a few foods such as wild-caught mackerel, salmon, and tuna. Many scientific organizations recommend intake of at least 1,000 IU of vitamin D per day for adults aged 50 years and older. Follow the doctor's suggestions and avoid taking vitamin D above 4000 IU per day for most adults.

3. Avoid excessive vitamin A

Vitamin A intake above 10000 IU has been shown to have detrimental effects on bone. A common cause of excessive vitamin A is the consumption of supplements that is high in vitamin A. Thus, pay attention to the total amount of vitamin A that you consume from supplements to avoid over-consumption.

4. Limit caffeine intake

Caffeine intake affects calcium absorption and increases calcium loss in the urine. It's recommended that caffeinated drink does not exceed 1-2 servings (8-12 ounces or 240-360 ml per serving), and dairy products are not replaced. Coffee, tea, and soft drinks (e.g., sodas) contain caffeine. Choose these drinks in moderation.

5. Regularly perform weight-bearing and balance exercise

Studies have shown that bone mineral density in postmenopausal women can be maintained or increased with therapeutic use, namely weight-bearing and muscle-strengthening exercises. 

Weight-bearing exercise includes walking, jogging, tai chi, stair climbing, dancing, and other activities. Muscle-strengthening exercise includes weight training and other resistive movements. 

Exercise is not without risks, especially for people with osteoporosis. Thus, a medical evaluation is recommended before initiating an exercise regime. 

6. Avoid tobacco use

Cigarette smoking is a risk factor for many diseases, and osteoporotic bone fracture is one of them. Studies show a higher fracture risk in current smokers compared with previous smokers. All smokers should be advised to cease smoking, not only for the risk of osteoporosis but also for overall health.

7. Limit alcohol intake

Excessive alcohol intake has a negative effect on bone formation, predisposes falls, calcium deficiency, and chronic liver disease, which in turn predisposes to vitamin D deficiency. Postmenopausal women who are at risk for osteoporosis should avoid drinking more than three drinks daily (1 drink equivalent to 120ml of wine, 30ml of liquor, or 260ml of beer).

8. Prevent falls

Approximately one-third of people aged 65 years or older and roughly half of those aged 80 years or older fall each year. People who particularly vulnerable are individuals who are older or frail, have stroke history, or are on medications that decrease mental alertness or have cognitive impairment. 

Measures can be taken to avoid falls at home. These measures include:

•Anchor rugs or use non-skid mats

•Minimize clutter

•Remove loose wires

•Install handrails in bathrooms, halls, and along stairways

•Light up hallways, stairwells, and entrances

•Wear sturdy, low-heeled shoes

•Keep all items within reach

•Avoid using stepstools

•For those who are predisposed to falling, recommend hip protectors

References:

[1] Camacho P, et al. AACE/ACE Guidelines for the diagnosis and treatmentof postmenopausal osteoporosis – 2016. ENDOCRINE PRACTICE Vol 22 (Suppl 4) September 2016

[2] Cosman F, et al. Clinician' guide to prevention and treatment ofosteoporosis. Osteroporos Int (2014) 25:2359-2381

[3] Tu K, et al. Osteoporosis: A review of treatment options. P&T. February2018. Vol.43 No. 2

[4] https://www.nof.org/preventing-fractures/general-facts

[5[ https://www.iofbonehealth.org/facts-statistics

Jackie Gao is a Chinese-born, Australian-trained dietitian and nutritionist. To make an appointment with her, please call our service center at 4008-919191.