6 Steps to Protect Bone Health

Rheumatologist from global health system Cleveland Clinic shares lifestyle strategies for all ages to aid in prevention and treatment of bone loss

It is never too early or too late to implement measures to prevent or slow down osteoporosis, says an expert from global health system Cleveland Clinic, speaking ahead of World Osteoporosis Day (20 October), which this year focuses on bone health and fracture prevention awareness.

Osteoporosis is a disease that weakens bones and puts them at greater risk for sudden and unexpected fractures. According to the International Osteoporosis Foundation, it is the most common bone disease, affecting one in three women and one in five men over the age of 50 worldwide.

Sarah Keller M.D., a rheumatologist at Cleveland Clinic’s Rheumatologic and Immunologic Disease department, says the disease often develops without any symptoms or pain, and usually is not discovered until the weakened bones cause painful fractures, often of the hip, wrist or spine.

Dr. Keller, who specializes in osteoporosis, says there are six steps individuals can take to protect their bone health.

1. Exercise regularly

Exercise is important in both prevention and treatment of osteoporosis, Dr. Keller says. She cautions, however, that individuals diagnosed with osteoporosis should speak to their healthcare provider or a physiotherapist before embarking on an exercise program as some activities, such as horse-riding or certain yoga positions, might need to be avoided to protect the spine. “I always advise patients to listen to their body and ‘start low and go slow’ to avoid the risk of injury,” she says.

For healthy individuals to build or maintain bone density, Dr. Keller recommends weight-bearing exercise, whether low-impact such as walking, or high-impact such as jogging. In addition, she says activities such as yoga or Pilates, or just safely practicing standing on one leg, are great for balance, which is important to avoid falls that can cause fractures.

2. Eat a nutritious diet

Diet is another lifestyle factor that plays a role in both prevention and treatment of osteoporosis, Dr. Keller says. She recommends that in addition to following a healthy eating plan such as the Mediterranean diet, individuals focus on ensuring they are getting sufficient calcium and vitamin D.

“There are many calcium calculators available online that can help people keep track of their calcium intake,” says Dr. Keller. “Getting these nutrients through natural sources such as food – and safe sun exposure in the case of vitamin D – is preferable, but if this is not possible, a healthcare provider will recommend supplements.”

3. Avoid high-risk habits

“Nicotine slows the production of bone-forming cells and decreases the absorption of calcium from diet, so I advise everyone not to smoke,” says Dr. Keller. In addition, excessive caffeine and alcohol consumption are associated with low bone density and should therefore also be avoided or limited. 

4. Know your personal risk factors

Some diseases and medications put individuals at greater risk for osteoporosis, so they should be extra vigilant, says Dr. Keller. Examples include people with type 1 diabetes, inflammatory bowel disease, some lung diseases, rheumatoid arthritis and those who have had bariatric surgery, as well as people taking medications such as glucocorticoids such as prednisone. In addition, menopause puts women at higher risk of osteoporosis as rapid bone loss occurs in the 5-10 years following menopause. Family history also plays a significant role; an individual’s risk of osteoporotic facture can increase if either parent had a hip fracture.

5. Ask your physician about screening

Bone density screening is usually done with a simple dual-energy X-ray absorptiometry (DXA) scan, and a physician will be able to advise when this should be done, says Dr. Keller. Screening guidelines differ between countries and health organizations, but as an indication, the U.S. National Osteoporosis Foundation and the International Society for Clinical Densitometry advise women to be screened from the age of 65 and men from the age of 70. Dr. Keller points out that higher-risk individuals should be screened earlier. Individuals whose results indicate osteoporosis or osteopenia should have follow-up DXA scans done every two years.

6. Take medication if needed

“Fortunately, there are many safe and effective medications to help build bone and to prevent the fractures caused by osteoporosis,” says Dr. Keller. “A course of anabolic agents is very effective in building bones in severe cases of osteoporosis or in those with fractures. Antiresorptive medications help prevent fractures.”

Dr. Keller says the focus in treating patients with osteoporosis is fracture prevention. So, in addition to calcium and vitamin D optimization as well as osteoporosis therapy if needed, it is important for patients to check their homes and eliminate any potential hazards. This includes measures such as ensuring adequate lighting, getting rid of loose rugs, wires or slippery surfaces, clearly demarcating steps, and installing grab rails if needed, particularly in bathrooms and kitchens.

“Following these six steps is important as spine and hip fractures can be life-altering. They often cause chronic pain and disability, and can lead to a shortened life span due to complications that can occur after the fracture,” concludes Dr. Keller.