Osteoporosis is a condition that occurs when the creation of new bone does not keep up with the loss of old bone. As a result, certain bones will become brittle, in a way that even a mild fall can cause hip, wrist or spinal fractures as one grows older.

Risk factors for osteoporosis include being of Caucasian or Asian ethnicity, especially older women with smaller body frames who are past early menopause, prolonged use of corticosteroids or a family history of hip fractures.

The presence of coeliac disease, inflammatory bowel disease, kidney or liver diseases, cancer, lupus, multiple myeloma, rheumatoid arthritis, as well as thyroid, parathyroid, adrenal or sex hormones imbalances have also been linked to an increased risk of developing osteoporosis.

A low dietary calcium intake, a sedentary lifestyle, eating disorders resulting in being severely underweight, along with an excessive alcohol and tobacco use may also contribute to a diminished bone density.

There are usually no warning symptoms in the early stages of decreased bone density. But once osteoporosis develops, one might experience any of the following symptoms, including back pain, loss of height over time, a hunched posture as well as the presence of compression or stress fractures that occur more easily than expected.

Osteoporosis can be diagnosed from a simple and painless bone density (DEXA) scan, which uses low-radiation X-rays to measure the level of bone density in the hip and spine respectively.

Prevention

The recommended daily intake of calcium is around 1200mg a day, which equals two to three portions of dairy, or the equivalent. Here are a few examples of one portion of calcium rich foods: one cup of milk or yoghurt, or fortified plant-based milk or yoghurt; 45g of cheese; half a cup of ricotta, or tofu prepared with calcium; 225g of frozen collard greens; frozen kale; or edamame.

There are other foods, such as oranges, dried fruit, nuts (especially almonds) and broccoli that contain smaller amounts of calcium, but when one tracks the total daily amount of calcium, it adds up quickly.

In order to maintain healthy bones, one should spend time outdoors

When it comes to bone strength, fruit consumption seems to impart a greater benefit than vegetables, so including fruit in the diet is a way of increasing bone strength and preventing osteoporosis. The mechanism may involve the interplay between phytonutrients, prebiotics and probiotics as well as the immune and inflammatory responses in the body.

Weight-bearing exercise is an often overlooked and a major contributor to bone health. Regular exercise, in fact, significantly reduces the risk of developing vertebral fractures.

In order to maintain healthy bones, one should spend time outdoors to obtain vitamin D by exposing the skin to sunlight for short amounts of time each day. If one’s vitamin D levels are consistently low despite adequate intake (from oily fish, red meat or egg yolk), and sunlight exposure, supplementation may be necessary.

Conventional treatment

Prevention is always better than cure, but if one is found to have osteoporosis and has a high risk of suffering from a fracture as a result of the condition, one of the following treatments may be recommended to help slow down or reverse the process. These include:

• Bisphosphonates: which act by binding to areas of active bone degeneration and decreasing osteoclast, bone breakdown cells’ activity.

• Monoclonal antibodies: which act by limiting the activity of osteoclasts, therefore helping to increase bone mass and strength.

• Hormone replacement therapy: in women, this supplies the body with oestrogen, one of the hormones that are essential for maintaining bone strength. There may also be a role for testosterone replacement in men to treat osteoporosis.

If the above conventional osteoporosis treatments are ineffective or bear side effects, there are other treatment modalities available, such as bone-building medications.

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Georgiana Farrugia Bonnici is a medical doctor and Antonella Grima is a functional medicine doctor specialised in public health as well as a registered nutritionist.