Known as the ‘silent disease’, it’s going on in a skeleton near you. Yes, your own skeleton! Even those of us who think we’re breezing through menopause without any obvious symptoms need to be aware of the risks, otherwise we face a brittle future of fractures and falls.
 “Dem Dry Bones” we sang about back in junior school are clattering towards us. The sneaky, sapping of bone strength and density isn’t something that we see, or feel until there’s a problem.

Bone building goes on until our early thirties and oestrogen plays a major role in supporting and maintaining this development. That means our risk of developing osteoporosis (fragile bones that break relatively easily after a simple fall) increases as oestrogen levels drop. Factor in age, genetics, low body weight, underlying health conditions and race (black women are at lower risk than white or Asian women due to the size and strength of their bones) and yep, menopause leaves bones high and dry. Around 1 in 3 women will develop osteoporosis, with 40% going on to experience a fracture. Our 21st century diets, and sedentary lifestyles don’t help either. And the good news is…. Whilst the odds are stacked against us with the hormone hand we’ve been dealt, there are a number of diet and lifestyle changes we can make to help improve bone health. 

The best ways to prevent osteoporosis You can’t change the fact that you’re a perimenopausal or menopausal woman! But you can get clued up on how to strengthen bones, be more flexible and prevent fractures. 

Lifestyle & wellbeing to help with osteoporosis 

Regular weight bearing and muscle strengthening exercises Those who exercise are more likely to retain calcium in their bones than those who don’t. Think about the regularity and type of exercise you do to guarantee that your bones, joints and muscles get maximum benefit. 
Weight-bearing exercises where feet and legs take the weight of your upper body, are especially good for improving bone density, key for preventing osteoporosis. So try skipping, running, fast walking and dancing. NHS Choices say that 150 minutes of ‘moderate-intensity aerobic activity, such as cycling or fast walking, every week’ should do the trick. 
Strengthening muscles is as important as building bone, some exercises can be carried out when you’re sitting at home or at your desk. Try some push-ups, squats, wall press ups and arm weight work, using tins of food or invest in arm or leg weights to make your body work harder. 
Keep a healthy body weight Being over or underweight can increase the risk of osteoporosis. Check your BMI. Lots of tools online to do this by using your height and weight to calculate your BMI. Normal range is between 18.5 and 24.9. 
Enjoy the sun Our bodies get 90% of vitamin D from the sun’s UVB rays acting on our skin. Fifteen minutes’ daily exposure to the sun for short periods from April to October, without sunscreen, should make enough vitamin D for most people. However, we live in a cloudy, grey country, with little sunshine in the winter months meaning that most of us will be deficient in Vitamin D. Public Health England recommends that we take a daily 10mcg vitamin D supplement in the grey, sunless months. Try a spray it absorbs into the bloodstream faster.

What to eat to help with osteoporosis

Eat it to beat it! 
Up your intake of the following nutrients for optimal bone health. The National Osteoporosis Society (NOS) recommend healthy eating for strong bones: 
Calcium*: get plenty into your body and keep it there, (calcium can be leached by eating and drinking certain things) for the best chance of healthy bones. Calcium to be found in: 
All dairy products, especially yogurt according to a study in Osteoporosis International 2017. A small matchbox portion of cheddar provides 40 per cent of your daily calcium. Or if lactose intolerant, soy based milk products fortified with calcium. 
Dark, leafy greens; broccoli, sprouts, kale, pak choi, edamame beans being a fantastic source of calcium 
Beans: chick peas, soya, cannellini and pinto beans (soak dried beans in water to draw out phytates which block calcium absorption) 
Nuts: almonds, peanuts, cashews, pine nuts. 
Seeds: sesame seeds and tahini 
Fish: sardines, pilchards and tinned salmon, with the bones please! 
*Parents take note: build up your daughters’ ‘bone bank’ during her teenage years, to help prevent osteoporosis in later life. Our girls need the same calcium rich diet as you, as they go through adolescence. 
Vitamin D: is essential as calcium can only be used effectively by your body if you are getting enough vitamin D. The best source is sunshine. In winter months, or sunless summers, we can get additional Vitamin D from our diet by eating: 
Oily fish, such as salmon, sardines and mackerel, according to findings published in the American Journal of Clinical Nutrition 2017 help to prevent going through menopause before the age of 45, therefore beneficial in the prevention of osteoporosis. 
Eggs, fortified fat spreads and fortified breakfast cereals. 
Apart from calcium and vitamins we need a range of minerals for bone health. 
Magnesium: Helps calcium and vitamin D absorption. Eat more: seeds, bananas, dried fruit, avocados, wholegrain bread, brown rice, tap water (hard water more than soft). 
Boron: May affect how minerals are used in our body and reduces mineral loss in urine. Eat more: green vegetables, avocados, potatoes, eggs, milk and according to the NOS - wine! 
Copper*: Not getting enough may reduce bone strength as it effects the formation and mineralisation of collagen. Eat more: nuts, seeds, fruit, beans, sunflower oil, mushrooms and shellfish. 
Potassium: can reduce the loss of calcium in our urine as it has an alkaline influence on our diet. Eat more: bananas, orange juice, milk, pulses, fish and shellfish, beef, chicken and turkey. 
Zinc*: Is necessary for bone building, mineralisation and growth. Eat more: Brazil and pecan nuts, eggs, cheese, yogurts, shellfish and a limited amount of red meat 
*According to the NOS “some studies have shown that high intakes of copper and zinc using supplements may increase bone loss and having too much of one can affect the work of the other. You can get the right amounts of copper and zinc by having a healthy, varied and balanced diet.” 
High fibre diet: A 2018 publication of the American Council on Science and Health, reported that a study on mice showed that a high fibre diet may be more effective than vitamin D in the prevention of osteoporosis. Dr. Mario M. Zaiss from Universitätsklinikum Erlangen, Erlangen, Germany reported that a high fibre diet is valuable in supporting healthy bones.  
Beans; all beans from baked beans, kidney beans, black beans. 
Wholegrain and wholemeal; skip white bread and pastas, it's wholemeal from now on. 
Brown or wholegrain rice, white rice has less fibre. 
Pulses; lentils, chickpeas, as well as beans, they are also high in protein and low in fat. 
Porridge; oats are a perfect start for the day, blitz them in a smoothy if you don't like porridge. 
Nuts; walnut, almonds and pecan nuts have more fibre than other nuts. 
Greens; especially brussels sprouts and broccoli, also artichokes and avocado. 
Fruit; raspberries and blackberries are high fibre, plus dried fruit, especially figs and apricots.

What to avoid to help with osteoporosis  

Cut out known bone loss triggers What we take away from our diet, is just as important as what we add, to improve bone health. Time to remove or reduce: 
Cigarettes: Smokers are at increased risk of fractures as they have weaker bones. 
Alcohol: Yet another reason to go easy on the booze! Heavy consumption contributes to low bone mass and decreases bone formation. Alcohol appears to slow down healing after a fracture and let’s face it if it is consumed in excessive amounts can cause unsteadiness leading to falls! Over two units a day increases your risk. 
Fizzy drinks: A high intake of sugary fizzy drinks may cause bone loss through increased amounts of phosphoric acid. NOS says “there is no clear evidence proving a detrimental effect of fizzy drinks on bone health” but you could moderate your intake and think about including more nutritious drinks, milk or yogurt based smoothies or simply water if you are thirsty. 
Red Meat: Cut down on red and processed meats. A study published in Advances in Nutrition in January 2017 reported that reducing your intake may have a positive impact on bone health. Too much protein causes the body to produce sulphates, causing bones to lose calcium. However, it is not necessary to illuminate it altogether as red meat contains bone building zinc. 
Caffeine: According to the NOS: there is some evidence to suggest that more than several cups of coffee a day, maybe as many as eight, may cause a slight imbalance between calcium intake and calcium loss from the body. The effect is only modest. But, if you already have other risk factors for osteoporosis, you may want to consider limiting your intake of caffeine. Interestingly, studies suggest that tea does not have the same effect. 
Processed sugars: There is no proven link between sugar and bone health, yet over consumption may prevent calcium absorption. Satisfy your sweet tooth with fruits rich in antioxidants, which are healthy nutrients that support bone health. 
Excess Salt and Processed Foods: Calcium from bones goes into the bloodstream, into the kidneys and down the toilet. The more salt you eat; the more calcium is lost to the kidneys. Cut out salt and monitor sodium levels in processed foods via the traffic light system on packaging.

Supplements worth trying for osteoporosis  

Vitamin D on its own, or in a multi-vitamin helps calcium absorption. Research says that oral vitamin D sprays outperform tablets, delivering straight to the bloodstream. 
Magnesium* supplements help vitamin D and calcium absorption. 
Consider a formulation that combines calcium and magnesium for bones and teeth. 
Red clover as a fermented red clover extract, could be a natural replacement to oestrogen, according to a 2017 Danish study, to treat osteoporosis.  
*Note: magnesium supplements may cause diarrhoea - if you have kidney or heart issues check with your doctor first. For most of us a healthy, balanced diet is the best route for getting enough magnesium. 

When to see your doctor about osteoporosis  

If you have a history of maternal osteoporosis in your family, ask your doctor about a bone density scan to confirm whether you have developed osteopenia, the precursor to osteoporosis, it’s diagnosed when bone density is low but not low enough to be osteoporosis. Women who have an early menopause (before age 45), also face a higher risk of low bone density in later life. So if that’s you, it’s important to have a bone density test within 10 years of going through menopause. 
If your doctor suspects you have osteoporosis, they can make an assessment using an online programme, such as FRAX or Q-Fracture. 
These tools help to predict a person's risk of fracture between the ages of 40 and 90 to give a 10-year probability of hip fracture and a 10-year probability of a major fracture in the spine, hip, shoulder or forearm. 
You’re doctor may be able to send you for a gold-standard DEXA scan but, anecdotally, we’ve heard they’re hard to get. 
There are medications options for treating osteoporosis. NICE guidelines offer two different treatment pathways for post menopause women following a diagnosis of osteoporosis who have or haven’t had a fracture. Talk to your doctor about what is best for you. Also check the National Osteoporosis Society for detailed information. 

And then there’s always HRT…. 
HRT may be recommended where there is a family history of osteoporosis, known risk factors or where women have experienced early menopause. It is thought that HRT may decrease the likelihood of fractures. The usual caveat here, that this is something to be discussed with your doctor. There are pros and cons to taking HRT. We don’t take a view. It’s for you to decide whether it’s for you or not. 

And we can help 
Your Fbl Team x