Osteoporosis and bone health

Exercise and Fitness

8 April 2020

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Last reviewed in April 2020 by Georgina Camfield, AXA Health Programme Lead Physiologist, Registered Associate Nutritionist (ANutr) and qualified fitness instructor.

There’s a lot we can do to build strong bones – including paying attention to diet, exercise and our lifestyle choices – and the earlier we start, the better.

Most of us tend not to think about bone health until we enter our 50s or 60s – or we start to creak! But it’s really important to start looking after our bones when we’re much younger. It may come as a surprise to know that you reach peak bone density in your mid to late twenties. After that, bone starts to decline. This is a natural part of the ageing process but for some the process is faster, leaving them at risk of developing osteoporosis. So the stronger your bones are at their peak – and the more you do to boost your bone health throughout your life time – the less likely you are to suffer from potentially debilitating problems later on.

Why is bone health important?

Jan Vickery, AXA Health's Head of Musculoskeletal Health explains: “Low bone density can lead to a higher risk of osteoporosis – a condition that results in particularly weak and porous bones that can break easily. These breaks are often referred to as fragility fractures. Osteoporosis develops slowly and usually goes undetected until a fracture following a relatively minor fall or impact prompts further investigation – usually in the form of a bone density (or DEXA) scan.”

“Fragility fractures can occur anywhere in the body but the most common injuries suffered by people with osteoporosis are fractures of the wrist, hip and spine. Spinal fractures can be difficult to diagnose, with the pain often being attributed to muscle damage. However they can be incapacitating, sometimes causing severe long term pain. They can also lead to height loss and stooped posture, when multiple fractures cause the spine to compress and eventually become unable to support the body in an upright position.”

“Although osteoporosis itself isn’t painful, the resulting fragility fractures can, cause both immediate and long term (chronic) pain, arthritis and restricted mobility.”

How common is osteoporosis?

Osteoporosis is very common condition in older adults, and women in particular. This is because the rate at which bone density declines rises sharply in the first 5 years or so after they enter menopause (from around 0.5% per year to as much as 3% each year.[1] Research suggests more than half of women over 50 and one in five men of the same age will sustain one or more fragility fractures in their lifetime.[2]

The good news is there are things you can start to do right now to keep your bones stronger for longer and reduce the risk of fractures in later life.

Steps to boost bone health and help prevent osteoporosis, at any age

Diet and bone health – what to eat for stronger, healthier bones

“Healthy bones need a well-balanced diet, incorporating minerals, vitamins and protein from a range of different food groups, including fruit and vegetables, carbohydrates, dairy products, meat, fish, eggs, pulses, nuts and seeds,” advises Georgina.

Government recommendations state that we should aim to consume 700mg of calcium a day to support good health. Calcium acts as the building blocks for bones, with 99% of the calcium in our bodies stored there. Our bodies constantly remove little bits of calcium and replace them with new calcium to remodel our bones, keeping them healthy. If we’re unable to replace the calcium removed from the bones they can slowly become weaker. Dairy products are the richest source of calcium, with milk, cheese and yoghurt all providing great options.

“Fear not if your dietary choices restrict your consumption of dairy products; there are plenty of other non-dairy based foods that can contribute towards your daily calcium intake. Including plenty of broccoli, kale, soy beans and fish (particularly sardines and salmon) in your diet will help keep your calcium stores topped up,” says Georgina.

Vitamin D is also essential for bone health[3], as low levels can lead to inadequate absorption of calcium from the foods that we eat. We absorb most of our vitamin D through the skin from sunlight. There are many factors that affect how much sunlight is enough to make sure we’re getting enough vitamin D, including our skin colour and clothing. However, getting out for a walk on your lunch break and exposing your face, hands and forearms to the sun – being sure to wear sufficient sun protection – should be enough to ensure adequate intake of vitamin D, particularly through the spring and summer months.  If you’re someone who works indoors away from natural light or works frequent night shifts, for example, you may need to increase your intake of dietary sources to maintain healthy vitamin D levels. Sources of vitamin D include tuna, mackerel, salmon, cheese, eggs and fortified dairy and cereals.

“While calcium and vitamin D remain the big guns in regard to bone health, there are other nutrients that have been shown to assist in maintaining healthy bones,” Georgina adds.

Magnesium: magnesium deficiency has been associated with an increased risk of osteoporosis.[4] While magnesium deficiency is rare in those with a healthy balanced diet, the body’s ability to absorb it decreases with age, so it’s worth topping up on magnesium rich foods as you get older. Sources of magnesium include green veg, legumes (peas, beans, lentils and peanuts), nuts, seeds and fish.

Zinc: important for bone tissue renewal and mineralisation.[5] Sources of zinc include red meat, poultry, cereals and pulses.

Phosphorus: calcium needs phosphorus to build strong bones and tissues.[6] While we need some, too much can also be a bad thing. Sources = dairy, nuts, seeds, beans, meats.

Fruit and veg: a higher intake of fruit and veg has been associated with a higher bone density.[7] The minerals and vitamins that they contain may influence bone health, particularly vitamin C which stimulates the production of bone forming cells. The antioxidants in fruit and veg may also protect these cells from damage.
Salt: some evidence suggests that a high intake of salt can increase the amount of calcium lost in urine[8] so if you’re at an increased risk of osteoporosis, it may be sensible to limit your intake of salt in future.

Dietary supplements for bone health

Some adults may be advised to take vitamin and mineral tablets for their bones if they have too little calcium in their diet or insufficient exposure to sunlight. We absorb minerals less efficiently as we get older and some older people may benefit from a dietary supplement. Patients on osteoporosis medication may be prescribed a calcium and vitamin D supplement. If you haven’t been prescribed supplements, they are readily available in pharmacies, supermarkets, health food shops and some online retailers. However you should always consult with your GP or other medical professional before you start taking any, to make sure you actually need them and that they won’t interfere with any medication you’re already taking.

Getting physical – exercise to keep bones stronger for longer

‘Use it or lose it’ is the message when it comes to improving or maintaining bone strength. Exercise is essential for building bone. It can also help us maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.

According to Arthritis Research UK’s State of Musculoskeletal Health 2018 report, regular physical activity can reduce your risk of hip fracture by up to half[9] and it’s never too early – or too late – to start.

Exercising later in life not only helps to increase bone density but also improves flexibility and stability, reducing the chances of a fall. Studies suggest that older people who walk outside every day for just 20 minutes, are less likely to suffer a fracture10. This is probably because their stability is much improved.

Bone-building for life

The best types of exercise for building and maintaining strong bones are weight bearing and muscle strengthening exercises[11,12]. A combined approach is usually recommended.

“Bone is a living tissue which reacts to increases in loads and forces by growing stronger,” says Georgina. “Short bursts of varied vigorous activity are most effective, but bear in mind that while any increase in physical activity has all kinds of benefits for your body and mind, not all types of exercise count when it comes to boosting bone strength. Swimming and cycling, for example, help build and maintain muscle strength and provide a great cardiovascular work-out, but they’re not the best way to improve bone health. Try to incorporate some of the activities suggested below into your weekly routine for the best results.”

Weight-bearing exercises – where you’re supporting the weight of your own body. These cover a wide range of activities, including brisk walking, jogging, hiking, aerobics, climbing stairs, skipping, tennis or dancing. So there’s something for everyone, regardless of age, agility or fitness level.

“A good way to boost your bones when you’re younger is simply jumping up and down on the spot or hopping,” says Georgina. “This provides a useful action on the hips and spine, as it’s the impact when your feet hit the ground that strengthens these bones.”

Muscle strengthening exercises – those that involve resistance or lifting weights – boost bone health due to the action of the tendons pulling on the bones. If the whole idea of weights is a little daunting, exercises as simple as lifting a tin of beans up and down while you’re watching TV
can help to strengthen your wrists – a common area for osteoporosis to cause broken bones.

Other muscle strengthening exercises to try include yoga, pilates and resistance training – using resistance bands or the machines found in gyms and increasingly in parks and other public spaces. Dancing and even gardening can also come into this category.

We would suggest talking to your GP to rule out osteoporosis or any physical issues that may limit your choice of activity. You may also want to look into a personal trainer to assess your ability.

For information, inspiration and motivation tips to get you started, visit our Exercise and fitness hub.

Other lifestyle factors to consider

Smoking has been shown to increase the risk of developing osteoporosis and the risk of bone fracture.[13] Smoking has also been shown to impair the bone healing process after a break, and women who smoke tend to enter menopause – itself a risk factor for osteoporosis – earlier than non-smokers. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, ‘the best thing smokers can do to protect their bones is to quit smoking; even those who stop later in life can help limit smoking-related bone loss.’ Of course there are a whole host of reasons to stop.

Excessive alcohol consumption can be detrimental to bone health both physiologically – by interfering with our calcium levels and the production of certain bone-protecting hormones – and by increasing our risk of a fall.[14] Even relatively small amounts make us more vulnerable to accidents and injury and as with smoking, a list of related health and other problems.

Effective medication for osteoporosis

A number of drugs are licensed for the treatment of osteoporosis in the UK. These include bisphosphonates, which slow bone breakdown; raloxifene and strontium ranelate, which improve bone density; and HRT, which replaces oestrogen lost after the menopause and makes bones less likely to break. As mentioned above, doctors may also prescribe calcium and vitamin D supplements if appropriate.

Are you at risk?

Many factors influence whether you are likely to develop osteoporosis. You are more at risk if you:

  • are female
  • have had irregular periods, an early menopause or a hysterectomy before 45
  • have a family history of osteoporosis or fractures
  • are of European or Asian descent
  • are over 60
  • have suffered from an eating disorder or are underweight
  • have a calorie-restricted diet –  low calorie diets (<1000kcal) have been linked with loss of bone density even when combined with exercise[15]
  • have taken long-term steroid medication
  • drink to excess
  • smoke
  • have a medical condition that affects food absorption such as Crohn’s disease or coeliac disease
  • are a man with low levels of testosterone
  • have reduced mobility
  • are pregnant.

If you have three or more of the risk factors above – particularly if you are post-menopausal – or if you have suffered a fracture after a minor fall, it's a good idea to talk to your GP about having a scan to measure your bone mineral density and assess whether you have osteoporosis or are at increased risk of developing it.


1. Know your back, North American Spine Society
2. van Staa TP, Dennison EM, Leufkens HG, Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29:517–522. doi: 10.1016/S8756-3282(01)00614-7. [PubMed]
3. Laird, E., Ward, M., McSorley, E., Strain, J. J. & Wallace, J. (2010) Vitamin D and bone health; potential mechanisms. Nutrients. 2; 693-724
4. Castiglioni, S., Cazzaniga, A., Albisetti, W. & Maier, J. A. M. (2013) Magnesium and osteoporosis: current state of knowledge and future research directions. Nutrients. 5; 3022-3033
5. Yamaguchi, M. (2010). Role of nutritional zinc in the prevention of osteoperosis. Molecular Cell Biochemistry. 338; 241-254
6. Penido, M. G. M. G., & Alon, U. S. (2012) Phosphate homeostasis and its role in bone health. Pediatric Nephrology.27; 2039-2048
7. McGartland, C. P., Robson, P. J., Murray, L. J., Cran, G. W., Savage, M. J., Watkin, D. C., Rooney, M. M. & Boreham, C. A. (2004) Fruit and vegetable consumption and bone mineral density: the Northern Ireland young heart project. The American Journal of Clinical Nutrition. 80; 1019-1023
8. Heaney, R. P. (2006) Role of dietary sodium in Osteporosis. Journal of the American College of Nutrition. 25; 271-276
9. State of Musculoskeletal Health 2018, Arthritis Research UK
10. Stattin, K., Michaelsson, K.,  Larsson, S. C., Wolk, A. & Byberg, L. (2017) Leisure-time physical activity and risk of fracture: a cohort Study of 66,940 men and women. Journal of Bone and Mineral Research. 32; 1599-1606
11. Exercise your bone health
12. Hong, A. R. & Kin, S. W. (.2018) Effects of resistance exercise on bone health. Endocrinology Metabolism. 33; 435-444
13. Smoking and Bone Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases
14. What People Recovering From Alcoholism Need To Know About Osteoporosis, National Institute of Arthritis and Musculoskeletal and Skin Diseases
15. Redman, L. M., Rood, J., Anton, S. D., Champagne, C., Smith, S. R. & Ravussin, E. (2009) Calorie restriction and bone health in young overweight individuals. Archives of Internal Medicine. 168; 1859-1866

Sources and further reading

Osteoperosis – NHS factsheet
Vitamins and minerals – NHS factsheet
How to reduce your salt intake – AXA Health
National Osteoporosis Society – 0808 800 0035

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