Bed rest leads to rapid loss of bone so it is best kept to a minimum if possible. If it is necessary to stay in bed for extended periods of time, physiotherapy and simple exercises will help reduce bone loss.
Drinking copious cups of coffee or strong tea during the day has been linked to osteoporosis. It is difficult to state a maximum level of intake, although a ceiling of two to four cups a day is generally recommended. Beware of caffeine in other products, particularly canned colas and some health drinks.
Diet lacking in calcium
Adequate amounts of calcium in the diet are essential to maintain bone strength. Women over the age of 40 need about 1,500 milligrams per day if they are not taking HRT. Women taking HRT have a lower requirement of 1,000 milligrams per day as the oestrogen itself helps strengthen bone. After the age of 60, daily requirements fall to 1,200 milligrams.
History of amenorrhoea
Amenorrhoea, when menstrual periods cease, is associated with insufficient oestrogen to maintain the normal menstrual cycle, leading to oestrogen deficiency. In primary amenorrhoea, the first menstrual period occurs several years later than the usual age of 13 but subsequent menstruation is normal. In other cases, secondary amenorrhoea, menstruation starts at the normal age, but then the periods stop. Anorexia nervosa, an increasingly common cause, leads to a marked loss of weight and altered body image.
Young gymnasts are also at risk from over-exercising. More recently, treatments for conditions such as endometriosis (when the womb lining is found in tissues outside the womb) stimulate a ‘medical menopause’ by switching off the ovarian production of oestrogen with a consequent drop in oestrogen levels. All these factors can increase the individual woman’s lifetime risks of oestrogen deficiency illnesses.
An overactive thyroid increases the resting metabolic rate, speeding up the normal process of bone formation and breakdown which can lead to osteoporosis. Hyperthyroidism also puts an extra burden on the heart, which beats faster and more forcefully.
Elderly women often stay indoors and get little sunlight on their skin. In certain cultures women are heavily covered in dark clothing and, particularly if they live in Europe, minimal daylight reaches their skin. Sunlight is very important because it stimulates the production of vitamin D in your skin. This vitamin aids the absorption of calcium from food, helping bones to stay strong. Only 15 to 30 minutes in daylight each day is necessary.
The more times you have been pregnant, the lower your risk of osteoporosis, because each pregnancy produces a surge in oestrogen. Women who have never been pregnant will not have had this oestrogen surge and their lifetime exposure to oestrogen will be lower, increasing long-term risks of osteoporosis.
Previous fractures can suggest existing osteoporosis, increasing your chances of further broken bones.
Women of black racial origin achieve a 10 per cent greater peak bone mass than white women, so white racial groups are more likely to develop osteoporosis.
Use of steroids
Prolonged use of oral steroids, over 5 milligrams each day, is linked to osteoporosis. Steroids are usually prescribed for conditions such as severe asthma or autoimmune diseases. In these conditions the body’s protective mechanisms are disrupted and normal tissue is seen as a foreign body which should be destroyed. Short-term courses of steroids, for one or two weeks, are not associated with increased risks unless frequently required.
If you are on long-term steroid therapy, speak to your doctor to discuss possible alternatives and ways in which you can prevent osteoporosis developing.