Osteoporosis — the loss of bone density and quality that makes bones fragile and prone to fracture — affects approximately 3.5 million people in the UK, causing over 500,000 fragility fractures every year. It is largely a silent condition until a fracture occurs, which is why prevention matters so much. The good news is that the lifestyle choices that protect bone health are well-established.
How Bone Loss Happens
Bone is a living tissue in constant remodelling — osteoblasts build new bone while osteoclasts resorb old bone. Peak bone mass is reached in the late 20s. After that, the balance gradually shifts toward net bone loss. In women, oestrogen withdrawal at menopause dramatically accelerates this loss for approximately 5–10 years. In men, gradual testosterone decline produces a slower but significant loss from the 50s onwards. By age 75, the average person has lost approximately 35% of peak bone mass. Lifestyle factors — diet, exercise, and certain medications — determine how much of this loss is preventable.
Risk Factors to Know
Non-modifiable: female sex (women have lower peak bone mass and greater menopausal loss), advancing age, family history of osteoporosis, small frame, early menopause (before 45). Modifiable: calcium deficiency, vitamin D deficiency, physical inactivity (particularly lack of weight-bearing and resistance exercise), smoking, excessive alcohol, low body weight, prolonged corticosteroid use (prednisolone is the most significant medication risk — cumulative doses above 7.5mg/day for over 3 months warrant bone protection consideration).
The Two Non-Negotiables: Calcium and Vitamin D
Calcium is the primary mineral component of bone. Adults need 700mg/day; postmenopausal women and men over 55 benefit from 1000–1200mg. Dietary sources: dairy (a 200ml glass of milk provides approximately 240mg), calcium-set tofu, canned sardines and salmon (eaten with bones), fortified plant milks, leafy greens (kale, pak choi). Calcium supplements (carbonate with food; citrate on an empty stomach or in those with low stomach acid) are appropriate when dietary intake is consistently insufficient. Vitamin D is essential for calcium absorption from the gut — without adequate D3, even high calcium intake is poorly utilised. The NHS recommends 10mcg (400IU) daily for all UK adults from October to April; 25–50mcg for those at higher risk. Deficiency is near-universal in the UK by late winter.
Exercise: The Most Powerful Bone-Builder
Bone responds to mechanical loading — the stress of weight-bearing and impact exercise stimulates osteoblast activity. Weight-bearing impact exercise (walking, jogging, aerobics, dancing, tennis) is the most effective for hip and spine bone density. Resistance training (weights, resistance bands, bodyweight) builds bone density specifically at the muscle attachment sites being loaded, and also builds the muscle strength that prevents falls. Swimming and cycling, though excellent for cardiovascular health, provide minimal bone-loading benefit. The goal is ≥150 minutes/week weight-bearing activity plus ≥2 resistance sessions. Even starting in your 60s produces meaningful bone density improvements.
Frequently Asked Questions About Osteoporosis
How is osteoporosis diagnosed?
A DEXA (dual-energy X-ray absorptiometry) scan measures bone mineral density and expresses it as a T-score — the number of standard deviations below peak young adult bone density. T-score above -1: normal. -1 to -2.5: osteopenia (reduced bone density, elevated fracture risk). Below -2.5: osteoporosis. The FRAX tool (frax.shef.ac.uk — developed at Sheffield) calculates 10-year fracture probability from clinical risk factors and DEXA results and guides treatment decisions.
Who should have a DEXA scan?
Your GP can refer for DEXA: women over 65 with risk factors; postmenopausal women under 65 with additional risk factors (early menopause, family history, low BMI); men over 50 with risk factors; anyone who has had a fragility fracture (fracture from a fall from standing height or less); anyone taking long-term corticosteroids. Ask your GP to calculate your FRAX score if you are uncertain.
Does dairy actually protect bones?
Population data is mixed — countries with high dairy consumption don’t always have lower fracture rates. However, calcium and protein from dairy do contribute positively to bone health. The association between dairy and fracture risk depends on total dietary context and other lifestyle factors. Non-dairy sources of calcium (leafy greens, canned fish with bones, fortified alternatives) are equally effective for bone health when consumed in adequate amounts.
Are bone health supplements worthwhile?
Calcium and D3 have the strongest evidence. Vitamin K2 (MK-7, 100–200mcg) directs calcium into bone rather than arteries and has growing clinical trial evidence for bone density. Magnesium is a cofactor in bone mineralisation — deficiency is common and correction is worthwhile. Collagen peptides have early evidence for bone density improvement alongside exercise. These are sensible adjuncts when dietary sources are insufficient.
Browse bone health supplements including calcium, D3 and vitamin K2 at Huncoat Pharmacy. Related: Calcium Guide, Vitamin D Guide, Exercise and Ageing.
At Huncoat Pharmacy: IV calcium & vitamin D infusion, Browse bone health supplements, Bone density home testing.