Osteoporosis isn't just a risk for old ladies. This bone disease can affect young women too – even men. But in almost all cases diet and lifestyle changes can prevent osteoporosis.

It seemed unthinkable. In 2005, medical student Alae Brand was just 20 years old and facing a diagnosis of osteoporosis.

Surprising? Yes. Impossible? No.

A dedicated sportswoman, ex-gymnast and keen long-distance athlete, Alae hadn't started menstruating yet – a fact that was attributed to a combination of intensive physical training and a family history of late menstruation. But during endocrinology lectures at medical school she learnt about the ins and outs of hormones and that late menses – after the age of 16 – is considered a risk factor for developing osteoporosis.

At 20 Alae still had the body of a 14-year-old. But she was more concerned about her short stature than about her bone density or the risk of osteoporosis. After numerous tests she started oestrogen therapy and was sent for a bone scan. The outcome: low bone density as a result of hormonal imbalances and indications of osteoporosis.

In women who start menstruating late the bones are denied the bone-protecting hormone oestrogen during the most important years of growth. Also, a body mass index (BMI) below 19 is considered another strong risk factor for the condition and, naturally, lower BMIs are more likely in slim athletes.

Alae already had some fractures, which could have raised her doctor’s concern about the health of her bones.

“I fractured my wrist but that was after falling off my mountain bike. It would've happened regardless of the possibility of osteoporosis,” she explains. “I have a very strong, muscular frame that supports my bones. I believe that anyone else with a bone density as low as mine would have had several fractures by now.”

To manage her osteoporosis Alae will be on oestrogen for the rest of her life. She’ll also have to take a calcium supplement to feed her bones the minerals they need.

“My main aim is to get my bone density as close to normal as possible before I reach 30,” she says. “To achieve this I need to take enough calcium, eat a healthy diet and spend time in the sun because vitamin D helps with calcium metabolism and healthy bones.”

Who’s being targeted by the ‘silent epidemic’?
Osteoporosis is referred to as the “silent epidemic” because the condition can develop painlessly, quietly and with no warning signs. Many sufferers discover they have the disease when it’s too late and they’ve already had a fracture.

It’s also a lot more common than most of us imagine. According to Osteoporosis Australia (www.osteoporosis.org.au), the condition affects more than 1 million Australians.

Women are at greater risk of developing osteoporosis because of the rapid decline of oestrogen levels during menopause. However, men are at risk, too: the gradual decline of testosterone also has an effect on bone mass. And, of course, Alae is proof that younger people, especially female athletes and ballet dancers, are sometimes affected too. On the other end of the scale, the condition can also occur in people who are inactive for long periods such as disabled people – they’re vulnerable because they’re not able to do weight-bearing exercise.

Apart from age, other risk factors include low body mass index, a prior fracture, a family history of hip fractures, smoking, alcohol abuse, rheumatoid arthritis and certain medical conditions such as premature menopause.

Prevention plan: invest in your skeleton
In the minority of cases, osteoporosis is caused by factors beyond the sufferer’s control. Certain medication such as cortisone or bone-toxic cancer drugs can compromise bone health, and research has shown genetics play a very strong role in how predisposed you are.

But the good news is that in the vast majority of cases osteoporosis is caused by lifestyle and can therefore be avoided. The key is to adjust your way of life to prevent the condition from developing with age.

Bone mass and strength reach a peak between the ages of 25 and 30. After bone mass peaks, it declines gradually in both women and men. Because female peak bone mass is usually about I0% to 25% lower than that of men and because decreasing oestrogen levels during menopause lead to rapid bone loss, osteoporosis occurs more frequently in women than in men.

But whether you’re male or female it’s best to feed and fortify your bones while you’re young, especially in your childhood and teenage years. This is when bones are formed and the amount of calcium consumed will set the stage for future bone health.

The bone-building lifestyle
There are three ways in which you can prevent osteoporosis:

    1. Up your calcium intake

    1. Up your vitamin D levels

    1. Start doing weight-bearing exercises

1. Up your calcium intake
Peak bone mass is determined by many factors of which a sufficient calcium intake is paramount. For adults the Recommended Dietary Allowance (RDA) of calcium is 800 to 1,000mg a day. Teenagers and pregnant or breastfeeding women need 1,500mg a day.

Getting enough calcium calls for a healthy diet that includes a regular intake of dairy products, green vegetables, fish and nuts. On average, a cup of milk contains 300mg of calcium, a matchbox-size piece of cheese 200mg, a 100g tin of sardines 500mg, and a small 26g handful of almonds about 60mg.

If you’re concerned about your calcium intake, you could consider a supplement – but be careful about taking calcium at night as it may interfere with your body’s natural process of repair.

Choosing a supplement can be confusing. Your best bet is to choose a well-known brand.

Most calcium supplements are easily absorbed in the body. But you can test your product by putting it in some vinegar. If it hasn’t dissolved after 30 minutes, it probably won’t dissolve in the stomach. Chewable and liquid calcium supplements dissolve well because they’re already broken down when they reach the stomach.

2. Vitamin D for dem bones
Vitamin D is essential for calcium absorption and this bone-friendly vitamin has also been found to be dependent on moderate exposure to sunlight. But surprisingly – and despite our sunny climate – many Australians older than 60 years aren't getting enough sunshine, which means they’re also not getting enough of this vital vitamin.

Vitamin D levels in the body also depend heavily on the amount of young and healthy skin that’s exposed to sunlight. The skin of most people over 60 isn't healthy or young enough to convert sun energy into sufficient vitamin D in the body.

Also, as sun exposure is dangerous and linked to skin cancer, a lot of people stay out of the sun.

What’s more, food sources containing vitamin D are few and far between. Vitamin D is found in oily fish such as salmon, and in cod-liver oil.

3. Weight-bearing exercise
You can’t rely on diet alone. Healthy bones need exercise – it stimulates bone formation and slows age-related bone loss. It’s not clear exactly how physical activity alters bone but the direct effect of muscle pulling on bone is known to generate electrical charges on the bone surface. These charges stimulate bone-building cells and bone formation.

Exercise also promotes the release of hormones that boost bone growth and slow bone loss. And, of course, exercise stimulates the flow of blood to the bones and improves balance, co-ordination and confidence – all of which help to prevent falls.

In general, weight-bearing exercise such as walking, stair-climbing or jogging is better for bones than non-weight-bearing exercise such as swimming or cycling. But don’t go overboard.

Over-training in young women – especially when coupled with strict dieting and a poor calcium intake – can in fact decrease oestrogen levels and promote bone loss and therefore do more harm than good.

Image via Thinkstock.