Bone diseases and conditions

 

Why are bones so important?

When you think about your general health, your bones are probably not the first thing that come to mind. In fact you could argue that, unless we develop a problem with them, we take our bones largely for granted.
 
However our bones are just as important as any other part of our bodies. Our skeletons are made up of 206 of them, all of which help give our bodies strength and structure. And let’s not forget that our bones also protect many of our delicate internal organs such as our heart, lungs and brain.
 
Bones are made up mainly of connective tissue made from collagen fibres strengthened with bone minerals such as calcium and phosphorus. Most of them also contain bone marrow, which itself is essential since it’s where your blood cells are made. Your bones work in combination with your muscles to allow movement too (collectively they’re called the musculoskeletal system). Bone tissue is also constantly renewing itself, with old bone tissue being broken down and replaced with new tissue – a process known as remodelling.
 
But while your bones keep growing throughout childhood and during your early 20s, once you get to your late 30s (if you’re a woman) or early 40s (if you’re a man) the density of your bones starts to decline – and it keeps declining gradually throughout the rest of your life (i). Also known as bone mineral density or bone mass, bone density refers to the amount of bone minerals (eg calcium and phosphorus) in your bone tissue. If your levels are too low, your bones may be described as brittle or porous – which means they are more fragile and more susceptible to fractures. Having low bone density is also a symptom or cause of certain bone conditions.
 

What are the signs and symptoms of a bone disease?

Not all bone conditions have symptoms and you may not even be aware that you have a problem until you break one of your bones too easily (during a routine or low-impact activity for instance). Depending on the type of bone condition you have, however, you may experience one or more of the following:
 

• Bone pain

• Sprains

• Joint pain

• Back pain

• Symptoms of infection (redness, heat and swelling, for instance)

• Stooped posture

 

High risk: bone health

You could say all of us who live long enough are at risk of developing a bone health problem, since losing bone density is a natural part of ageing. There are, however, other risk factors that can play a part in bone conditions, including:
 

• Family history of bone disease

• Diet low in bone nutrients      

• Hormonal changes (low oestrogen levels during and after menopause and low testosterone levels can affect bone density)

• Certain medicines (some of the drugs linked with bone density problems include corticosteroids, antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs), some anti-seizure medications and heartburn medicines called proton pump inhibitors)

• Physical inactivity

• Smoking

• Drinking alcohol in excess

• Being underweight or obese

• Ethnic background (people of white European or Asian descent are more likely to develop certain bone conditions than others from different ethnic backgrounds)

 
If you’re a woman, you may also have a higher risk of developing a bone condition than a man, since women’s bones are already naturally smaller and can lose density faster because of the hormonal changes they experience, especially during menopause.
 

What is the most common bone disease?

 

Osteroporosis    

 
The most common bone condition is osteoporosis. According to the Royal Osteoporosis Society, more than three million people are living with osteoporosis in the UK (ii). Women during the menopause are particularly at risk, especially if they had an early menopause or their ovaries removed. But while osteoporosis used to be thought of as a condition that mostly affects women, we now know that one in five men over 50 will experience a fracture caused by osteoporosis too (iii). Other groups can also be affected, including younger women and even children.
 
If you have osteoporosis it means your bone mineral density is too low, which increases your risk of having a fracture. In fact, many people don’t know they have osteoporosis until they break one of their bones (when caused by osteoporosis, a broken bone is often called a fragility fracture). Age and gender are commonly thought as the most significant risk factors for osteoporosis, but there are other factors involved too. These include:
 

• A family history of osteoporosis or hip fracture

• An inflammatory condition such as rheumatoid arthritis, cystic fibrosis, Crohn’s disease or chronic obstructive pulmonary disorder (COPD)

• An overactive thyroid or parathyroid gland

• Cushing’s syndrome

• Type 1 diabetes 

• Inflammatory bowel disease 

• Neuromuscular disease such as multiple sclerosis, Parkinson’s disease or cerebral palsy

• Heavy drinking and/or smoking 

• Taking certain medicines

 
There are treatments for osteoporosis, including medicines that help keep your bones stronger. Fall prevention is also crucial, since falling and breaking a bone when you’re older can be debilitating and even contribute to poor physical and mental health – hip fractures, for instance are the most common reason for admission to a hospital orthopaedic ward, with about 10 per cent of older people with a hip fracture dying within a month and one third within 12 months (iv).
 
Find out lots more about osteoporosis, including what you can do to help prevent it, in our osteoporosis guide. 
 

Other common bone diseases

 
Meanwhile, here’s a brief rundown of some other common bone conditions:
 

Osteopenia

 
If a bone density scan shows your bone density is lower than it should be – but not low enough to be diagnosed as osteoporosis – the condition is called osteopenia. However, according to the NHS, osteopenia doesn’t always lead to osteoporosis (v). In fact there are ways you can reduce your risk of developing osteoporosis if you have osteopenia – for examples see Natural ways to support your bones, below. 
 
Then again some people with osteopenia may be prescribed the same bone-strengthening treatments that are given to people with osteoporosis. This depends on how weak their bones are and whether or not they have a high risk of having a fracture.
 
We don’t know exactly how many people are affected by osteopenia in the UK, but experts at Harvard Medical School in the US reckon it affects about half of Americans aged 50 and older (vi).
 

Paget’s disease of bone (osteitis deformans)

 
Paget’s disease of bone, also called osteitis deformans, affects the natural process of bone remodelling, causing bones to become weaker and sometimes deformed. If you have Paget’s disease it means your bone tissue renews much too quickly, which can cause new areas of bone forming that are thicker and sometimes wider than normal bone. However, thicker doesn’t mean stronger, and new bone in Paget’s disease is usually much weaker than normal bone, which raises the risk of fractures and the development of deformities caused by bones bending (especially in major bones such as leg bones, for instance).
 
In many cases there’s no obvious reason why Paget’s disease develops – though some experts believe bone cells called osteoclasts could be affected by a virus, making them bigger and more active than they should be. In some people, however, the problem could be genetic, since around 15 in 100 people with Paget’s disease have a close relative who’s also affected (vii).
 
Paget’s disease mostly affects people aged 50 and older, with more men affected than women (for every three men with Paget’s disease there are two women) (vii). It’s difficult to say exactly how many people are affected by Paget’s disease, since most people with the disease have no symptoms so they don’t realise they have it. However it’s thought that around five in 100 women and eight in 100 men in their 80s have some degree of Paget’s disease (vii).
 
If you do develop symptoms they’re likely to include bone or joint pain, changes in the shape of a bone and a warm sensation in the skin over an affected bone. Some people with Paget’s disease also develop the symptoms of a nerve condition called peripheral neuropathy, such as numbness, tingling and balance problems.
 
People who’ve been diagnosed with Paget’s disease can be treated with medicines that help control bone regeneration and pain, as well as therapies such as physiotherapy and occupational therapy.
 

Osteogenesis imperfecta (brittle bone syndrome)

 
This is a bone condition that makes your bones more brittle, making them susceptible to breaking easily. It’s an inherited condition, since people with a family history of osteogenesis imperfecta have a higher risk of developing it too. Also called brittle bone syndrome, osteogenesis imperfecta is thought to affect one in every 15,000 to 20,000 people – though this may be an underestimation, since some people may have a mild form of the condition that goes undetected (viii).
 
Osteogenesis imperfecta is caused by a change or mutation in the genes that carry information for producing collagen. It’s often diagnosed in children who have bones that break easily or bones that aren’t correctly formed. Other symptoms can include muscle weakness, loose joints, a curved spine, skin that bruises easily and soft, discoloured teeth.
 

Osteomalacia (rickets)

 
Also called rickets when it affects children, osteomalacia causes soft, weak bones that can become deformed and easily broken. In either case, the most common cause is a low level of vitamin D in the body. There aren’t usually any symptoms during the early stages of osteomalacia, but if it progresses you may experience:
 

• Bone and joint pain

• Muscle cramps

• Muscle weakness

• Walking difficulties caused by deformities in leg bones

• Pins and needles in the hands and feet 

 
People who have a high risk of not getting enough vitamin D include those who are housebound and people who keep their skin covered when they’re outdoors. That’s because most of us get the majority of our vitamin when we expose our skin to sunlight. And since people with dark skin don’t process vitamin D from sunlight as well as those with pale skin, they may have an increased risk of vitamin D deficiency too.
 
The good news is that, with treatment – which often includes vitamin D supplements and also sometimes calcium supplements to speed up bone healing – most people with osteomalacia will recover, though it may take some time for their bones and muscles to regain their full strength.
 
Read on for more information on vitamin D and the UK government’s recommendations for taking vitamin D supplements. 
 

Osteomyelitis (bone infection)

 
If one of your bones becomes infected, the condition is called osteomyelitis. This can happen when bacteria settle on a section of bone and multiply, causing symptoms such as pain and tenderness, skin redness, a tender lump and a general feeling of being unwell, sometimes with a high temperature.
 
Bacteria – often a germ called Staphylococcus aureus – can get into a bone through your bloodstream or after you’ve had an injury (if you have a deep cut in your skin where your bone is broken, for instance). You have a higher risk of developing osteomyelitis if:
 

• You’ve recently had bone surgery or broken a bone,

• You have diabetes (particularly if you have a diabetic foot ulcer) 

• You have a weakened immune system

• You need regular kidney dialysis

• You have a certain type of blood disorder (sickle cell disease, for example)

• You’re dependent on alcohol or you inject street drugs that are contaminated with bacteria 

• You take steroids regularly

 
The usual treatment for osteomyelitis is a course of antibiotics, though some people may need surgery if it causes complications or becomes persistent. The good news is that if it’s treated quickly, there’s a good chance you’ll recover fully.
 

Osteoarthritis

 
Most people realise osteoarthritis – the most common form of arthritis – affects your joints, but it affects your bones too. This happens because the cartilage that cushions the ends of your bones in your joints breaks down, making your bones rub together and causing pain, stiffness and swelling.
 
Osteoarthritis is very common and affects a third of women and almost a quarter of men between 45 and 64 years of age (ix). It’s traditionally seen as a degenerative condition that affects people as they get older, but osteoarthritis can affect anyone of any age, even the very young.
 
To find out more about osteoarthritis and what you can do to manage the symptoms – including conventional and natural remedies to help your joints feel less painful – take a look at our guide to osteoarthritis treatments.

 

Natural ways to support your bones and bone disease prevention

It isn’t always possible to prevent some of the risk factors involved with bone conditions – having a family history of a genetic bone disease, for instance, or indeed getting older. But there are lots of things you can do to reduce      some of the other risks and keep your bones as healthy as possible, including staying physically active and eating a diet rich in bone health nutrients and taking bone health supplements.
 

Why exercise is important for bone health    

 
Staying active – especially by taking part in certain types of activities – can help prevent or reduce bone density decline. It can also help you manage your weight and keep it in the normal range, which is also one of the best things you can do to keep your bones healthy (read our article Bone health: why weight matters to find out more about this) 
 
According to the Royal Osteoporosis Society, the most effective way to keep your bones strong through exercise is to combine weight-bearing exercise with impact and muscle strengthening exercise (x):
 

• Low-impact activities include walking, marching and stair climbing.

• Moderate-impact activities include skipping, hopping, jogging, running, team and racket sports and Highland dancing.

• High-impact activities – the most effective for improving bone density – include star jumps, tuck jumps, track events, volleyball and basketball.

• Meanwhile muscle strengthening exercise includes moves such as squats, lunges, leg presses, chest presses, deadlifts and bicep curls.

Whatever exercise you do, start slowly, and build up your fitness levels gradually if you haven’t been very active lately. Always speak to your GP before starting any new exercise regime if you have a medical condition.
 

Healthy eating to keep your bones strong      

 
Having a diet rich in foods containing certain nutrients is essential for good bone health.
Here are the main nutrients you need to keep your bones strong:
 

Vitamins for bone health

 

Calcium  

t’s well known that you need calcium for healthy bones (in fact the calcium stored in your bones is what gives them their strength). Yet many people may not be getting enough calcium in their diets. You need at least 700mg of calcium a day if you’re an adult, which for some people may not be that easy to achieve through food alone (good sources of calcium include milk and other dairy foods, foods fortified with calcium, fish that includes edible bones and some green leafy vegetables such as kale). Calcium supplements are also widely available, including single supplements, multivitamin and mineral formulas and multi-nutrient products designed for bone health.
 

Vitamin D  

Vitamin D is another essential bone nutrient because it helps your body to absorb calcium from your food or supplements, with studies suggesting taking vitamin D with calcium may help prevent bone loss (xi).
 
However many people living in the UK and other northern hemisphere countries are at risk of vitamin D deficiencies during certain times of the year, since skin exposure to sunlight is our main source. This is why the Department of Health and Social Care advises everyone in the UK to consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter months (those who are at high risk of not getting enough vitamin D during the spring and summer are advised to take a supplement all year round) (xii).
 
The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D your body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, plus you can now get them in veggie-friendly drops too. Most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. Thankfully vegan vitamin D3 supplements sourced from lichen are now more widely available.
 

Vitamin K  

Probably best known for its role in blood clotting, vitamin K is fast becoming a bone health must-have as we now know it’s needed for making important bone proteins too. Vitamin K also works alongside calcium and vitamin D to keep your bones strong: while vitamin D helps your body absorb calcium, vitamin K helps calcium to get where it’s needed (that is, into your bones and teeth instead of your soft tissues where it can cause problems). Clinical evidence for the role of vitamin K in human (rather than animal) bone health is still at a relatively early stage, but some studies have linked poor bone health with low vitamin K levels (xiii), with others have found the amount of vitamin K in people’s diet and their bone mineral density are related (xiv).
 
Meanwhile, a study that looked at some of the data from the large-scale Nurses’ Health Study suggests women who consume at least 110 micrograms of vitamin K each day are 30 per cent less likely to break their hip than those who eat less (xv). The researchers claim low intakes of vitamin K may increase the risk of hip fracture in women.
 
Scientists analysing information from another large-scale study – the Framingham Heart Study – also found a link between vitamin K intake and the risk of hip fracture, not just in women but in men too (xvi).
 
Vitamin K is found in plant foods such as leafy greens as well as in animal-sourced foods and fermented foods. Find out more about vitamin K and the foods that contain it in Bone health: the importance of vitamin K. [ADD LINK WHEN PUBLISHED] You can also get vitamin K in supplement form or as part of a good multivitamin and mineral supplement or a multi-nutrient bone health supplement.
 

Magnesium  

Magnesium is important for bone health because it helps keep bones hard and rigid. Indeed, 70 per cent of the magnesium in your body is stored in your bones and teeth. Magnesium also helps convert vitamin D into the form that boosts calcium absorption in the body. Many people, however, may not be getting enough magnesium in their diet (sources include nuts, seeds, green leafy veg, whole grains, beans and lentils).
 
If you’re looking for a magnesium supplement, look for a form of magnesium that’s absorbed more readily than others, such as magnesium citrate.
 

Zinc  

Researchers have shown zinc is another mineral that plays an essential role in bone metabolism and mineralisation (xvii). Other scientists claim zinc is an essential mineral required for normal skeletal growth, and that it may also be involved in promoting bone remodelling (xviii). Like magnesium, the citrate form of zinc in supplements is thought to be better absorbed by the body than other forms. You can also try getting more zinc-rich foods in your diet such as dairy foods, shellfish, meat, bread and wheatgerm.
 

Vitamin C  

Healthy bones need collagen, which means they need vitamin C as it contributes to normal collagen formation. More recently, however, researchers have discovered vitamin C has other functions that may help keep bones strong too. Some have claimed the ways in which vitamin C affect how our genes work are central to bone formation, and that it may help prevent common bone-degenerating conditions (xix). Vitamin C is found in a wide variety of fruit and vegetables, but a good-quality supplement can help make sure you’re getting the amount you need every day.
 

Protein  

The International Osteoporosis Foundation claims adequate dietary protein is essential for optimal bone mass gain during growth and also for preserving bone and muscle mass with ageing (xx). In older people, for instance, bone mineral density appears to be positively linked with protein intake, with those eating less protein having a higher risk of falling.
 
Foods high in protein include animal foods such as meat, dairy foods, eggs and fish. Meanwhile vegetable sources include soya products, nuts, seeds, grains, beans and lentils. You can also boost your protein intake by drinking protein shakes or adding protein powders to your meals – these can be convenient for those who struggle to get enough protein through food alone.
 

Find out more about bone diseases

To find out more about bone health including how your lifestyle can help keep your bones strong and healthy, visit the bone health section of our pharmacy health library. Meanwhile if you’re affected by osteoporosis you can find out more about your condition by reading Osteoporosis Symptoms. There’s further help and support available from the Royal Osteoporosis Society, including a list of local support groups located around the UK.
 
 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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