Q: I am now 50 years old and my periods stopped in July of last year. I wondered how I would know if I had brittle bones, which I hear mentioned in the newspapers quite a lot nowadays. I smoke about 15 cigarettes a day and wondered whether this could have an effect on my bones and I know I am not exercising as much as I should.

A: Osteoporosis affects 1 in 2 women over the age of 50 in the UK. And osteoporosis isn’t just a matter of brittle bones. It can kill. In fact it is a bigger female killer than ovarian, cervical and uterine cancers combined.

But the biggest problem is that osteoporosis is so often a ‘silent disease’, bone loss happens gradually over time, without any symptoms. Osteoporosis, at the moment, remains woefully unrecognised and yet it is preventable and treatable.

There are a number of risk factors for osteoporosis and these include: family history of osteoporosis, yo-yo dieting or an eating disorder such as anorexia or bulimia, irregular menstrual cycles or long gaps between periods when younger, certain medications – steroids, heparin, anticonvulsants, diuretics, long-term laxatives or antacids, low level of physical activity and smoking. Smoking not only reduces bone density (by up to 25%) but also increases the risk of hip fractures so you need to think about stopping.

The gold standard for testing for osteoporosis is a DEXA scan but unfortunately is hard to get on the NHS nowadays. In the clinic in Tunbridge Wells I use an ultrasound machine which passes sound through the heel bone. Recent research has shown that ultrasound scans can predict those patients who subsequently go on to have a fracture as well as DEXA scans.

Another way of assessing bone health is to do a Bone Turnover test which measures biochemical markers in urine that show the rate of bone breakdown. Higher levels of these bone resorption markers, indicating higher bone turnover and higher bone loss, have been found to be associated with a two fold increased risk of osteoporotic fracture. This is an easy test to do and can be done by post.

Once you have found out the condition of your bones there is a lot you can do nutritionally and with your lifestyle to improve your bone density. I have discussed the natural approach to osteoporosis in my book ‘Osteoporosis — the Silent Epidemic’).

As well as getting your nutrition right it is also important to take a good ‘bone’ supplement. The first nutrient that comes to mind is calcium. But many other nutrients are equally crucial for healthy bones, and these include magnesium, vitamin C, vitamin D, zinc and boron.

Magnesium helps to metabolise calcium and vitamin C and converts vitamin D to the active form necessary to ensure that calcium is efficiently absorbed. Vitamin C is vitally important in the manufacture of collagen, which is a sort of ‘cement’ that holds the bone matrix together (use an alkaline form of vitamin C like magnesium ascorbate not ascorbic acid).

Boron is an important mineral in relation to osteoporosis as it plays a crucial part in the conversion of vitamin D into its active form, which, in turn, is necessary for calcium absorption, and zinc is needed for the proper formation of bone cells. There are many good ‘bone’ supplements, the one I use in the clinic is called OsteoPlus and also contains digestive enzymes.

Calcium, the body’s most abundant mineral, plays a critical role in bone health and the prevention of osteoporosis, but it does much more than that. Calcium allows cells to divide, regulates muscle contraction and relaxation, keeps the heart beating and the brain working, plays an important role in the movement of protein and nutrients inside cells, helps control blood pressure, and is essential for blood clotting. Calcium also seems to protect against heart attacks and certain types of cancers.

The body maintains its blood calcium level at any expense so if you’re not absorbing enough calcium from what you eat to satisfy your body’s requirement, you’ll steal it from your bones. In effect, the body uses its bones as a calcium bank. It constantly takes calcium from the bone and supplies it to the blood to make sure that all of these essential functions can continue.

Many adults shrug off the need for adequate calcium and feel it’s not necessary since they’re no longer building bone, a process that ends at about age 30. But if you continue to consume an inadequate amount of calcium, you’ll gradually erode your skeleton to the point where breaks are more likely. According to research, if adults made sure they were eating enough calcium rich foods and either walked or participated in some other form of weight-bearing exercise for 30 minutes a day, they could substantially reduce the incidence of broken bones resulting from osteoporosis.

Because vitamin D plays a role in the body’s absorption of calcium, consuming a sufficient amount is also crucially important. And, since your body makes vitamin D when exposed to the sun’s rays, 15 to 30 minutes of sunlight on your face and hands two to three times a week will take care of it. If you are over the age of 40 then take a good multivitamin and mineral containing vitamin D (see Resources, page 41).

Good Sources of Calcium:

Although the optimal amount of calcium isn’t known, “enough” in the US is 1,200 mg a day for women over 50 whereas in the UK it is 700mg.

Everybody tends to think of getting calcium only from dairy products. But you can get calcium from many other foods as well. Tofu, eggs, hazelnuts and sesame seeds contain good amounts of calcium. Leafy green vegetables, canned sardines, and tinned salmon with bones are other good sources. Even carrots and green peas contain calcium.

The most important message about calcium is also the simplest: Make sure you get an adequate amount. You don’t have to count milligrams with every bite, but learn which foods are rich in calcium and make them a regular part of your diet. And, to guarantee that the calcium you eat becomes available to your body, get sufficient vitamin D, via the sun or in a multivitamin and mineral supplement.

Research published in the October, 2006 Journal of the American Society of Nephrology looked at the effects of making the body more alkaline on the risk of osteoporosis.

Dr. Reto Krapf of the University of Basel in Switzerland and colleagues conducted a study of 161 post-menopausal women whose average age was 59. Krapf split the women into two groups: The first received a daily supplement of potassium citrate for up to 12 months, and the second was given a daily supplement of potassium chloride for up to 12 months.

The researchers hoped to prove that potassium citrate — a base chemical — could make the body more alkaline and counteract the effects of acidity generally caused by poor lifestyle and dietary choices. Potassium chloride was used in the control group because it is a neutral chemical that does not affect body pH.

After six to 12 months, the researchers conducted bone mineral density tests on the participants’ lower spine and hips. The group taking the potassium citrate (alkaline) supplements experienced a one percent increase in bone mineral density in the lumbar spine area, as well as a one percent increase in bone density in the hips. Conversely, the group taking the potassium chloride (neutral) experienced a one percent loss of bone density at both test sites. The researchers also found that the women taking potassium citrate lost less calcium through their urine than those taking potassium chloride.

The important message here is one which I have discussed in detail in my book ‘Osteoporosis — the Silent Epidemic’ in that we need to eat a more alkaline diet with more fruit and vegetables in order to protect ourselves against loss of bone density and osteoporosis.