Looking after your bones

1. How can you look after your bones?
2. Diet, calcium and vitamin D
3. Alcohol
4. Physical activity
5. Smoking
6. Further support

1. How can you look after your bones?

If you are worried about your risk of osteoporosis, certain lifestyle changes can help to look after your bones. For example:

• Diet, calcium and vitamin D
• Alcohol
• Physical activity
• Smoking

If you have already lost some bone density, or have osteoporosis, lifestyle changes cannot cure or reverse the problem but may stop it getting worse. Find out more about osteoporosis and breast cancer treatment.

2. Diet, calcium and vitamin D

A varied and balanced diet will give you the nutrients that are important for strong, healthy bones.

Calcium

Calcium is a vital mineral for teeth and bones because it gives them strength and hardness. Our bodies contain about 1kg of calcium and 99% of it is found in our bones.

Our main dietary source of calcium is dairy produce. Most people get enough calcium through a healthy diet that includes dairy products. Three portions of dairy a day will give you the recommended amount of calcium if you do not already have osteoporosis.

If you do not eat or drink any dairy products, it’s important to ensure you still get enough calcium in your diet from other non-dairy sources. Milk alternatives such as soya, rice and almond milk do not naturally contain as much calcium as cow’s milk. Choosing dairy alternatives with added calcium can be helpful.

Good sources of calcium include:

• Milk and dairy products (including low-fat varieties) such as yoghurt, fromage frais and cheese
• Calcium-fortified breakfast cereals
• Dried fruit such as apricots and figs
• Fish with edible bones such as anchovies, sardines, pilchards and whitebait
• Green leafy vegetables like broccoli, watercress and kale
• Pulses, beans and seeds such as kidney beans, green beans, baked beans and tofu
• Nuts and seeds such as almonds, brazil nuts, hazelnuts and sesame seeds
• Okra

The calcium content of drinking water varies greatly across the UK. Some bottled mineral waters are calcium enriched. You may need to take a calcium supplement if you do not get enough calcium from your diet alone.

How much calcium do I need?

Adults need around 700mg of calcium a day. Someone with or at risk of osteoporosis may be advised to have around 1,000–1,200mg a day. See the table below for a guide to the calcium values of some common foods (all figures are approximate).

Calcium rich food per average portion:

Food	Amount	Calcium value
Edam/Gouda cheese	40g	300mg
Milk (skimmed, semi-skimmed or whole)	200ml	200mg
Soya milk (calcium boosted)	200ml	200mg
Yogurt (low-fat fruit, plain)	125g (1 pot)	200mg
Sardines (canned)	50g	200mg
Cheddar cheese	30g	200mg
Dried figs	40g (2 figs)	100mg
Baked beans	200g (1 small tin)	100mg
Plain naan bread	43g (half a naan)	100mg
Broccoli steamed	110g	50mg
Almonds	22g (10 whole nuts)	50mg
Brazil nuts	30g (9 whole nuts)	50mg

 

There are calculator tools online that can tell you how much calcium is in the foods you eat.

Vitamin D

Vitamin D is needed to help your body absorb calcium. You can get vitamin D from:

• Sunlight
• Food
• Supplements

The main source is sunlight, which your body uses to make this vitamin in your skin.

From April to September, the light from the sun is strong enough that we can make vitamin D on exposed skin such as the face, legs, and arms. However, make sure you stay safe in the sun.

The body stores vitamin D for use during the winter months, but it’s recommended that all adults take a vitamin D supplement especially in the winter months. Some people may not get enough vitamin D from sunlight because of little or no exposure to the sun. If this is the case, your doctor may recommend you take a vitamin D supplement throughout the year. The recommended dose of vitamin D is 10 micrograms (400 International Units (IU)) per day.

You can get some vitamin D from food. However, even if you have a healthy and well-balanced diet that provides all the other vitamins and goodness you need, it’s unlikely to provide enough vitamin D. Good sources of vitamin D in food include:

• Egg yolks
• Red meat
• Mushrooms
• Oily fish such as herrings and sardines
• Cod liver oil
• Margarine, yoghurts and breakfast cereals that have added vitamin D (vitamin D-fortified)

3. Alcohol

Drinking too much alcohol can affect your bone strength and thickness (density). Also regularly drinking alcohol increases the risk of developing breast cancer, although it’s less clear if this affects the outlook (prognosis) for people who have had breast cancer. NICE (National Institute for Health and Care Excellence) recommend people who have had breast cancer limit their alcohol intake to below five units per week.

You can find out how many units are in your drinks by using an online unit calculator. As a general guide:

• A can of beer or cider (440ml, 5.5%) = 2 units
• A 175ml glass of wine (12.5%) = 2.1 units
• A single 25ml measure of spirits (40%) = 1 unit

4. Physical activity

Regular physical activity and exercise are important for managing osteoporosis. Regular weight-bearing exercise or activities help stimulate growth and maintain the strength of the bones and muscles. Weight-bearing exercise is any exercise where you support the weight of your own body. Weight-bearing exercises can be moderate-impact or low-impact.

Moderate-impact activities:

• Running
• Skipping
• Aerobics
• Tennis

Low-impact activities:

• Walking
• Dancing
• Stair climbing
• Cross training machines

The type of activity you do will depend on your individual needs and current abilities. For example, your fitness levels, any effects of treatment or other health problems you might have.

If you have osteoporosis and have a high fracture risk, you may need to change your exercises and avoid any awkward or sudden bending and twisting because of a higher chance of injury.

The Royal Osteoporosis Society has information on exercise for bone health.

The NHS website also has information on exercise for strong bones and on building strength and flexibility.

You should speak to your GP or treatment team before starting any new exercise routine. They may refer you to a physiotherapist if you need extra guidance or support.

Listen to our podcast on exercise.

5. Smoking

Smoking has been linked to a higher risk of fractures, so it’s a good idea to stop or cut down if you smoke. If you need help to stop smoking, speak to your GP or visit the NHS Smokefree website.

6.Further support

If you would like more support in looking after your bones during treatment, call our Helpline team on 0808 800 6000 or get in touch with our nurses.

You can also download our free BECCA app for useful tips on exercise and diet.