From childhood, we are told to drink milk for strong bones. However, this is not the only factor that determines how strong our bones will be when we grow older. Unfortunately, there are certain unavoidable factors, such as a person’s bone frame, medical conditions, family history, medications and others that can predispose an individual to osteoporosis.


Osteoporosis is a condition in which there is loss of calcium and other minerals in a person’s bones, making them thin, brittle and prone to fractures. Osteoporosis literally means porous bone. Osteopenia is a precursor to osteoporosis, and is a condition where the bone mineral density is lower than normal. We reach our peak bone mineral density in our mid-twenties, and it slowly decreases as a person gets older.

The good news is that there are lifestyle habits we can implement to strengthen our bones and prevent osteoporosis. The earlier in life these steps are implemented, the better. When we pass menopause, it becomes much more difficult to increase our bone density, but it is important to maintain it.


Just as your mother told you, a nutritious diet including calcium-rich foods will reduce the risk of osteoporosis in later years. In the UK, the recommended intake of calcium for the general population is 700mg per day. The main sources of calcium are dairy products, such as milk, yogurt and cheese. But we must remember that calcium can be obtained from other sources, such as leafy greens (e.g. kale and broccoli), seafood (salmon, tinned fish) and vegetables. Fruit also contains calcium and many foods and drinks are fortified with the mineral. Vitamin D also plays an important role in calcium absorption and bone health. Although food sources of Vitamin D include egg yolks, saltwater fish and liver, we get most of our vitamin D from sunlight. We are lucky to live in Malta where the sun shines all year round. Try to expose your bare skin to sunlight daily, but not during the peak hours of sunshine.

If you smoke, quit as soon as possible. Apart from causing heart and lung disease, several research studies have identified smoking as a risk factor for osteoporosis and bone fracture.

Do not consume excessive amounts of alcohol. Chronic alcohol use has been linked to an increase in fractures of the hip, spine and wrist. Drinking too much alcohol interferes with the balance of calcium in the body. It also affects the production of hormones, which have a protective effect on bone and of vitamins, which we need to absorb calcium. Excessive alcohol consumption can also lead to more falls and related fractures.

Exercise! A sedentary lifestyle encourages the loss of bone mass, while exercising regularly can reduce the rate of bone loss. Choose exercises that are appropriate for your fitness level, abilities and health status. A combination of weight bearing exercises, muscle strengthening and balance exercises are needed.

In weight bearing exercise, muscles and bones of the legs and trunk work against gravity while supporting your body weight. Examples of low impact weight bearing exercises that can be carried out by people who already have a low bone mineral density include walking, dancing, low-impact step aerobics and stair climbing. If you do not suffer from osteoporosis, you may go in for high-impact activities, such as jumping, running or jogging.

Strength training: Strength training refers to exercise where free weights (dumbbells), weight machines or exercise bands are used to make the bones and muscles work by lifting, pushing or pulling a load. Strength training is useful to improve muscle mass and protect the bone.

Balance exercises can include anything, depending on your age and general condition. Tai chi is an excellent exercise for people with existing osteoporosis. Balance exercises can be attempted in various ways, using equipment or while free standing.

What to avoid if you already have osteoporosis.

Avoid exercises that increase the risk of falling – no skiing or rollerblading, please.

Avoid high impact exercises as these can lead to fractures in weakened bones.

Avoid jerky, rapid movements.

Avoid exercises in which you bend forward and twist your waist, such as touching your toes or doing sit-ups. This can increase your risk of compression fractures in your spine. Other activities that may require you to bend or twist forcefully at the waist are golf, tennis, bowling and some yoga poses.

Regular exercise should be a part of every osteoporosis programme. Consult a physiotherapist for a tailored programme and for advice.

Always start slowly and at a low intensity.

WARNING: Always consult your doctor, physiotherapist or healthcare professional before you decide on an exercise programme if you suffer from cardiovascular or pulmonary disease, arthritis or neurological problems.