Endocrine Abstracts

Osteoporosis is characterised by compromised bone strength leading to an increased risk of fracture. Many lifestyle factors are known to affect bone strength and moreover, may further affect fracture risk through modification of the risk of falling. Bone mineral density (BMD) is a major determinant of bone strength and reflects peak bone mass and subsequent rates of bone loss, both of which are influenced by lifestyle factors. Peak bone mass is a strongly heritable trait but may be modified by environmental factors. For example, data suggests an interaction between dietary calcium intake and physical activity on bone acquisition in children and adolescents. Later in life these factors are important in the maintenance of bone mass and may modify age-related bone loss. Vitamin D repletion is required to facilitate adequate calcium absorption and through effects on muscle may reduce falls risk in the elderly. The role of other nutrients on bone health is less clear: data suggest a beneficial effect of diets high in fruit and vegetables and containing adequate but not excessive protein. Chronic alcohol excess is associated with increased fracture risk due to a multifactorial aetiology including dose-dependent inhibition of osteoblasts, malnutrition and impaired neuromuscular function. Smoking is not only associated with low BMD and increased fracture risk but has also been shown to impair fracture healing. Weight loss, particularly in cycles of gain and loss, or of a severity leading to amenorrhoea, impairs bone health as can other lifestyle factors associated with suppression of gonadal hormones such as excessive exercise. In summary, lifestyle may influence bone health and fracture risk throughout life. The mechanism, magnitude and persistence of these effects remain to be fully elucidated but it is likely that adequate dietary calcium intake, vitamin D sufficiency, regular weight-bearing exercise and avoidance of smoking and excess alcohol intake have a positive influence on bone.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.