Questions & Answers

Below is a list of general questions from the patient community. Although we cannot provide treatment-specific advice, If you have general questions related to osteoporosis and other bone-related diseases, don’t hesitate to contact us:

1. Is spinach a good source of calcium?

Although the reported amount of calcium in spinach is high, spinach (and for e.g.  rhubarb or leeks) are high in oxalates (oxalic acid), a compound that binds to calcium and interferes with the body’s ability to absorb it. As a result, only about 5% of the calcium is actually absorbed. By comparison, a cup of cooked broccoli contains less calcium—but up to 60% of this is absorbed. So, even though broccoli contains less calcium than spinach, it turns out to be a better non-dairy source of calcium.

2. What are the warning signs of osteoporosis?

Osteoporosis is a silent disease which shows no real symptoms until a broken bone occurs. However there is a ‘red flag’ that might be a sign of osteoporosis: loss of 3 cm or more in height (just over 1 inch) or a curved back may indicate that a person has already experienced one or more spinal compression fractures due to osteoporosis without realizing it. In fact any fracture in people aged 50 years or more should be followed up for suspicion of osteoporosis. For example, a broken wrist or leg after a minor slip or fall from standing height, could be a sign of osteoporosis.

3. Can osteoporosis be cured or reversed?

Although there is no cure for osteoporosis, it can be treated.  The goal of treatment is to prevent fractures from occurring by slowing down bone loss, maintaining bone, or improving bone density as far as possible. Therapy involves being physically active (bone building and muscle strengthening exercises), getting enough calcium and vitamin D, and taking osteoporosis drugs if prescribed. So, although osteoporosis can’t be reversed, depending on the state of your bones, drug therapy in combination with lifestyle modification can help you maintain or even build some bone to reduce your future risk of fracture.

4. Is caffeine bad for your bones? 

Caffeine has been shown to interfere with calcium absorption and cause an increase in the amount of calcium in the urine. However, studies in postmenopausal women showed that as long as calcium intake is sufficient (above about 800 mg/day), caffeine intake had no detrimental effects. If on the other hand calcium intake was low, caffeine intake of about 3 cups of brewed coffee per day caused more bone loss. The take-home message: As long as you’re getting enough calcium, you shouldn’t be concerned – you can keep enjoying coffee in moderate amounts.

5. I am vitamin D deficient and was prescribed vitamin D supplements. Can I skip the supplements and go to a solarium every once in a while to get 'sunshine' through ultraviolet rays?

Given the potential for skin damage (not to mention skin cancer risk), it is safer and easier to keep taking the supplements prescribed by your doctor. Although UVB lamps can stimulate vitamin D synthesis in the skin, you would need to use special medically approved lamps under medical supervision. Also, this may not be very effective in senior citizens, whose skin, compared to younger people, doesn’t build vitamin D efficiently. 

6. Should men have bone mineral density tests too?

Osteoporosis is not just a women’s disease! Men over 60 years of age with risk factors for osteoporosis should discuss bone health with their doctors and they may be advised to have a bone density test to determine whether they have osteoporosis. One clear risk factor is a previous broken bone after the age of 50. Other risk factors may include smoking, drinking three or more alcoholic beverages per day, a family history of a hip fracture, being on treatment for prostate cancer, or taking glucocorticoids like cortisone. If you are concerned about your potential risk start by taking the IOF One Minute Risk Test. If there is a calculator available for your country, you should complete a FRAX calculation[LM1]  to share with your doctor. Men aged 70 years or older, even without risk factors, should ask for a BMD test - as osteoporosis becomes more common at older age.

7. What is a compression fracture?

This is also commonly referred to as a vertebral fracture. The vertebral bones that make up your spine stack on top of one another like building blocks, with a disc between each two vertebrae. Because of osteoporosis the vertebrae become porous and weak. A vertebral fracture occurs when a vertebra squashes down (like a compressed sponge). This can cause the spine to hunch over because vertebrae don’t compress evenly—the front squashes down more than the back. As a result, people with vertebral fractures will often have a hunched back, also known as kyphosis.

8. Which foods provide vitamin K2?

New evidence points towards the positive role of vitamin K in bone health, especially in postmenopausal women. Vitamin K2 is the most important form of vitamin K for bone health. Vitamin K2 is found in meat, eggs and dairy foods, especially fermented products such as yoghurt and cheese (which are also high in calcium). Vitamin K2 levels are particularly high in a fermented soybean product known as natto, popular in Japan. If you are considering taking a vitamin K2 supplement, it is recommended that you first discuss this with your doctor.