Bone health and looking after yourself
There are changes you can make to your lifestyle to improve or maintain your bone health and reduce your risk of osteoporosis. These changes are also good for your general health.
Keeping your bones healthy is important throughout your life, not just during cancer treatment. These changes are helpful for everyone, so your family and friends can benefit from them too.
Eat a healthy and balanced diet. Try to include foods that contain calcium and vitamin D. This will help keep your bones strong and healthy.
A balanced diet includes:
- fruit and vegetables
- protein, such as meat, fish, soya beans and lentils
- starchy foods (carbohydrates), such as rice, bread, pasta, potatoes and whole grains
- milk and dairy products, such as yoghurt and cheese or non-dairy alternatives
- only a small amount of foods that are high in fat, salt and sugar.
We have more information about healthy eating and cancer.
Public health bodies in the UK recommend most adults should have 700mg of calcium a day. If you have osteoporosis, your doctor may advise that you have 1,000mg a day.
Foods that have lots of calcium in them include:
- dairy products (these contain the highest amounts of calcium)
- tinned oily fish where you eat the bones, such as sardines
- leafy green vegetables, such as broccoli and curly kale
- soya beans, tofu, kidney beans and baked beans
- dried fruit, such as figs, apricots and raisins.
If you have a dairy-free diet, make sure you eat non-dairy foods that contain enough calcium. You may also choose to have products with added calcium. These include some types of fortified non-dairy milks and orange juice. Always shake the carton well before use. This makes sure the calcium is mixed through the drink.
Some foods and drinks can upset the calcium balance in the body. Avoid large amounts of:
- red meat
- fizzy drinks that contain phosphates, such as cola.
The Royal Osteoporosis Society has more information about the amount of calcium in specific foods.
Vitamin D helps your body absorb calcium. It is important to get enough vitamin D to maintain healthy bones and muscles.
Sunlight is the best natural source of vitamin D. In the UK, exposing your skin to sunlight every day between 11am and 3pm, from May until September increases vitamin D levels.
Guidelines recommend that adults get 10 minutes of sun on bare skin (without sun cream) once or twice a day, depending on their skin type. But take care not to burn, especially during strong sunshine. On cloudy days, it will take longer than 10 minutes to get enough vitamin D.
Your cancer doctor, nurse or GP can advise you on whether this is safe for you to do. Some people may need to take special care when out in the sun.
We only get a small amount of vitamin D from the food we eat. But it is important to include foods in your diet that have a lot of vitamin D in them, such as:
- oily fish
- red meat
- egg yolks.
Some breakfast cereals, yoghurts or margarines have vitamin D added to them. You can check the labels to find out.
Vitamin D supplements
During the autumn and winter when sunlight levels are low, it is difficult to get enough vitamin D. Guidelines suggest that people take a daily supplement of 10mcg (800 IU) of vitamin D.
The government advises that people who are more likely to have low levels of vitamin D consider taking a vitamin D supplement all year round. This includes people who:
- cover their skin when outside
- have dark skin, from African, African-Caribbean and South Asian backgrounds
- do not spend regular time outdoors every day, such as people who are housebound or in a care home.
You can buy vitamin D supplements from supermarkets, health food stores and pharmacies. If you are not sure what to buy, ask your GP or pharmacist for advice.
If you are having cancer treatment that increases the risk of osteoporosis, your GP or hospital doctor may prescribe vitamin D and calcium supplements for you.
If you drink alcohol, keep to the recommended guidelines. Current drinking guidelines recommend drinking no more than 2 units of alcohol a day or 14 units a week. It is also recommended that you have a couple of alcohol-free days each week.
There is more information about alcohol and drinking guidelines at drinkaware.co.uk.
Physical activity and strength training makes bones stronger. It can also improve your coordination and balance, which makes you less likely to fall. Falls are a common cause of fractures, especially as you get older.
If you have not exercised much before, you need to start slowly and increase the amount you do gradually. Talk to your doctor or nurse before starting any exercise programme. This is especially important if you have, or are at risk of, osteoporosis. Your GP can tell you if there are any exercises you should not do. They may be able to tell you if there are any suitable exercise schemes in your area.
Different types of exercise
There are lots of different ways to exercise. It is best to find something you enjoy. This will make it easier for you to keep doing it. You need to exercise regularly to get the most benefit.
It is best to do the following types of exercise:
- Activities that raise the heart rate for 30 minutes, five times a week. The 30 minutes could be made up of three, 10-minute periods of activity. This type of aerobic activity strengthens the heart and lungs.
- Physical activity that improves muscle strength on at least two days each week.
- Exercises to improve balance and coordination on at least two days each week.
When exercising, do not push yourself too hard. At the end of an activity, you should feel warm and slightly out of breath, but not exhausted. With practice, you will soon find you are able to do more.
Exercise that is weight-bearing is particularly good for your bone health. Weight-bearing exercises include walking, jogging, skipping, climbing stairs, dancing and hiking. Swimming and cycling are good for your heart and health but are not weight-bearing. Weight-bearing exercises can be high-impact or low-impact.
High-impact exercises include:
- racket sports like tennis
- some types of dancing.
Low-impact exercises include:
- walking (outside or on a treadmill machine)
- using an elliptical training machine or cross-training machine
- low-impact aerobics
- stair-step machines.
Check with your doctor if you are not sure whether it is safe for you to do high-impact exercises. If you have a high risk of fractures, or have had a fracture in the past, you may be advised to only do low-impact exercises.
These exercises make your muscles work against some form of resistance. They strengthen muscles, bones and joints. They may also improve your balance. You can do them with:
- hand weights
- resistance exercise machines
- exercise (resistance) bands.
Exercises to improve balance and flexibility
Having flexible joints helps you stay supple and prevents injuries and strains. Simple stretching exercises are a good way to start. It is best to do these stretches as part of your daily routine. They will only take you a few minutes.
Exercises that are good for flexibility and balance include:
- tai chi
- body balance
- qi gong.
These can also help you relax and reduce stress. Balance exercises help increase strength as well as balance.
If you have osteoporosis, or have had a fracture in the past, avoid sudden movements or exercises where you bend forward and twist your waist. These movements can increase your risk of fractures in the spine.
We have more information about physical activity and cancer. You can also get more information about physical activity and bone health from the Royal Osteoporosis Society.
The infographic below shows the type and amount of physical activity recommended for adults.
Below is a sample of the sources used in our bone health information. If you would like more information about the sources we use, please contact us at email@example.com
National Institute for Health and Care Excellence (NICE). Bisphosphonates for treating osteoporosis. TA464. 2019 www.nice.org.uk/guidance/ta464 (accessed Sept 2019).
National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture. CG146. 2017. www.nice.org.uk/guidance/cg146 (accessed Sept 2019).
National Institute for Health and Care Excellence (NICE). Osteoporosis: Quality standard QS149. 2017. www.nice.org.uk/guidance/qs149 (accessed Sept 2019).
Royal Osteoporosis Society (ROS). Care: Frameworks and guidance. 2019. theros.org.uk/healthcare-professionals/courses-and-cpd/osteoporosis-resources-for-primary-care/frameworks-and-guidance (accessed Sept 2019).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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