Osteoporosis is a progressive, systemic skeletal disease characterised by low bone mineral
density (BMD) and deterioration of the bone architecture, resulting in increased bone fragility
and fracture risk (Gregson et al., 2022). Osteoporosis is identified by a BMD of below a
T-score of -2.5 standard deviations (SD) below the average BMD of a young, healthy person,
whereas a T-score of between -1 and -2.5 is classified as osteopenia, where BMD is below
normative values but not low enough to be diagnosed as osteoporosis (Mosti et al., 2013;
Gregson et al., 2022). There are approximately 137 million females and 1 million males
worldwide who have osteoporosis, with this prevalence expected to double in the next 40 years
(Brooke-Wavell et al., 2022). A reason for the discrepancy between sexes is that women are at
increased risk of developing osteoporosis due to oestrogen deficiency post menopause and are
more likely to start gradual bone loss younger than men (Alswat et al., 2017). Other risk factors
for developing osteoporosis include genetic inheritance, European descent, age, calcium
deficiency, medications known to reduce BMD, excessive alcohol and tobacco consumption
and physical inactivity (Borba-Pinheiro et al., 2016). Bone mineral density gradually decreases
as the human body ages; however, this decline can be altered through modifiable behavioural
(lifestyle) factors such as dietary intake or physical activity (i.e., level and intensity) changes
(Smith et al., 2009).