If you have osteoporosis it means that you have lost some bone material. Your bones become less dense. This makes them more prone to break (fracture). ‘Thinning’ of the bones (osteoporosis) mainly affects older people but it can affect someone of any age.
Osteoporosis is a condition that affects bone strength. (The word osteoporosis literally means ‘porous bones’). Bone is made of tough, elastic fibres (collagen fibres) and gritty, hard material (minerals). It is a living tissue and contains cells that make, mould and take back up (resorb) bone. Initially, as you grow, bone forms faster than it is resorbed. But, as you get older, this reverses. As a result, from about the age of 35, you start to lose a certain amount of bone material overall. Your bones become less dense and less strong. The amount of bone loss can vary. If you have a lot of bone loss then you have ‘thinning’ of the bones (osteoporosis). If you have osteoporosis, your bones can break more easily than normal, especially if you have an accident such as a fall. If you have a milder degree of bone loss, this is known as osteopenia.
How common is osteoporosis?
Approximately 1.2 million Australians aged over 20 years have osteoporosis, and a further 6.3 million have osteopenia. Thus, 34% of the population has low bone density. Focusing on Australians aged over 50 years,a new report indicates that 66% in this age group have poor skeletal health: 1.04 million with osteoporosis and 3.7 million with osteopenia. Women lose bone material more rapidly than men, especially after the menopause when their levels of oestrogen fall. Oestrogen is a hormone and helps to protect against bone loss. At the age of 50, about 2 in 100 women have osteoporosis. This rises to 1 in 4 women at the age of 80. However, osteoporosis can also affect men.
Who is at risk of osteoporosis?
All men and women have some risk of developing ‘thinning’ of the bones (osteoporosis) as they become older, particularly over the age of 60. As mentioned above, women are more at risk than men. The following situations may also lead to excessive bone loss and so increase your risk of developing osteoporosis. If you:
- Are a woman and you had your menopause before the age of 45.
- Have already had a bone fracture after a minor fall or bump.
- Have a strong family history of osteoporosis (that is, a mother, father, sister or brother affected).
- Have a body mass index (BMI) of 18.5 or less (that is, you are very underweight) – for example, if you have anorexia nervosa. In this situation, your levels of oestrogen are often low for long periods of time and, combined with a poor diet, this can affect bones.
- Are a woman and your periods stop for six months to a year or more before the time of your menopause. This can happen for various reasons. For example, over-exercising or over-dieting.
- Have taken, or are taking, a steroid medicine (such as prednisolone) for three months or more. A side-effect of steroids is to cause bone loss. For example, long-term courses of steroids are sometimes needed to control arthritis or certain other conditions.
- Are a smoker.
- Have an alcohol intake of more than four units per day.
- Lack calcium and/or vitamin D (due to a poor diet and/or little exposure to sunlight).
- Are not very mobile. For example if you have to use a wheelchair, or are confined to a bed or chair and unable to get about.
What can I do to prevent osteoporosis?
The following may help to prevent, or slow down, bone loss. This advice is for everyone. However, it is particularly important if you are at increased risk of developing ‘thinning’ of the bones (osteoporosis). If you already have osteoporosis, the following measures can also help to try to slow down any bone loss.
Exercise
Exercise can help to prevent osteoporosis. The pulling and tugging on the bones by your muscles during exercise help to stimulate bone-making cells and strengthen your bones. Regular weight-bearing exercise throughout life is best but it is never too late to start. This means exercise where your feet and legs bear your body’s weight, such as brisk walking, aerobics, dancing, running, etc. For older people, a regular walk is a good start. However, the more vigorous the exercise, the better. For most benefit you should exercise regularly – aiming for at least 30 minutes of moderate exercise or physical activity at least five times per week. (Note: because swimming is not weight-bearing exercise, this is not so helpful in preventing osteoporosis.)
Muscle strengthening exercises are also important. They help to give strength to the supporting muscles around bones. This helps to increase tone, improve balance, etc, which may help to prevent you from falling. Examples of muscle strengthening exercises include press-ups and weight lifting but you do not necessarily have to lift weights in a gym. There are some simple exercises that you can do at home.
Food and diet
Calcium and vitamin D are important for bone health. Your body needs adequate supplies of vitamin D in order to take up (absorb) the calcium that you eat or drink in your diet. The recommended daily intake for calcium in adults over the age of 50 is at least 1000 mg per day.
Calcium – you can get 1000 mg of calcium most easily by:
- Drinking 600ml of milk a day (this can include semi-skimmed or skimmed milk); plus
- Eating 50 g (2 oz) of hard cheese such as Cheddar or Edam, or one pot of yoghurt (125 g), or 50 g of sardines.
Bread, calcium-fortified soya milk, some vegetables (curly kale, okra, spinach and watercress) and some fruits (dried apricots, dried figs and mixed peel) are also good sources of calcium. Butter, cream, and soft cheeses do not contain much calcium. You can check how much calcium you eat with an online dietary calcium calculator. There are several available calcium calculators for this online.
There is a possibility that taking calcium supplements when you have enough calcium in your diet might cause other problems such as heart disease. Therefore, it is best not to take calcium supplements without first discussing this with your doctor.
Vitamin D – there are only a few foods that are a good source of vitamin D. Approximately 115 g (4 oz) of cooked salmon or cooked mackerel provide 400 IU of vitamin D. The same amount of vitamin D can also be obtained from 170 g (6 oz) of tuna fish or 80 g (3 oz) of sardines (both canned in oil). Vitamin D is mainly made by your body after exposure to the sun. The ultraviolet rays in sunshine trigger your skin to make vitamin D. This may not provide as much vitamin D as you need. It is estimated that 31% of Australian adults are Vitamin D deficient. A similar proportion have inadequate dietary calcium intake.
If you are unsure about whether you should have calcium and/or vitamin D supplements, ask your practice nurse or GP.
Smoking and drinking
Chemicals from tobacco can get into your bloodstream and can affect your bones, making bone loss worse. If you smoke, you should try to make every effort to stop. Also, you should try to cut down on your alcohol intake if you drink more than fourteen units of alcohol per week.
Hormone replacement therapy
Hormone replacement therapy (HRT) contains oestrogen. A few years ago, HRT was widely used to prevent osteoporosis. However, the studies on the possible long-term health risks of HRT have meant that it is now not commonly used for this purpose alone (except in women who have had an early menopause). This is because of the small increased risk of breast cancer if HRT is used in the long term.
Osteoporosis treatment
If you have ‘thinning’ of the bones (osteoporosis) but have not had a fragility fracture, your doctor will be able to advise whether or not treatment is recommended in your case. They may use a special risk calculator to look at your risk of having a fragility fracture, to help with this decision. This incorporates things such as:
- Your age.
- Your bone density measurements on a DXA scan.
- Any history in your family of hip fracture.
- How much alcohol you drink.
- Whether you smoke.
- Your BMI.
- Whether you have other medical conditions such as rheumatoid arthritis.
If you are found to have osteoporosis and you have already had a fragility fracture, medication is usually recommended to help prevent a further fracture.
If treatment is started, repeat DXA scanning on a regular basis may be suggested to look at how effective treatment is. Lifestyle measures and prevention of falls are important for all people with osteoporosis.
Inverell Pharmacy – your locally owned and operated pharmacy at 132 Byron Street (next to Telstra). Phone 0267 223146.