The Medical Perspective by Dr. Nelda Frater

Osteoporosis or “porous bone” is a condition in which fragile bones fracture easily, there is shrinkage in height and back pains. The fractures occur most frequently in the wrist, spine or hip. Osteoporosis is common. It is found in 1 in 3 women and 1 in 20 men.

Bone strength is partly genetic. Women have thinner bones then men. Young women who lose a lot of weight or diet repeatedly, or women who exercise excessively, are particularly at risk. In addition, menopausal women or those who have an early menopause i.e. before age 45 years, are prone to osteoporosis. In general, anyone, male or female with low calcium intake or remains immobile for a long time, heavy drinkers, heavy smokers, those taking water tablets (diuretics), or those on long term steroid treatment, are also at greater risk of fractures.

Each year in the UK population there are approximately:

60,000 hip fractures

40,000 spine fractures

50,000 wrist fractures.

The DEXA Scan

The world health organisation has stated that those people requiring treatment for osteoporosis, should demonstrate low bone mass, as shown by bone mineral density measurements of the hip with a DEXA scan. To achieve this measurement, bone mineral density (BMD) of the patient’s hip is measured with a DEXA scan, and this result is compared with that of a normal young adult’s result. This measurement is awarded a T-score.

A DEXA T-Score of ≤ -2.5 confirms osteoporosis. In fact, any measurements between -1.0 and -2.5 are deemed to confirm the diagnosis of osteoporosis

Underlying Disease Conditions

It is imperative to look for any underlying disease condition, which could be the cause of osteoporosis in men. These include:

What can you do to minimise your risk of osteoporosis?

1. Seek advice from you GP if you are on long term steroid therapy as the dose could possibly be adjusted.
2. Discuss your problems with your GP if you are anorexic or have bulimia, as treatment is possible.
3. Reduce your smoking and try to stop if you are a smoker.
4. Be careful that your diet does not exclude foods rich in calcium, as you may not be getting enough calcium which is needed for healthy bones.
5. Exercise regularly. Bones need exercise to remain strong (see below)
6. Enjoy walks. People who remain constantly indoors seldom get enough exposure to sunlight which makes vitamin D in the skin and this is essential for bone health.

How can osteoporosis be treated?

Once identified, medical treatment of this condition includes the bisphosphonates for established disease and raloxifene which both treats and reduces the incidence of vertebral (spine) fractures. Strontrium improves bone strength and reduces the risk of vertebral and hip fractures, whilst, Calcitonin (salmon) helps to maintain bone mass and treat osteoporosis. In addition to these drug therapies, both calcium and vitamin D3 are important for preventing bone loss.

Nutrition and Exercise by Ann Mather

Nutrition

A varied, well-balanced diet is important to build and maintain healthy bones. Foods rich in calcium are especially valuable for healthy bones.

Whilst we typically turn to dairy products for our calcium, it is not clear that dairy products are really the best source. Whilst calcium and dairy can lower the risk of osteoporosis and colon cancer, high intake can increase the risk of prostate cancer and possibly ovarian cancer. In addition, dairy products can be high in saturated fat as well as retinol (Vitamin A) which at high levels can weaken bones. It is therefore recommended that dairy is balanced with non dairy. Good, non dairy sources of calcium include collards, bok choy, other green leafy vegetables, broccoli, tofu, canned fish with bones, spinach, rhubarb, calcium fortified soya products, and calcium fortified breakfast cereals.

Your body also needs vitamin D to absorb calcium properly, so you need calcium and vitamin D together to make and maintain healthy bones. The best source of vitamin D is exposure to sunlight - 15 to 20 minutes of sun exposure, three to four times each week from April to September will create the vitamin D your body needs for the year. You don't need to sunbathe to get enough sunlight - going outside with bare face and arms should be enough, but not for more than 20 minutes without protectoin. You should take care not to burn and also stay out of the sun in the middle of the day when the sun's rays are at their strongest. Vitamin D is naturally present in very few foods, but can be found in oily fish, eggs, and fortified fruit juices.

The following decrease calcium intake:

Exercise

Recent studies have shown that the risk of osteoporosis is lower for people who are active, and especially those who do load-bearing, or weight-bearing activities at least three times a week.

Muscle pulling on bone builds bone, so weight-bearing exercise builds denser, stronger bones. The more bone mass you build before age 25 or 30, the better off you will be during the years of gradual bone loss. Exercise can also help you maintain bone density later in life.

The best exercises for building bone are weight- or load-bearing exercises. These include weight-lifting, jogging, hiking, stair-climbing, step aerobics, dancing, racquet sports, and other activities that require your muscles to work against gravity. Swimming and simply walking, although good for cardiovascular fitness, are not the best exercises for building bone. Thirty minutes of weight-bearing exercise daily benefits not only your bones, but improves heart health, muscle strength, coordination, and balance. Those 30 minutes don't need to be done all at once; it's just as good for you to do 10 minutes at a time.

If you already have osteoporosis, you might wonder whether you should exercise at all. The answer for most people is YES. You should speak to your doctor to learn what types of exercises you can safely do to preserve bone and to strengthen your back and hips. Keep in mind, however, that exercise alone can't prevent or cure osteoporosis.

Exercise Tips:

Put LIVE into action!

L - Load or weight-bearing exercises make a difference to your bones
I - Intensity builds stronger bones.
V - Vary the types of exercise and your routine to keep interested.
E - Enjoy your exercises. Make exercise fun so you will continue into the future!