Osteoporosis means porous bones. Bones affected by osteoporosis are less dense than normal bones. They are also more likely to break, even as a result of a minor bump or fall, or even without an injury. It is around four times more common in women than men, and most common in women who have been through the menopause. About three million people in the UK are affected - one in three women and one in 12 men over the age of 50. Each year there are around 70,000 hip, 120,000 spine and 50,000 wrist fractures due to osteoporosis. What is osteoporosis?
The inside of a bone consists of a strong mesh made of protein and minerals (particularly calcium). This mesh is living tissue that is constantly being renewed by a process called bone turnover. Old, worn out bone is broken down and absorbed by the body while, at the same time, new bone tissue is created from fresh protein and minerals. In children and young people, more new bone is created than is broken down. This makes bones bigger and more dense. The bones are at their strongest when the peak bone mass is reached, and this usually occurs in a person's mid-twenties. Peak bone mass is then maintained for about ten years, with roughly equal amounts of bone creation and breakdown. After the age of about 35, bone loss begins to overtake creation as part of the normal aging process. With osteoporosis, the process happens much more quickly, leading to premature bone weakness. Dr C A Speed BMedSci, MA, Dip Sports Med, PhD, FRCP, FFSEM Consultant in Rheumatology, Sport & Exercise Medicine c/o Cambridge Centre for Health and Performance As well as bones, such as the wrist or hip, breaking more easily than usual, osteoporosis can result in small fractures of the bones in the spine. This can cause a curved back and a loss of height. Low levels of oestrogen
The female hormone oestrogen reduces the amount of bone that is broken down and so helps to protect against osteoporosis. In women, the ovaries make oestrogen from puberty to the menopause. Any condition that reduces the number of years that a woman produces oestrogen tends to increase the risk of osteoporosis. These risks include: having an early menopause (before the age of 45), an early hysterectomy (before the age of 45, especially if both ovaries are removed), missing periods for six months or more as a result of over-exercising or over-dieting (especially due to anorexia). Other risk factors
Men who have low levels of the male hormone, testosterone, are also at a higher risk of osteoporosis. For both men and women, the following factors also increase the risk of developing osteoporosis: Long-term use of steroid tablets
A family history of broken hips,
Digestive disorders that affect absorption of nutrients, such as Crohn's disease
or ulcerative colitis,
Lack of exercise Moderate weight bearing exercise keeps the bones strong
during childhood and throughout adulthood. Anyone who does not exercise, or
has an illness or disability which makes exercise difficult, will be more prone
to losing calcium from the bones, and so more likely to develop osteoporosis.
Exercise is therefore very important in preventing osteoporosis.
Excessive exercise: Those who exercise very intensively, in particular
endurance athletes with low body weight, are at an increased risk of
osteoporosis at ceetain sites in their body. This may result in frequent stress
fractures or poor healing of sports injuries, in addition to overt bone fracture.
Males and females can be affected, although the condition is more frequently
diagnosed in females. See The Female Athlete Triad for further information.
Poor diet A diet which does not include enough calcium or vitamin D can
make osteoporosis more likely (see below).
Dr C A Speed BMedSci, MA, Dip Sports Med, PhD, FRCP, FFSEM Consultant in Rheumatology, Sport & Exercise Medicine c/o Cambridge Centre for Health and Performance Heavy smoking Tobacco lowers the oestrogen level in women and may cause
early menopause. In men, smoking lowers testosterone activity and this can
weaken the bones.
Heavy drinking A high alcohol intake reduces the ability of the body's cells
to make bone.
Low body weight.
Osteoporosis has been called the "silent disease". Most people affected are unaware that their bones are thinning until they experience a break, or notice more gradual signs such as height loss, or curvature of the spine (sometimes known as "dowager's hump"). The bones most likely to break as a result of osteoporosis are the hip, wrist and the vertebrae of the spine. Prevention
People who reach a high peak bone density when they are young are less likely to develop osteoporosis. Bone density can be boosted by a healthy diet and regular exercise, particularly in people under 35. This means prevention needs to begin at a young age. A varied, well-balanced diet is important to build and maintain healthy bones. A combination of bread and cereals, fruit and vegetables, milk and diary products, and protein (from meat, fish, eggs, pulses, nuts and seeds) should provide the nutrients that your body needs. Foods rich in calcium are especially valuable for healthy bones. Good sources include milk and diary products, such as cheese and yogurt. The body needs vitamin D to absorb calcium properly. About 15-20 minutes of daylight on the face and arms during the summer months will enable the body to store enough vitamin D for the rest of the year; you don't need to sunbathe. Vitamin D is also available in foods such as margarine and oily fish. If you are watching your weight it's worth knowing that skimmed or semi-skimmed milk actually contains more calcium than full-fat milk. We recommend a daily intake of calcium of 1000 milligrams (mg) or 1500 mg if you are over 60. A pint of milk a day, together with a reasonable amount of other foods which contain calcium, should be sufficient (see Table 1). Dr C A Speed BMedSci, MA, Dip Sports Med, PhD, FRCP, FFSEM Consultant in Rheumatology, Sport & Exercise Medicine c/o Cambridge Centre for Health and Performance Vitamin D is needed for the body to absorb calcium. Vitamin D is produced
by the body when sunlight falls on the skin, and it can be obtained from the
diet (especially from oily fish) or vitamin supplements (see arc booklet
'Osteomalacia'). For people over 60 it may be helpful to take a supplement
containing 10–20 micrograms (µg) of vitamin D.
0.2 litre (1/3 pint) calcium-enriched soya milk 125 g (41/2 oz) calcium-enriched soya yogurt Exercise
Exercises for Osteoporosis are very important and ideally should be customised
to suit your needs.

Weight-bearing exercise helps to promote bone formation and bone health. Good exercises include running, skipping, aerobics, tennis, weight-training and brisk walking. Ideally, try to do this type of activity three times a week for at least 20 minutes. Lifestyle
Smoking can have a harmful effect on bone and can also cause an early menopause. If you smoke, try to give up. You should also be careful not to drink too much alcohol. Dr C A Speed BMedSci, MA, Dip Sports Med, PhD, FRCP, FFSEM Consultant in Rheumatology, Sport & Exercise Medicine c/o Cambridge Centre for Health and Performance Diagnosis
The condition can be suspected by identifying risk factors during a consultation with your doctor. A scan (DEXA scan) will measure the density of the bones, typically lumbar spine and hip. How can osteoporosis be treated?
Apart from the preventative measures already described there are other treatments available if you have osteoporosis. These may slow down the loss of bone or reduce the risk of fractures. Calcium and vitamin D: As mentioned earlier, people over 60 may benefit
from taking small daily amounts of vitamin D, along with 1500 mg of
calcium. Stronger vitamin D preparations are also commonly used.
It should be noted that Vitamin D insufficiency is a common problem in
many individuals.
For more information on Vitamin D, click here.
Bisphosphonates: This group of drugs works by slowing bone loss; in many
people, an increase in bone density can be measured over 5 years of treatment.
Both alendronate (Fosamax) and risedronate (Actonel) reduce the risk of
hip and spine fractures in patients with osteoporosis. Bisphosphonates can be
administered by tablet form or by an intravenous infusion. The oral form of
the drugs cannot be taken with food, and specific instructions on how to take
the tablets are provided as they can cause irritation of the gullet. They are
available either as daily-dose tablets or weekly-dose tablets. The infusions
have the advantage of possible greater effectiveness, and some can be given
just once a year. They are particularly useful in those who have difficulty with
taking weekly tablets. Etidronate (Didronel) is a slightly weaker drug of the
same group, which is well tolerated and is taken in 3-month cycles.
Hormone replacement therapy (HRT):Women who have been through the
menopause may consider using hormone replacement therapy to reduce their
menopausal symptoms. HRT is only beneficial for bones while it is being
used. A very large clinical trial reported in 2002 that using the commonest
type of HRT tablet is associated with a reduction in fracture, but also with an
increase in the risk of heart disease and breast cancer. It can also increase the
risk of venous thrombosis. If you are considering long-term HRT use, discuss
the potential risks and benefits with your doctor.
Selective estrogen receptor modulators (SERMs): As previously
mentioned, the hormone oestrogen helps to keep the bones strong. Raloxifene
is a SERM which mimics this effect and reduces spine fractures. It
also reduces the risk of breast cancer without increasing the risk of heart
disease. It is taken by mouth once a day without the need to follow special
instructions. It may cause side-effects like menopausal 'flushing' and, as with
HRT, may increase the risk of venous thrombosis.
Dr C A Speed BMedSci, MA, Dip Sports Med, PhD, FRCP, FFSEM Consultant in Rheumatology, Sport & Exercise Medicine c/o Cambridge Centre for Health and Performance Calcitonin (Miacalcic): Calcitonin is a substance which the body produces
naturally and which helps keep the bones healthy. When used as a treatment it
has enabled the bones of people with osteoporosis to grow stronger. Calcitonin
can only be given in the form of an injection or by nasal spray. Injections of
calcitonin are normally given only as a short-term treatment for painful
vertebral fractures, but the nasal spray may be used as a long-term treatment
for osteoporosis. Possible side-effects include hot flushes, nausea, an
unpleasant taste in the mouth, tingling in the hands and, rarely, an allergic
reaction. The nasal spray may also cause a blocked or runny nose, sneezing
and headaches.
Teriparatide (Forsteo): Teriparatide is an effetive drug which helps new
bone to form and therefore reduces the risk of fractures. It is taken by daily
injection into the thigh or tummy (patients are shown how to do this
themselves). It is used for up to 18 months, during which time the bones are
strengthened. At present it is used mainly for people who have had fractures
despite using other treatments, or who have had side-effects from other
treatments. Side-effects of teriparatide include nausea, limb pain, headaches
and dizziness, but because it is a new drug the long-term side-effects are not
Further information
National Osteoporosis Society
Arthritis Research Campaign
Dr C A Speed BMedSci, MA, Dip Sports Med, PhD, FRCP, FFSEM Consultant in Rheumatology, Sport & Exercise Medicine c/o Cambridge Centre for Health and Performance

Source: http://www.progresshealth.co.uk/pdfs/Osteoporosis.pdf


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