Bone density reduces to some degree in all people as they age. Osteoporosis is a condition where the bones become excessively thin and weak, such that there is a greater risk of fractures. It affects more than 50% of women and about 30% of men over 60 years, as well as a few younger people. Osteoporosis is also called the ‘silent disease’ as it can develop without any symptoms, until you find you have broken a bone.

What is osteoporosis?

Bone density reduces to some degree in all people as they age. Osteoporosis is a condition where the bones become excessively thin and weak, such that there is a greater risk of fractures. It affects more than 50% of women and about 30% of men over 60 years, as well as a few younger people. Osteoporosis is also called the ‘silent disease’ as it can develop without any symptoms, until you find you have broken a bone.

How does bone grow?

Bone is a living tissue that grows in a porous mesh-like structure. Throughout life the body breaks down old bone and rebuilds new bone in a continuous cycle. We gain bone by building more than we lose.

Bones contain the protein collagen and minerals such as calcium and phosphorus, which make the collagen hard and dense. To maintain bone density, the body needs adequate calcium and other minerals and certain levels of hormones, including oestrogen in women and testosterone in men. Vitamin D is also needed so the body can absorb calcium from food and incorporate it into bones.

Interior of healthy bone. Interior of thin, porous bone.

How does bone become thinner?

Bones grow more and more dense until around the age of 20. After about 40, bone loss occurs slightly faster than it is replaced and bones slowly become less dense.

In women, after the menopause, the ovaries stop releasing eggs and the level of oestrogen decreases. Over many years, low oestrogen causes the inner mesh of bones to become thinner, weaker and more brittle. In men, this can happen if there is too little testosterone.

Am I at risk for osteoporosis?

Some people are more at risk than others. The following risk factors are linked to having osteoporosis, or getting it later on. The more of these that apply to you the more important it is to discuss osteoporosis with your doctor:

  • being female
  • previous fracture due to osteoporosis
  • family history of osteoporosis
  • being aged 50 years or older
  • being past the menopause
  • having your ovaries removed or reaching menopause before the age of 45
  • being thin or ‘small boned’
  • White (Caucasian) or Asian ancestry
  • too little calcium in your diet – less than four servings of dairy products a day
  • smoking
  • alcohol (more than four standard drinks a day)
  • less than 30 minutes outdoors in sunlight each day
  • less than 30 minutes of physical activity each day
  • long term use of some medications, such as steroids (eg, cortisone, prednisone) or anticonvulsants.

The last six of these are the risk factors you can modify or have some control over throughout your life to reduce the chances of osteoporosis in old age. For osteoporosis, prevention is far more successful than treatment.

How can my doctor help?

Your doctor can assess your risk for osteoporosis from your medical history and by asking you about your lifestyle. Physical signs that you may have weak bones include previous fractures (often of the wrist, hip or spine), a loss of height or stooping, and a curved spine. If your doctor doubts their strength you may need a bone density scan (a type of x-ray) to check this.

What can be done about osteoporosis?

If you have weak bones there are practical steps you can take in consultation with your doctor – these depend on your age, gender, medical history and the degree of bone thinning. These measures will help you avoid a fracture and maintain your quality of life. Unfortunately, once you have had one osteoporotic fracture, you are more likely to have others.

Weight-bearing exercise, such as walking or climbing stairs, can help bone become denser. It is a good idea to start this after having a check up with your doctor. Stopping smoking and drinking only moderate amounts of alcohol also helps prevent further bone loss.

To reduce your risk of injury in day to day life:

  • plan your movements
  • avoid straining your back or falling by, for example, wearing slip-proof shoes, putting slip-proof mats in the bath and shower, and always holding handrails
  • be careful when lifting, bending or reaching
  • use any cane or walker correctly and consistently
  • if you fall, make sure you are unhurt before moving
  • if you fall, ask your doctor to check your health; your sight or medications may need checking.

Treatments for osteoporosis

There is no complete cure for osteoporosis, but there are supplements and medicines that can increase bone thickness and reduce fracture risk. You can talk to your doctor about these before deciding which to try.
Calcium supplementation – typically 1000mg daily – slows bone loss but does not usually stop it completely (loss of bone calcium is common in old age). A 250ml glass of milk contains about 300mg calcium – older people may find taking calcium tablets easier than having four dairy portions a day.

Vitamin D (calciferol) supplementation can correct vitamin D deficiency, which is common in older people who are seldom outdoors. Vitamin D helps you absorb the calcium in your diet and your bones to utilize it.

Calcitriol is also a form of vitamin D that helps the body absorb calcium and incorporate it into bone. Supervision by a doctor is needed as it can raise calcium too much.

Hormone replacement therapy (HRT) is a long-established treatment for osteoporosis in women with low oestrogen levels (usually due to the menopause) and is available as a pill, patch, implant and cream. HRT can be oestrogen alone or with a progestogen hormone to balance the effect on the womb (uterus). HRT increases bone density and probably reduces fracture rates, but a return of menstrual symptoms and risks associated with blood clotting or breast and uterus cancer may make it unsuitable for some women. Men with low testosterone levels may benefit from testosterone replacement.

Bisphosphonates are bone-specific medicines (not hormones) that increase bone density and prevent fractures to a similar extent as HRT. They can sometimes cause indigestion.

 

www.naturalsolutionsradio.com  is intended as an educational tool only. A physician or healthcare provider, is essential to diagnose conditions and supervise the use of any medications to treat individual health problems. This website is not intended to be used as a substitute for professional medical care. You should seek the best medical resources available to help make informed medical decisions.

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