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eMedical Features 

This Week's Topic


1 July 2007

Osteoporosis means 'bones with holes'. Bones become less dense, lose strength and break (fracture) more easily due to calcium loss. Most people show no signs of developing osteoporosis until a fracture occurs. Breaks are most common in the spine, hip and wrist and often occur after only a minor fall. The disease particularly affects women in their middle and later years.

Osteoporotic fractures of the spine cause loss of height, pain and gradual development of the 'Dowager's hump'. This hump is caused by a compression of the spinal fractures due to the force of gravity.

About your bones
Bone is formed by specialised cells. Like the rest of the body, bone is constantly being broken down and renewed. Bone is living tissue that needs exercise to gain strength, just like muscle.

In the early years of life, more bone is made than is broken down, resulting in bone growth. By the end of your teens, bone growth has been completed and 'peak bone mass' achieved.

Sex hormones, such as oestrogen and testosterone, have a fundamental role in maintaining bone strength in men and women. The fall in oestrogen blood levels that occurs during menopause results in accelerated bone loss. During the first five years after menopause, the average woman loses up to 10 per cent of her total body bone.

Risk factors for osteoporosis
Several factors can place a person at risk of osteoporosis. Risk factors include:

* Family history of osteoporosis (mother, sister or grandmother)
* Inadequate amounts of dietary calcium
* Low vitamin D levels
* Cigarette smoking
* Alcohol intake of more than two standard drinks per day
* Caffeine intake of more than three cups of tea, coffee or equivalent per day
* Lack of physical activity
* Early menopause before the age of 45
* Loss of menstrual period if it is associated with reduced production of oestrogen, which is vital for healthy bones. The menstrual cycle can cease following excessive dieting and exercise
* Long-term use of medications such as corticosteroids for rheumatoid arthritis and asthma.

Some conditions place people at a higher risk of osteoporosis. These conditions include:

* Thyroid disease or an overactive thyroid gland
* Rheumatoid arthritis
* Chronic liver and kidney disease
* Conditions that affect the body's ability to absorb nutrients, such as Crohn's disease, coeliac disease and other inflammatory bowel conditions.

Preventing osteoporosis
Both men and women can take steps from a young age to prevent osteoporosis by ensuring they:

* Have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains
* Eat calcium rich foods
* Absorb enough Vitamin D
* Avoid smoking
* Limit alcohol consumption
* Limit caffeine
* Do regular weight bearing and strength training activities.

A varied and calcium rich diet is the key
We need calcium to build and maintain strong and healthy bones, help our muscles work and support our nervous system. Good sources of calcium include:

* Dairy foods - low fat varieties are available to reduce the risk of weight gain or raised cholesterol levels
* Canned fish with edible bones - for example, sardines.

The minimum recommended daily intake of dietary calcium is:

* Infants and children - 700mg calcium per day
* Adolescents - 1300mg calcium per day
* Young women - 1000mg calcium per day
* Postmenopausal women - 1300mg calcium per day.

Adequate vitamin D
Vitamin D levels are increased with sun exposure. People who are housebound or who dress with most of their body covered are at risk of vitamin D deficiency. Up to 22 per cent of Australian women have inadequate levels of vitamin D during winter months. All that is needed is 10 minutes of sun exposure to the arms and face daily, without sunscreen and not through glass. This exposure is safest before 11am or after 3pm.

Avoid smoking
Evidence has shown that smokers have a lower bone density. Nicotine is known to be toxic to bone cells.

Limit alcohol intake
Excessive alcohol consumption is associated with the development of osteoporosis. Restrict your alcohol intake to no more than four standard drinks a day (for men) and two standard drinks a day (for women). Both men and women should have at least two alcohol-free days each week.

Reduce caffeine intake
A large amount of caffeine (more than two to three cups per day of cola, tea or coffee) has also been associated with an increased risk of osteoporosis.

Do regular weight bearing and strength training activities
You should exercise at least 30 minutes three to four times a week to maintain healthy bones. Recommended activities are:

* Walking
* Jogging
* Tennis
* Dancing
* Using weights.

The most reliable way to diagnose osteoporosis is to measure bone density using a DEXA scan. This is done with x-ray technology; this involves minimal radiation, is accurate and can be used to follow up treatment.

Ultrasound tests are available at many pharmacies and involve an ultrasound measurement of the heel. These tests are not as accurate in assessing for osteoporosis as a DEXA study and are not recommended by doctors.

Treatment - hormone therapy
All treatments for osteoporosis are aimed at preventing fractures. Oestrogen replacement at menopause prevents bone loss and fractures, but the effect lasts only as long as oestrogen is used.

Oestrogen is used to prevent fractures mainly for younger women with premature menopause. This is because most fractures do not occur until after the age of 65 and long-term oestrogen use is not recommended.

It's never too late for treatment
If you have osteoporosis, it is never too late to seek treatment. Treatment can halt bone loss and significantly reduce the risk of fractures. It is important that your doctor excludes other medical conditions that can cause osteoporosis, including vitamin D deficiency.

Medications and treatments are available to strengthen bones and prevent fractures by slowing down bone loss. They may improve bone density in women with osteoporosis after the menopause. The range of available medical treatments includes:

* Bisphosphonates
* Selective oestrogen receptor modulators (SERMs)
* Hormone therapy (HT)
* Potential therapies, including Tibolone (Livial) and parathyroid hormone
* Vitamin D derivatives and calcium supplements.

Falls are a risk for people with osteoporosis
For people with osteoporosis, even minor trauma - such as coughing, knocks on the limbs and simple falls - can lead to fractures. Falls are a particular problem in the elderly as they are often more likely to result in fractures, particularly of the hip. Any fracture occurring from minimal trauma should be investigated as it may indicate underlying osteoporosis.

There are several ways to minimise your risk of falls. It may be necessary to see a physiotherapist and/or occupational therapist to provide assistance with walking aides and ensure your home environment is safe. Talk with your doctor or contact your community health centre to find the services you need.

Where to get help

* The Jean Hailes Medical Centre for Women Tel. (03) 9562 7555
* Your doctor
* Local community health service
* Specialised women's health clinic.

Things to remember

* Osteoporosis occurs when bones lose their density and strength.
* A healthy lifestyle throughout life (adequate dietary calcium and regular physical activity) can help prevent osteoporosis.
* Oestrogen replacement helps maintain bone density in women with premature menopause.
national osteoporosis foundation (usa)

Rating: 4
Description: Osteoporosis is a disease in which bones become fragile and more likely to break. This site from the US National Osteoporosis Foundation is a comprehensive source of information on osteoporosis.There is also basic medical information at http://www.nof.org/osteoporosis/stats.htm, tips for prevention, news for patients, as well as listing of international support groups. In summary, this site is well worth a visit.

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