Osteoporosis - Boost Your Bone Health Today

Like a good bottle of wine, we can all expect to get better with age. Or we'd like to think so! But it pays to plan for a long and healthy life by looking after your bones. Here's how you can reduce the risk of developing osteoporosis.

What is osteoporosis?

Osteoporosis is a condition in which bones become fragile and brittle, leading to a higher risk of fractures than in normal bone. It occurs when there is a loss of bone mineral density. In Australia, someone is admitted to hospital every five to six minutes with an osteoporotic fracture and this figure is expected to rise to every three to four minutes by the year 2021, as the population ages.

Osteoporosis is often called the ‘silent disease' as there are usually no signs or symptoms until a fracture occurs, most commonly in the hip, wrist, spine, ribs and pelvis. One in two women and one in three men over 60 years will have an osteoporotic fracture in Australia.

The risk factors

Osteoporosis risk factors fall into two categories: modifiable and fixed. Modifiable risk factors arise because of unhealthy diet or lifestyle choices, including:

• Poor nutrition
• Low body mass index
• Eating disorders
• Alcohol
• Smoking
  
• Insufficient exercise

Fixed risk factors are those that one is born with or cannot change, including:

• Age
• Gender - hormonal changes at menopause make it more common in women
• Family history
• Previous fracture
• Race / ethnicity - Caucasian and Asian peoples are more prone.
• Menopause / hysterectomy
• Low testosterone in men

Secondary factors including diseases and conditions such as rheumatoid arthritis and asthma, and medications like corticosteroids or high-dose thyroid hormone treatment, can have a negative impact on bone health.

How you can ‘beat the break'

Professor Peter Ebeling, Head of Endocrinology at Melbourne's Western Hospital, says the key is to identify whether you are at risk, and to consider strategies to prevent the onset of osteoporosis with your GP.

As a guide, Prof. Ebeling suggests the following prevention plan for the 50-plus age group, based on the latest research published in Medicine Today in January 2007 and in the Osteoporosis Australia Calcium, Vitamin D and Osteoporosis Guide (2nd Edition).

Calcium intake of 1000mg a day (or 1300mg a day if you are a woman over the age of 50 or a man over the age of 70, or suffer osteoporosis).

Adequate intake of vitamin D - the current recommendation is at least 400 -800IU a day.

Weight-bearing exercise. Walking is not enough; you will need to incorporate short bursts of higher intensity exercise including stepping, skipping, jumping, dancing, or medium-impact aerobics four times per week.

Resistance exercise - weight lifting or strength training. You will need to lift and lower light-to-moderate weights slowly to target specific muscle groups.

For the 70-plus age group, Prof. Ebeling advises participation in exercise like tai chi to improve balance. If you're at home, try balancing while placing a pillow under your feet, or tandem walking, also known as heel-to-toe walking.

Bear in mind it is important to seek professional guidance before starting any exercise program.

How is osteoporosis diagnosed and treated?

If you have suffered a fracture or are concerned about your risk of developing osteoporosis, make an appointment with your GP and ask for a bone density scan. A Medicare rebate applies in certain circumstances.

If you are diagnosed with osteoporosis, your GP or specialist will discuss which medication is most suitable for you.

Medications available for treating osteoporosis include:

Bisphosphonate - a non-hormonal drug which helps increase bone density and reduce spinal, non-spinal and hip fractures in women and men.

Selective Oestrogen Receptor Modulators or SERMS - strengthen bones and reduce the risk of spinal fractures, but without increasing the risk of cancer of the breast or uterus in women.

Strontium Ranelate - treats osteoporosis in post-menopausal women, reducing the risk of spine and non-spine fracture.

Teriparatide - an injection administered daily for the treatment of advanced osteoporosis. It is not covered by the Pharmaceutical Benefits Scheme (PBS).

When taking any new medication, it's important to make sure you understand:

• Why you are taking it
• How you take it
• Any possible side effects
• What to do if any side effects occur

Useful links

Osteoporosis Australia: www.osteoporosis.org.au
National Prescribing Service: www.npsradar.org.au

Falls prevention

As we age, all of us should pay particular attention to conditions that could potentially lead to falls - and increase our risk of developing osteoporosis - because a history of fracture puts us a greater risk of further fractures.

Reduce your risk of falling by:

• Seeing your doctor if you have any problems with eyesight, balance or walking.
• Reviewing your medication with your doctor, particularly if you are taking three or more.
  
• Assessing your home for any hazards such as cluttered furniture and debris; slippery floors; poor lighting; loose floor coverings like rugs; and uneven paths outside your home.
• Wearing safe, supportive shoes.
• Being as physically active as possible to maintain muscle strength, bone strength and flexibility.
• Making sure your walking aid, if you use one, has rubber stops to prevent slipping.

Osteoporosis Case Studies

Kerry (58)

Executive Kerry believes ‘bad genes' are responsible for her developing osteoporosis; her mother, who passed away in 2004, suffered crippling osteoporosis - the simple task of turning on a tap would leave her with broken bones. This prompted Kerry to have a bone density test five years ago, which revealed her spinal density was "going downwards."

Describing the condition as "a scary disease," Kerry says the lack of treatment options and conflicting information are a constant frustration. She has been taking Actonel for the past four months but is very wary of its long-term effects. Instead, Kerry is hoping to manage her condition naturally and is in the process of finding as much information as she can about how magnesium and vitamin D impact the regrowth of bone.

Kerry now lives with back pain day-to-day. She has joined a gym where she does weight-bearing exercise, and walks for an hour three times a week, but admits she should be doing more. Then again, Kerry is cautious about doing too much because a friend of hers, who also suffers osteoporosis, has been walking 10 kilometres a day for 10 years in an effort to maintain her bone health and she's now got a crushed vertebra. Kerry says most people associate osteoporosis with a ‘thin' body shape; the fact that she's not ‘thin' highlights the condition doesn't discriminate.

Looking to the future, Kerry is open to learning more about the condition from both the perspectives of traditional medicine and alternative therapy. She hopes her experience will prompt others to be proactive about bone health, even if they think they're not high risk.

Julie (60)

Like Kerry, Julie feels she was predisposed to developing brittle bones because her father suffered osteoporosis. She currently has the condition osteopenia or low bone density, which is considered a precursor to osteoporosis. At the moment, Julie is trying to prevent it "going into the zone" of osteoporosis but concedes she is "on a slippery slope."

Julie has been on the medication Fosamax - a bisphosphonate drug - for five years. She says it's considered the "Rolls Royce" of the medications available but is not "totally convinced" it is right for her. The problem, she says, is that no one really knows if there are any side effects and you're not likely to know until it's too late.

In saying that, Julie believes your life is your responsibility so all you can do is take all the advice on board and make a decision that best suits your situation. According to Julie, the trouble is what's good in medicine today is often not good tomorrow so she views the opinions of specialists as a guide only.

Being of a slight build herself, Julie says it makes sense people who "don't have a lot of weight on their bones" are more prone to developing bone density problems. To maintain bone strength, she regularly participates in Pilates and body balance but knows she should also be doing more walking because "walking is weight on bones."

As for the future, Julie hopes there will be advances in medicine to reduce the rate of bone mineral loss. She advises others to be diligent in recognising risk factors because osteopenia and osteoporosis are "quiet diseases" whereby many sufferers don't realise they have it until they fall, which is often too late.

 

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