What is it?

What causes it and can it be prevented?

Is there any treatment once it has been established?

Did you know that you can influence your teenager’s chances of becoming osteoporotic?

Osteoporosis is a common problem in postmenopausal women, although it can also happen to younger people as well as to men. It literally means thinning of the bones, and usually starts around the age of 40, with loss progressing at 1-2% per year after age 50; it is related to both hereditary and lifestyle factors such as family history, smoking, diet, and body weight. There may be no symptoms until a bone breaks, usually in the spine or hip, with often serious consequences. Multiple spinal fractures cause the bent back so familiar in the elderly.

Bone density can be measured by DEXA (dual-energy x-ray absorptiometry), which measures bone density at the sites at which major fractures are likely to occur in the spine and hip. This test is painless and can be performed in about 15 minutes.

The maximum bone density i.e. the thickest bone is reached by age 35. This is affected 60% by your genes, and 40% by environmental factors such as diet, so it is essential to take in enough calcium in the pre adolescent and adolescent years, when most growth takes place, to protect from later problems. In post menopausal women bone calcium is lost at a rate of 300mg/day, which must be replaced in the diet.

How can you minimise this bone loss?

 Eat plenty of green leafy vegetables such as broccoli, kale, bok- choi, Brussels’ sprouts etc, which are rich in both calcium and Vitamin K.  [Spinach is a poor source of calcium due to its oxalate content, which prevents calcium absorption in the intestine.]

  Ensure that you eat or drink dairy produce, at least 1 cup daily. Soy products are also an excellent source of calcium, and also contain phyto estrogens, which may retard bone loss.

 Sardines, pilchards and salmon are rich sources of both calcium and essential omega-3 fats.

  In South Africa sufficient Vitamin D is usually manufactured by sun exposure under normal circumstances, requiring approximately 15-20 minutes of unprotected exposure every day. Vitamin D deficiency becomes a problem in those that are house-bound, those who cover their bodies for religious reasons, and dark skinned people living in Europe, where the sun is rarely seen. It is wise and easy to test Vitamin D levels with a blood test.

 Weight bearing exercise such as brisk walking, will help retain bone density as well as the many other health benefits of exercise. When combined with anaerobic exercise such as lifting weights, it also slows down muscle loss after menopause.

  • Alcohol, excess caffeine and smoking all decrease bone density, so should be taken in moderation [-cigarettes not at all!].
  • Carbonated cool drinks are very high in phosphates, which can lead to loss of calcium from the bones, and they should therefore also be avoided.

What about supplements?

  1. Calcium: Post menopausal women should take at least 1200mg calcium per day. All calcium supplements are well absorbed from the intestine, although calcium carbonate may cause constipation. Calcium should not be taken at the same time as phytate or oxalate containing foods which may interfere with its absorption.

If a mineral supplement is also being taken, it should be taken separately as the iron and zinc may also interfere with calcium absorption.

2. Magnesium: Post menopausal women should take at least 320mg Magnesium per day. Many calcium supplements also contain magnesium.

3.Trace minerals are also required, and a good multivitamin and mineral supplement should be used.

What treatment is available if I have osteoporosis?

There are several drugs used in both prevention and treatment:

Biphosphonates are the most common drugs of which several preparations exist in the South African market. They must be taken with a full glass of water at least 30 minutes before the first meal of the day and you may not lie down during this period, as they can irritate the lining of the oesophagus and cause severe heartburn. Weekly therapy is generally preferred for its greater convenience and fewer side effects. These drugs are not suitable for people with certain conditions of the oesophagus or stomach, pregnant or nursing women, people with low levels of calcium in the blood or people with severe kidney disease.

Hormone replacement therapy (HRT) is used in the prevention and treatment of osteoporosis as oestrogen replacement helps maintain bone density in women. This is most effective when started within four to six years after menopause, but starting it later can still slow bone loss and reduce the risk of fractures. Use of oestrogen increases the risk of venous clotting disorders and endometrial cancer, and may increase the risk of breast cancer.

Calcitonin is rarely used for the treatment of osteoporosis and only as a second-line drug. It may be used in osteoporosis patients who develop acute painful vertebral collapse, as it prevents further bone loss during the period of immobilisation, which it also shortens. It may be taken by injection or nasal spray and needs to be used with adequate calcium and vitamin D.

Parathyroid hormone (teriparatide) is rarely used in the treatment of established osteoporosis as it is expensive, but seemingly effective if given daily by injection for an average of 20 months.

Testosterone: Men do not benefit from oestrogen but may benefit from testosterone replacement therapy if their testosterone level is low.

Strontium ranelate is used as first line treatment in younger patients under 60 years.

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