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Osteoporosis in later life

Article published Jan 2004

Osteoporosis – brittle bone disease

Osteoporosis currently affects 1 in 3 women over the age of 50 in the UK.

How can you avoid it? How do you know if you’ve got it? And if you’ve been taking HRT, what do you do now?

HRT, Hormone Replacement Therapy, has for many years been the first choice of treatment by many doctors for osteoporosis. Following recent reports on long-term risks, it is now considered best as a short-term treatment only for menopausal symptoms such as hot flushes, night sweats and vaginal dryness. This is because of possible risk of breast cancer, blood clots and strokes. But HRT is not the only treatment. There are several alternatives.

Everything you need to know about osteoporosis:

What is osteoporosis?

Osteoporosis means literally ‘porous bone’, where the strong lattice-like structure of bone (comparable to a sponge like structure) thins and becomes literally porous and open, more like lace.

Osteoporosis often results in fractures, pain, anxiety, a loss of independence and sometimes death. It is estimated that forty people die in the UK from these fractures each day, and that it currently costs the NHS £1.5 billion a year in hospitalisations and treatment. Not only do 1 in 3 women over 50 develop osteoporosis, but 1 in 12 men do so too.

What causes bone loss?

Our bones are continually renewing themselves in a process where old bone is removed and replaced by new and healthy bone material. Until we reach our thirties be build bone faster than we lose it, but after this, the rate at which we lose bone is faster than we can replace it. Bone loss is a natural and gradual process, but the speed with which it happens is determined partly by genes, partly by lifestyle. It is only when we lose too much bone that we go on to develop osteoporosis.

What are the symptoms?

Osteoporosis is a ‘silent’ problem. It gives no clue to its presence until a slight bump, knock or fall produces a fracture. Osteoporosis usually accelerates after the menopause. Fewer men develop osteoporosis because they tend to build stronger, and more dense bones when they are younger, giving a greater ‘reserve’ of bone strength to be drawn on in later years.

How can it be diagnosed?

A bone scan, carried out at a menopausal clinic or the doctor’s surgery, can reveal any bone loss. Check the risk list below, and ask your GP to arrange a scan if you think you are at special risk.

  • Does/ has anyone in your family had osteoporosis?

  • Do you smoke, or have you been a heavy smoker?

  • Did you exercise very little when you were younger?

  • Do you currently exercise infrequently or not at all?

  • Do you /have you avoided dairy products as part of watching your weight or as a result of a dietary intolerance?

  • Do you have any of the following medical conditions?

    • An early menopause or hysterectomy

    • Liver or thyroid problems

    • Digestive absorption problems (eg Crohn’s, coeliac disease)

    • A health problem treated by steroids

If the answer to any of these questions is ‘yes’, then you may have an increased risk of developing osteoporosis and you should start to take active steps to keep your bones healthy - it’s never too late to start! If in doubt, talk to your GP.

How to protect against osteoporosis

Diet, exercise, supplements such as calcium and minerals all help to protect against osteoporosis. A diet containing a variety of vitamins and minerals is essential for bone health. Calcium and magnesium are two key building blocks of bone material, and our intake of these and other nutrients directly affect our rate of bone formation and loss. If we draw on reserves of calcium and don’t get regular replenishment for a long time, bones can become brittle as the rate of bone loss is increased. Foods containing good supplies of calcium are milk, including skimmed milk, and all dairy products, such as cheese and yoghourt. There is a fair amount of calcium in watercress and sardines.

There are many other substances required for bone development and maintenance such as vitamins B6 and B12, D, K and C, plus minerals magnesium, copper and phosphorus, and also boron. All play a part in keeping bones healthy. See below for details about a supplement containing these nutrients.

Things you can do to help keep your bones healthy

  • Keep exercising regularly - it helps to maintain bones. Weight-bearing exercises like walking, rowing, tennis are good

  • Don’t smoke

  • Don’t drink to excess – too much alcohol damages the process of bone turnover

  • Ensure you are eating enough calcium, magnesium and Vitamin D

  • If you avoid dairy foods for any reason, compensate with other sources of calcium

  • Consider taking a daily bone health supplement

HRT and other medical treatments

If you are currently taking HRT for osteoporosis, you should discuss your situation with your GP. There are effective alternatives to HRT for osteoporosis which can be prescribed.

  • SERMs (Selective Estrogen Receptor Modulators) are new generation of synthetic hormone replacement, known to reduce the risk of osteoporosis and heart disease, but do not appear to have the increased risk of cancers associated with traditional HRT. Raloxifene is a SERMs licensed for the prevention and treatment of osteoporosis in post-menopausal women.

  • Calcitonin is a hormonal injection that prevents the osteoclasts (cells that break down bone) from working properly, so allowing the osteoblasts (bone building cells) to work more efficiently. One form, Salcatonin (Calsynar) is licensed for the treatment of post-menopausal women. The injection may also be given to men who have started to develop the disease, to inhibit release of calcium from the bone. The injection has a pain-killing effect, and can be used for a short time after a spinal fracture.

  • Biphosphonates are a non-hormonal treatment that work by turning off the osteoclasts, so allowing the osteoblasts to work more efficiently. There are three types; Cyclical disodium etidronate (Didronol PMO) with calcium carbonate which is used for osteoporosis of the spine; Alendronate sodium (Fosamax), which has a similar action to etidronate, and claims to be effective at reversing osteoporosis at other important bones as well; and finally risedronate (Actonel). Both the etridonate and alendronate are licensed for the treatment of osteoporosis caused by corticosteroids and for the prevention of osteoporosis in women who have low bone mass.

  • Calcitriol is a synthetic form of active vitamin D, for the absorption of calcium, and is used for the treatment of osteoporosis of the spine.

  • Teriparatide is a new treatment (marketed as Forsteo) used to strengthen bones and reduce risk of broken bones. Teriparatide is the first treatment to renew the skeleton by stimulating the osteoblasts which form new bone, as against other available treatments which work by suppressing the action of the osteoclasts which break down bone. It is designed for women with severe osteoporosis or those that haven't responded to other treatments. It is given as a subcutaneous injection (just under the skin into the fatty layer) by the individual on a daily basis. If you are prescribed this treatment, you will need a healthcare professional such as a nurse to instruct you on how to use the pen injection device. According to the National Osteoporosis Society, post menopausal women who have had spinal fractures could see real benefits. They hope that future research might one day show that it can also help men.


Women going through the menopause are often recommended to increase their calcium intake to 1500 mg per day, which can be difficult to obtain without the help of supplements.

Calcium supplementation is slightly effective in decreasing bone loss in women who have passed through the menopause more than 5 years previously, but is not an effective treatment on its own. Calcium supplements taken at the same time as HRT can, however, reduce the oestrogen dose required for HRT.

A combined calcium and vitamin D supplement may be particularly useful. Extra calcium is not advisable for those with a history of kidney stones so if this applies you should discuss taking calcium with your GP.

Product of the Month: CalMag

CalMag Tropical™ is a new supplement drink which contains a selected blend of calcium, magnesium, vitamins and trace minerals to help keep bones healthy and strong

CalMag Tropical has been carefully designed and balanced to produce optimum delivery of calcium. In order for the body absorb calcium, it needs to be dissolved in a slightly acidic environment. CalMag Tropical, which is in powder form, to be dissolved in water, delivers the ideal level of pH (providing a slightly tangy, refreshing taste) for rapid absorption. This also ensures that all of the powder is fully dissolved without mixing, with no chalky or gritty residue to consume. CalMag Tropical contains four different forms of elemental calcium, two types of magnesium, vitamin D and other selected vitamins and trace minerals.

N.B. A daily dose of two scoops of CalMag could provide too much calcium and vitamin D if you are already taking a multivitamin supplement. Vibrant Life, suppliers of CalMag, say that in such cases, a single daily scoop would be sufficient.

Nutricentre2.jpg (19300 bytes)Discuss this with your doctor or practice nurse if you have any doubts.

CalMag Topical costs £14.95 for a 492g tin, sufficient for 30 two-scoop daily servings.

Vibrant Life CalMag Tropical is available from The Nutri Centre - click on the logo to enter the Nutricentre.

Further Information  

National Osteoporosis Society

British Nutrition Foundation  

Vibrant Life CalMag Tropical  


Serving Size: 1 scoop (8.2 grams)

Servings per container: 60

Average Calories per 100ml of drink: 1.5  




Amount Per Serving

RDA% Adults

Amount Per  Day

RDA% Adults

Principle Ingredients






Calcium: from  

  • calcium lactate  

  • calcium citrate  

  • calcium carbonate  hydroxide  

  • calcium glycerophosphate  


400 mg




800 mg




150 mg


300 mg


Vitamin D

2.5 mg


     5 mg


Thiamin (B1)

0.7 mg


1.4 mg


Riboflavin (B2)

0.8 mg


1.6 mg



9 mg


18 mg


Vitamin B6

1 mg


2 mg


Pantothenic Acid

3 mg


6 mg


Vitamin B12

0.5 mg


1 mg







Trace minerals 






20 mg


40 mg



100 mg


200 mg



20 mg


40 mg


Food Supplements should not be used as a substitute for a balanced and varied diet, and are not medicines or intended to diagnose, treat, cure, or prevent any disease. Persons with health problems or concerns should always consult their medical practitioner for advice and guidance.



laterlife interest

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