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 youve got it? And if youve 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
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 Crohns, coeliac
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
Dont 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
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.
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.
National Osteoporosis Society www.nos.org.uk
British Nutrition Foundation www.nutrition.org.uk
1 scoop (8.2 grams)
Calories per 100ml of drink: 1.5