Everything you need to know about Osteoporosis

Osteoporosis is a disease where bones become weak and can fracture more easily than normal bone (for example from a minor bump or fall). It is associated with low bone mineral density (BMD).

Throughout life, new bone is added to the skeleton and old bone is taken away – a process called remodelling. One of the most important bone minerals is calcium. Bones require calcium for strength and bones also act as a storage bank for calcium in the body. That is why we need adequate daily calcium to replenish calcium needs, otherwise the body will snatch calcium stored in bones for other essential functions (e.g. blood and nerves). People naturally lose some bone density as they age (particularly women at time of menopause) but with osteoporosis serious bone loss results in a high risk of fractures. Peak bone mass is reached by the mid 20’s so it is important to support growing bones.

Osteoporosis can affect any bone but the most common fracture sites are hip, spine and wrist. Many people do not know they have osteoporosis until a bone fracture occurs. In some cases of Osteoporosis, there may be no symptoms at all before a fracture, and in other cases, there may be pain in bones or muscles, especially in the back region.

There are a number of important risk factors for osteoporosis including:

  • Family history of Osteoporosis.
  • Lack of calcium intake.
  • Low vitamin D levels.
  • Lack of exercise.
  • Excessive alcohol intake/smoking.

Certain medications and conditions also have an influence:

  • Fracture from a minor bump/fall (over age 50).
  • Corticosteroid use (commonly prescribed for asthma).
  • Malabsorption Disorders e.g. Coeliac disease.
  • Inflammatory Conditions e.g. Rheumatoid Arthritis.
  • Early menopause in women and low testosterone in men.
  • Certain cancer treatments.
  • Certain anti-epileptic drugs.
  • Liver or kidney problems.

Treatment options

Osteoporosis is usually diagnosed with a Bone Density Test, a simple scan. The treatment for Osteoporosis varies according to each patient and the causes of their osteoporosis. In most cases, lifestyle changes such as dietary changes, specific exercises and the avoidance of certain substances such as excess alcohol are required. Your Doctor may also recommend dietary supplements such as calcium and vitamin D, which help maintain bone strength if dietary intake is inadequate.

Various medications are available to help slow bone loss and in some cases build bone. Treatment is usually prescribed in combination with calcium and vitamin D.

Always consult your Doctor regarding the diagnosis and treatment of Osteoporosis.

Dietary hints:

  • Calcium. Good Sources include dairy products (milk, cheese, yoghurt), canned sardines, salmon, green leafy vegetables (broccoli, spinach), almonds, tofu (calcium set), eggs, oranges, whole grains and some cereal.
  • Vitamin D. Sources include sunlight acting on the skin. Some fortified foods.

Your diet should be low in:

  • Phosphorus (soft drinks).
  • Caffeine.
  • Avoid excessive alcohol /caffeine /salt.

Prevention is better than cure:

Three key elements for eventing Osteoporosis and maintaining healthier bones include:

  1. Calcium
    Adequate daily calcium. 1 000mg for adults, increasing to 1 300mg for women over 50 and men over 70. Dietary intake is important and for people who do not have adequate intake, supplementation is recommended.
  2. Vitamin D
    From safe sun exposure and from some fortified foods. For people with low vitamin D levels or vitamin D deficiency, supplementation may be required
  3. Exercise
    There are 2 main types of exercise that assist bone health:

    1. Weight-bearing exercise (which means in a standing position) e.g. brisk walking, netball, basketball, tennis, jogging, skipping and dancing.
    2. Resistance exercise with gym equipment or hand/ankle weights.

Up to 30 minutes of weight-bearing and resistance exercise 4 to 6 times per week can help maintain and strengthen bones. Exercise for improving balance, co-ordination and muscle strength can reduce risk of falls e.g. walking in a straight line (heel-to-toe), standing on one leg and Tai Chi.

People with diagnosed osteoporosis should consult their doctor or physiotherapist before commencing an exercise program.

Pharmacist’s advice

  1. Stop smoking. Ask your Pharmacist for suggestions. Smoking may reduce bone density.
  2. Limit intake of alcohol, salt and caffeine as these can impact on bone health. Ask your Pharmacist for advice about reducing these in your diet.
  3. Up to 30 minutes of weight bearing and resistance exercise 4 to 6 time per week.
  4. Discuss calcium intake and vitamin D with your Pharmacist. These are essential for your bone health
  5. People with inadequate calcium in their diet may require supplements. A supplement of 500 to 600mg calcium is suggested if the person cannot or does not consume the recommended daily sources of calcium.
  6. Vitamin D is also necessary for strong bones. The body synthesises this vitamin from sunlight. A nutritional supplement of vitamin D may be required by people who have little exposure to sunlight.