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Osteoporosis literally means ‘bones with holes’. It occurs when bones lose minerals such as calcium more quickly than the body can replace them. They become less dense, lose strength and break more easily.
Most people don’t realise they have osteoporosis until a fracture happens, as there are usually no signs or symptoms. This is why osteoporosis is often called the ‘silent disease’. Osteoporosis particularly affects women in their middle and later years, although some men are also affected.
If you have osteoporosis, lifestyle changes and medical treatment can prevent further bone loss and reduce your risk of bone fractures.
Osteoporosis and bone growth
Bone is formed by specialised cells. Like the rest of the body, bone is constantly being broken down and renewed. It is living tissue that needs exercise to gain strength, just like muscle. In the early years of life, more bone is made than is broken down, resulting in bone growth. By the end of your teens, bone growth has been completed and by about 25 to 30 years of age, ‘peak bone mass’ is achieved.
Sex hormones, such as oestrogen and testosterone, have a fundamental role in maintaining bone strength in men and women. The fall in oestrogen that occurs during menopause results in accelerated bone loss. During the first five years after menopause, the average woman loses up to 10 per cent of her total body bone mass.
Fractures of the spine caused by osteoporosis can lead to pain, loss of height and changes in posture, such as the ‘dowager’s hump’. This hump is caused when spinal fractures are compressed due to the force of gravity, resulting in an abnormal bending of the spine (kyphosis).
Symptoms of osteoporosis
Osteoporosis causes no specific pain or symptoms. However, it does increase the risk of serious or debilitating fractures. If you think you may be at risk of developing osteoporosis, see your doctor.
Diagnosis of osteoporosis
Currently, the most reliable way to diagnose osteoporosis is to measure bone density with a dual-energy absorptiometry scan or DXA. A DXA scan is a short, painless scan that measures the density of your bones, usually at the hip and spine, and in some cases, the forearm.
You can qualify for a Medicare rebate for a DXA scan if you:
have previously been diagnosed with osteoporosis
have had one or more fractures due to osteoporosis
are 70 years or over
have a chronic condition including rheumatoid arthritis, coeliac disease or liver disease
have used corticosteroids for a long time.
Your doctor will be able to tell you whether you fit the criteria to receive a Medicare rebate. It is possible to have a DXA scan performed if you do not fit the criteria for the Medicare rebate, however, there will usually be an out-of-pocket cost associated with the scan.
Risk factors for osteoporosis
There are many risk factors for osteoporosis, some of which you cannot change, such as being female, and having a direct relative who has had an osteoporotic fracture.
Other risk factors include:
inadequate amounts of dietary calcium
low vitamin D levels
cigarette smoking
alcohol intake of more than two standard drinks per day
caffeine intake of more than three cups of tea, coffee or equivalent per day
lack of physical activity
early menopause (before the age of 45)
loss of menstrual period if it is associated with reduced production of oestrogen, which is vital for healthy bones (the menstrual cycle can cease following excessive dieting and exercise)
long-term use of medications such as corticosteroids for rheumatoid arthritis and asthma.
Some conditions place people at a higher risk of osteoporosis. These conditions include:
thyroid disease or an overactive thyroid gland
rheumatoid arthritis
chronic liver and kidney disease
conditions that affect the body’s ability to absorb nutrients, such as Crohn’s disease, coeliac disease and other inflammatory bowel conditions.
Prevention of osteoporosis
Both men and women can take steps from a young age to prevent osteoporosis by making sure that they:
have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains
eat calcium-rich foods
absorb enough vitamin D
avoid smoking
limit alcohol consumption
limit caffeine
do regular weight-bearing and strength-training activities.
Calcium-rich diet and osteoporosis
Enjoying a healthy, balanced diet, with a variety of foods and an adequate intake of calcium, is a vital step to building and maintaining strong, healthy bones. If there is not enough calcium in the blood, your body will take calcium from the bones. Making sure you have enough calcium in your diet is an important way to preserve your bone density.
It is recommended that the average Australian adult consumes 1,000 mg of calcium per day. Postmenopausal women and men aged over 70 years are recommended to have 1,300 mg of calcium per day. Children, depending on their age, will need up to 1,300 mg of calcium per day.
Dairy foods have the highest levels of calcium, but there are many other sources of calcium including sardines, spinach and almonds. If you are unable to get enough calcium from your diet alone, you might need to talk to your health professional about calcium supplements.
Vitamin D and osteoporosis
Vitamin D and calcium promote bone density. Vitamin D is important because it helps your body absorb the calcium in your diet. We obtain most of our vitamin D from the sun, and there are recommendations for the amount of safe sun exposure for sufficient vitamin D production, depending on your skin type, geographical location in Australia and the season.
Vitamin D can also be found in small quantities in foods such as:
fatty fish (salmon, herring, mackerel)
liver
eggs
fortified foods such as low-fat milks and margarine.
For most people, it is unlikely that adequate quantities of vitamin D will be obtained through diet alone. Talk with your health professional about vitamin D supplements if you are concerned that you are not getting enough vitamin D.
Exercise to prevent osteoporosis
Weight-bearing exercise encourages bone density and improves balance so falls are reduced. It does not treat established osteoporosis. Consult your doctor before starting a new exercise program, especially if you have been sedentary, are over 75 years of age or have a medical condition.
General recommendations include:
Choose weight-bearing activities such as brisk walking, jogging, tennis, netball or dance. While non-weight-bearing exercises, such as swimming and cycling, are excellent for other health benefits, they do not promote bone growth.
Include some high-impact exercise into your routine, such as jumping and rope skipping. Consult your health professional – high-impact exercise may not be suitable if you have joint problems, another medical condition or are unfit.
Strength training (or resistance training) is also an important exercise for bone health. It involves resistance being applied to a muscle to develop and maintain muscular strength, muscular endurance and muscle mass. Importantly for osteoporosis prevention and management, strength training can maintain, or even improve, bone mineral density. Be guided by a health or fitness professional (such as an exercise physiologist) who can recommend specific exercises and techniques.
Activities that promote muscle strength, balance and coordination – such as tai chi, Pilates and gentle yoga – are also important, as they can help to prevent falls by improving your balance, muscle strength and posture.
A mixture of weight-bearing and strength-training sessions throughout the week is ideal. Aim for 30 to 40 minutes, four to six times a week. Exercise for bone growth needs to be regular and have variety.
Lifestyle changes guard against osteoporosis
Be guided by your doctor, but general recommendations may include:
Stop smoking – smokers have lower bone density than non-smokers.
Get some sun – exposure of some skin to the sun needs to occur on most days of the week to allow enough vitamin D production (but keep in mind the recommendations for sun exposure and skin cancer prevention).
Drink alcohol in moderation – excessive alcohol consumption increases the risk of osteoporosis. Drink no more than two standard drinks per day and have at least two alcohol-free days per week.
Limit caffeinated drinks – excessive caffeine can affect the amount of calcium that our body absorbs. Drink no more than two to three cups per day of cola, tea or coffee.
Management of osteoporosis
If you have osteoporosis, the strategies listed to prevent osteoporosis will help to manage the condition, but you may also need to consider:
safer exercise options
falls prevention
medication.
Safer exercise options with osteoporosis
If you have osteoporosis, the risk of a fracture (break) with high-intensity exercise and poorly performed strength training can outweigh the bone-building benefits of these exercises. The best approach is to have an exercise program put together specifically for you by a physiotherapist or exercise physiologist.
The program may include:
modified strength-training exercises
weight-bearing exercise such as brisk walking
gentle exercises that focus on posture and balance.
Falls prevention
A third of people aged over 65 fall every year and six per cent of those falls lead to a fracture. Reducing the risk of falls is important.
Be guided by your doctor, but general recommendations include:
Perform exercises to improve your balance as prescribed by a physiotherapist or exercise physiologist.
Wear your prescription glasses as directed by your optician.
‘Trip proof’ your home – for example, remove loose rugs, install handrails in the shower and toilet, and make sure all rooms are well lit. An occupational therapist can assist with this.
Wear sturdy flat-heeled shoes that fit properly.
Consider wearing a hip protector. This is a shield worn over the hip that is designed to spread the impact of a fall away from the hi
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