Osteoporosis has been called the “silent disease” as those suffering from it are unaware of the condition. Only when they experience a fracture, does it become apparent that they have weak and fragile bones as it is only through x-rays and bone density tests that this disease can be diagnosed.
A condition of increased susceptibility to fractures due to fragile bones, where bones become porous like a sponge and can snap when put under stress which in normal individuals with normal bone density would not occur.
It has been estimated in an American Surgeon General Report that by 2020 half of all Americans over 50 will have weak bones unless they make some serious lifestyle changes. The statistics for the rest of the world don’t look much better.
The most common areas where fractures are likely to occur are the spine, hips, ribs and wrists.
Causes
Bones are living organs, with cells and body fluids, which are constantly renewed and grow stronger with a good diet and physical activity. The amount of calcium, amongst other elements, in the body determines how strong they are. If the body needs calcium for normal functioning, and there is not enough free calcium available, it will be taken from the bones. Calcium is deposited and withdrawn from the bones daily, but be careful that the withdrawal of calcium is not more than what is being deposited. Just like a banking account, the body will go into overdraft when the savings account is empty and this puts the body at risk of developing osteoporosis.
Our bodies deposit calcium efficiently until about the age of 30, then basically stop adding new bone, and this is when healthy habits can help a person keep the bone strength they have.
Risk factors
- Being of the female gender puts a person at risk, mainly due to the oestrogen levels in the body, which decrease during and after menopause and which have been shown to help prevent osteoporosis.
- Caucasians and Asians have a higher risk, and a small and thin body frame doesn’t help.
- A family history of osteoporosis should alert a person to going for regular bone density tests, especially after the age of 40, but even earlier would be a good idea.
- Lifestyle choices such as smoking, excessive alcohol consumption, poor nutrition, lack of exercise and a diet low in calcium will add to the risk profile.
- In men low testosterone levels will put them at risk.
- People who exercise vigorously and have low body fat, or those suffering from anorexia nervosa.
- Chemotherapy can cause early menopause due to the toxic effects on the ovaries.
- Lack of calcium and vitamin D would be a more obvious cause, but this is preventable.
- Certain medicines such as long term use of heparin, phenytoin or oral corticosteroids.
Symptoms
Osteoporosis can be present without any symptoms for decades because there are no symptoms until a bone fractures. When these occur, pain is the most likely symptom and the location of the pain depends on the fractured bone. For example, a fracture of the vertebra in the spine can cause a lower back pain as well as a loss of height due to the curving of the spine where the vertebrae have collapsed. In older females this appears as a hunched back and is often called a dowager’s hump.
Hip fractures typically occur after a fall and these may have difficulty healing after surgical repair because of the osteoporosis that is present.
Diagnosis
As stated above, only routine x-rays or bone density tests can reveal the problem. It is apparent on the x-rays that the bones are thinner and lighter than normal bones, and they are not the most accurate indicators of bone density. A (DXA)DEXA scan is considered more accurate and will measure bone density in the hip and the spine. It is a short procedure, painless and quite precise. Bone density tests, or ‘T-scores’ express bone density in terms of the number of standard deviations below peak young adult bone mass and osteoporosis is diagnosed if the T score is -2.5 or below.
Bone Density
Recommend that the following people should be tested:
- All postmenopausal women below age 65 who have risk factors for the disease.
- All women over 65 years of age.
- Postmenopausal women who have had fractures.
- Although less prevalent in men, if osteoporosis is suspected as a result of medication or lifestyle, they should be tested.
Treatment
Lifestyle changes would be the first part of the treatment as it will have a variety of benefits, not only for osteoporosis, but for general health as well. Currently weight bearing exercise, such as daily walking, is recommended. Caution should be taken to ensure that the exercise is mild and will not put any additional strain on the bones. Other changes such as stopping smoking, limiting alcohol intake and a healthy diet would be beneficial.
Supplements
Building strong and healthy bones needs regular calcium intake and should start in childhood and especially during the fast growing teenage years when the body is depositing calcium in the bones. There are various recommendations on optimum calcium intake, but in general the consensus is:
- 800 mg/day for children aged 1-10 years of age
- 1 000 mg/day for men, premenopausal women and postmenopausal women also taking oestrogen.
- 1 200 mg/day for teenagers and young adults (11-24 years)
- 1 200 – 1500 mg/day for pregnant and women who are breastfeeding
- Postmenopausal women not taking oestrogen should take about 1 500 mg/day.
- Calcium intake should not exceed 2 000 mg/day and no additional benefit can be seen when a person does exceed this dosage.
This can be part of a person’s daily diet, or can be taken as supplements to ensure adequate calcium intake.
Information on the calcium content of most foods is available on the packaging, but dairy products contain more calcium than most other foods.
Most of the supplements available are a combination of calcium carbonate, vitamin D, magnesium and some other elements, but vary in strength and combinations. Calcium supplements are safe and generally well tolerated and the most well known brands are Caltrate Plus®, Calcium Sandoz®, B Cal D® and B Cal Ultra®, but there are many other brands available as well.
Vitamin D is usually one of a good calcium supplement’s ingredients and has been shown in some studies to help, in conjunction with calcium, increase bone density. Vitamin D comes from sunlight, but often elderly people, or those living in colder climates, do not get enough exposure to sunshine and thus there can be a deficiency.
Hormone Therapy
Oestrogen after menopause has been shown to help prevent bone loss and increase bone density, and is available orally, but can only be prescribed by a doctor and certain tests are needed. There are potential risks involved here and should be a personal decision after discussion with their health care practitioner.
Other medication
There are other medicines available that are antiresorptive agents which decrease the removal of calcium from bones. All of these need certain tests and can only be prescribed by a doctor. However, people should be aware that there are choices that can be made to increase a person’s bone density.
In essence, bone density can be improved in most cases once a diagnosis of osteoporosis has been made, and that is good news. Supplements or medication alone should not be the only change that is made. Most people should make some lifestyle changes from couch potato to healthier living, it’s just a matter of reorganizing a few things to find some time for it.
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