Osteoporosis

The Markland Clinic Cotswold Leisure Centre Tetbury Road, Cirencester GL7 1US

Tel: 01285 654059www.marklandclinic.comwww.sportsperform.co.uk

What is Osteoporosis? The bones that make up our skeleton are constructed of a thick outer shell with an inner ‘honeycomb’ mesh made of tiny struts of bone. With osteoporosis, some of these supporting struts become thin, causing the bone to become weaker and more fragile, and thus more likely to break after what would normally be a minor break or fall. Such broken bones are sometimes called ‘fragility fractures’.

Although these fractures can occur in any part of the body, the most commonly affected areas are the wrist, hip and spine. These thin and fragile bones are not painful in themselves, but the broken bones that can result can cause pain and other problems.

Although it's often thought of as a women's disease, osteoporosis affects men too – half of women over 50 in the UK and a fifth of men are likely to experience bone fractures, and this is mainly as a result of osteoporosis.

Your BonesYour bones are made up of calcium salts and other minerals and collagen (protein), both creating the structure of a thick outer layer and the honeycomb mesh inside. Throughout your lifetime, old, worn bone is broken down and replaced by new bone; bone is alive and constantly replacing itself, although a process that takes just two years to complete in children takes up to ten years in adulthood. And although bones have usually stopped growing in length by the age of 18, bone density continues to increase into the mid-20s.

The balance between bone demolition and bone construction then remains stable until the age of about 35, when bone loss increases very gradually as part of the natural ageing process.  For women, this bone loss becomes more rapid for several years following the menopause which can lead to osteoporosis and an increased risk of broken bones, especially in later life.

Consequences of osteoporosis If you have osteoporosis, it doesn’t automatically mean that your bones will break, but it does mean that you have a ‘greater risk of fracture’. And osteoporosis does not generally slow down or stop the healing process once a fracture has occurred. The older we get, the greater our risk of breaking a bone, however there are precautions we can take to limit the damage that osteoporosis can cause. It's never too late — or too early — to do something about osteoporosis. You can take steps to keep your bones strong and healthy throughout life.

Who is at risk of osteoporosis and broken bones?There are several factors that can put us at a higher risk of developing osteoporosis:

GENERAL RISK FACTORS

Genetics - The genes we inherit from our parents have a strong effect on our own bone structures. If one of your parents has broken a hip, you may be more susceptible to developing osteoporosis and fragile bones.

Gender - Women have smaller bones than men and they also experience the menopause, when the ovaries almost stop producing oestrogen, reducing the protection it gives to their bones.

Race - People of Black Afro Caribbean descent are at a lower risk of osteoporosis as they tend to have bigger, stronger bones. You're at greatest risk of osteoporosis if you're white or of Asian descent.

Age - As bone density decreases in later life, about half of people will have osteoporosis by the age of 75.

Low body weight - If you have a low BMI (body mass index) you are at greater risk of developing osteoporosis.

MEDICAL CONDITIONS THAT INCREASE YOUR RISKOF OSTEOPOROSIS

Rheumatoid arthritis

A hysterectomy with removal of ovaries (before the age of 45) and other conditions which affect the hormones in your body (such as gender reassignment), and reduce the protective effects of oestrogen and testosterone.

Anorexia nervosa

Hyperthyroidism (levels of the thyroid hormone are abnormally high) 

Conditions such as Crohns or coeliac disease which affect the absorption of food (therefore preventing your healthy diet protecting you)

Various conditions that lead to long periods of immobility (so reducing the opportunity for weight-bearing exercise)

Organ transplants

Respiratory diseases

Diabetes

HIV (AIDS)

MEDICINES THAT INCREASE YOUR RISK OF OSTEOPOROSIS

Corticosteroid tablets (steroids) if they are taken for other medical conditions for over three months

Anti epileptic drugs

Some breast cancer treatments such as aromatase inhibitors

Prostate cancer drugs that affect either the production of the male hormone testosterone or the way it works in the body.

OTHER RISK FACTORS INCREASING THE LIKELIHOODOF OSTEOPOROSIS

Other risk factors increasing the likelihood of osteoporosis:

Smoking – current smokers are more likely to break bones. Stopping smoking can lower this risk.

Alcohol - intake of more than 3 units daily. Cutting down your alcohol intake can lower this risk.

Falling – older people who are at risk of falling are more likely to have fractures especially of the hip after the age of 75 years. So it's important to maintain balance and co-ordination for as long as possible, by keeping active and reducing risks in the home.

If you think you are at risk…You can't see or feel your bones getting thinner, so many people are unaware of a problem they might have until they break a bone or start to notice a loss of height. If you think you have risk factors for osteoporosis then it's a good idea to discuss this with your GP.You can be referred for a dual energy x-ray absorptiometry (DEXA) scan to measure your bone density, and then possibly drug treatment to strengthen your bones.

Parts of the body commonly affected by OsteoporosisWRISTS

A broken wrist is often the first indication that you have osteoporosis. They often occur in middle aged women who have put out their arm to break a fall; healthy bones should be able to cope with many falls, but a fragile bone will fracture at this point.

HIPS

Osteoporosis can lead to broken hips; this happens most in our late 70s or 80s. They happen as a result of a fall and can affect all aspects of life; and the fear of falling can often lead older people to

become less active, therefore often less steady on their feet and more prone to trips and falls.

SPINAL BONES

Fractures due to osteoporosis of the bones in the spine occur when the bones become compressed because of their reduced strength.

A ‘compression fracture’ can happen in different ways, including 'wedge' fractures which can tip the spine forward, causing an outward curve (kyphosis) and possible loss of height and curvature, which can cause further problems with the internal organs.

It is rare for these fractures to affect the spinal cord with consequent loss of sensation or paralysis, but the problems they can cause can still be significant.

Building healthy bones and preventing fracturesOsteoporosis becomes more common as bone density and strength decreases with age.  Poor balance and co-ordination in the older patient can lead to a higher risk of falls, and thus a higher risk of fracture. The way we live our life in the first place, lifestyle changes and keeping active can help to prevent falling and fractures. And if the risk of fracture does become high, there are drug treatments available that strengthen bones and lower the risk.

One way to think about keeping our bones strong is to imagine a ‘bone bank’, made up of the bone we accrue in the early part of our life, and the withdrawals made from it as ageing takes its toll. Although genetics decide the potential height and strength of our skeleton, the way we live our life can also play a part in the amount of bone we invest in our bone ‘bank’ during our youth and how much we save in later life.

When the skeleton is growing, during childhood through to early adulthood, it is vitally important to maximise bone strength. This can, and should, be done in a variety of ways, for example eating a healthy, balanced and calcium-rich diet and taking plenty of load-bearing exercise. ‘Banking’ plenty of bone in these ways, in these early years and beyond, puts the skeleton

in a better position to withstand the natural losses that come with age.

A HEALTHY DIET

Everyone's body contains about a kilogramme of calcium, 99% of which is stored in our bones. Of course, it's important to eat plenty of calcium to help build and maintain healthy bones, but there are other vitamins and minerals which are also important. A balanced diet including a wide variety of foods will ensure you take in the correct nutrients to protect and maintain good health throughout your life.

Food Standards Agency recommendations for a healthy balanced diet Include:

Lots of fruit and vegetables (at least 5 portions of a variety every day)

Plenty of starchy foods, such as bread, rice, potatoes and pasta

Choose wholegrain ('brown') varieties of starches wherever possible

Some milk and dairy foods

Some meat, fish, eggs, beans, and other non-dairy sources of protein

Just a small amount of food and drinks high in fat and/or sugar. 

VITAMIN D

Vitamin D is vital for helping our bodies to absorb calcium. Our primary source of Vitamin D is the sun shining on our skin. The body converts this into vitamin D and stores it in our fat. Most of us will get enough sun to help our bones without even having to think about it, if we get out and about in the summer. However, it is possible for older people, people who do not go out much and

people who cover up to become deficient - they will need to take a supplement.

EXERCISE

Childhood, adolescence and early adulthood - Bank plenty of bone density in these years by doing a variety of weight bearing exercise as well as eating that well-balanced, calcium-rich diet. Weight-bearing exercise includes any kind of physical activity where you are supporting the weight of your own body, for example jogging, aerobics, tennis, dancing and brisk walking. Weight lifting is another good type of bone-building exercise, where the action of the tendons pulling on the bones seems to boost strength.

The middle years - Your skeleton grows stronger if you do regular weight-bearing exercise. Keep up with the walking, jogging, dancing, aerobics and weightlifting. Join a gym or get together with friends, but make sure this is maintained throughout these active and important years.

Older age - Osteoporosis becomes more common as bone density and strength decreases with age.  Poor balance and co-ordination in the older patient can lead to a higher risk of falls, and thus a higher risk of fracture. The way we live our life in the first place, lifestyle changes and keeping active can help to prevent falling and fractures. And if the risk of fracture does become high, there are drug treatments available that strengthen bones and lower the risk.

STOP SMOKING AND REDUCE YOUR ALCOHOL INTAKE

The toxic effect from smoking comes from the fact that it stops the construction cells from doing their work in building new, strong bone to replace the old. Once you stop smoking, this risk is reduced.

Enjoying a glass of wine now and then could actually help your bones. But drinking too much alcohol (more than 3 units a day) damages the skeleton and increases the risks of fracture.

If you already have osteoporosis...If you have osteoporosis, it doesn’t automatically mean that your bones will break, but it does mean that you have a ‘greater risk of fracture’.

And osteoporosis does not generally slow down or stop the healing process once a fracture has occurred. The older we get, the greater our risk of breaking a bone, however there are precautions we can take to limit the damage that osteoporosis can cause.

So, if you already have osteoporosis, you can still keep yourself safe and strong and reduce the risks of fractures in a number of ways:

Exercise - although you need to be more careful of vigorous, high impact exercise, it's important to stay active. Leading an active lifestyle will make sure you have good balance and co-ordination and will also help to develop muscle strength, reducing the risk of falls and fractures. Find something you enjoy, such as swimming, gardening, walking, golf or Tai Chi.

Balance and co-ordination - Get help from your GP or social services if you are at risk of falling or starting to fall more frequently. Ask your physiotherapist to help with exercises to maintain your balance and co-ordination.

Keeping in good general health - As well as exercising gently and eating a healthy diet, do have your hearing and eyesight checked. Poor eyesight can increase your risk of falling and some kinds of hearing issues can affect your balance.

Medication - Ask your doctor for a medication review. Taking lots of different medications can sometimes cause side effects such as dizziness or drowsiness which increase your risk of falling and hurting yourself.

Hazard reduction - Review your home environment (or ask someone to help you) to avoid the risk of tripping and falling. Clear pathways through the house are vital.

Looking after your spineIn the middle years the weakening of bone structure can result in a slow but progressive reduction in height and curvature of the middle or thoracic part of the spine, accompanied by an increased risk of fracture.

Research conducted at the Mayo Clinic in the US has demonstrated that extension exercises performed regularly significantly reduce the number of compression fractures. A similar group exercised differently and another did no exercise at all and both of these groups had more fractures in a year than those regularly extending.

This study suggests that women and those in high risk groups may benefit from performing regular extension exercises. These should be practised from about the age of 40 onwards, four times a week (15-20 stretches per session)

If you are uncertain about this advice please make an appointment to discuss your personal situation with us. Or if you have difficulty

performing the movements we can show you ways to modify the exercise without necessarily reducing its effectiveness.

The muscles strengthened when performing this exercise are also the muscles responsible for holding you upright, and it is probable that maintaining good posture at all time will assist the strengthening process.

Contact us now if you would like a specific exercise programme to help you strengthen your bones or prevent falls 01285 654059.

For more information on Osteoporosis and especially with coping with a diagnosis and living with the condition, we recommend you visit the National Osteoporosis Society website:

http://www.nos.org.uk/

We hope you have found this guide useful. For more information about how we can help you, contact The Markland Clinic on 01285 654059 or click here for more information.