Osteoporosis Bone Disease

Osteoporosis Bone Disease

What is Osteoporosis?

• Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue.
• This leads to increased bone fragility and risk of fracture (broken bones), particularly of the hip, spine, wrist and shoulder. Osteoporosis is often known as “the silent thief” because bone loss occurs without symptoms.
• Osteoporosis is sometimes confused with osteoarthritis, because the names are similar.

• Osteoporosis is a bone disease; osteoarthritis is a disease of the joints and surrounding tissue.
• Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined.

• At least one in three women and one in five men will suffer from an osteoporotic fracture during their lifetime.

Treatment

Treatment for osteoporosis will depend upon the results of bone density scans, age, gender, medical history and the severity of the condition.  Treatment most commonly involves lifestyle changes and medications and aims to maximise bone density and reduce the risk of bone fracture.

LIFESTYLE CHANGES

Exercise:

• If possible, regular weight bearing exercise (eg: walking, tennis, golf) should be maintained as it can help to reduce bone loss and stimulate new bone formation.  To be of benefit, doctors recommend at least 30 minutes of exercise at least three times a week. 
• Prior to beginning any new exercise it is important to consult a doctor to ensure that the proposed exercise is safe to undertake.

Diet:

• As the body cannot make its own calcium, a diet high in calcium is necessary and helps to slow the rate of bone loss.
• Vitamin D is also essential as it enables calcium to be effectively absorbed by the body. 
• Eating a balanced diet that includes calcium and vitamin D-rich foods is important in supplying the bones with the calcium required.
• Foods high in calcium include dairy products, dark green vegetables, beans, legumes, fish, soybean products, cereals and nuts.
• It is recommended that at least 1000mg of calcium is taken in each day.
• Foods high in vitamin D include sardines, tuna, eggs and liver.

Smoking, alcohol and caffeine:

• Smokers will be advised to stop smoking. 
• Minimizing alcohol and caffeine intake (eg: tea, coffee, cola drinks) may also be recommended.

Exposure to sunlight:

• Regular but moderate exposure to sunlight helps to produce vitamin D in the body.  
• Note, excess sun exposure poses other health risks.

Reducing the risk of fractures:

• It is important to take extra care with movement and daily activities in order to minimise the risk of fractures.
• This can include using mobility aids if unsteady on the feet, removing objects or hazards that can lead to falls (eg: loose floor rugs), installing hand rails in areas such as entranceways and bathrooms, and using non-slip mats in the bath or shower.
• Padding to protect vulnerable parts of the body eg: the hips, can also help in the prevention of fractures.
• Special "hip protectors" have been developed for this purpose. These can be enquired about at GP clinics and pharmacies.

MEDICATIONS

Calcium:

• If dietary intake of calcium is insufficient, calcium supplements may be prescribed in order to increase the amount of calcium available in the body. 
• A dosage of 1000mg per day in usually recommended.

Vitamin D:

• As vitamin D is important for the effective absorption of calcium into the bones, vitamin D supplements such as calciferol are usually given in conjunction with calcium supplements. 
• An activated form of vitamin D called calcitriol (Rocaltrol) has also been shown to be beneficial.

Biphosphonates:

• These non-hormonal medications can increase bone density by reducing the rate of bone loss.
• They have been shown to reduce the fracture rate in people with osteoporosis. These medications are usually given in an alternating cycle with calcium supplements.
• Common biphosphonate medications used in the treatment of osteoporosis include alendronate (Fosamax) and etidronate (Etidrate).
• A common side effect of these medications is nausea and indigestion. This can limit their use in some people.

HRT:

• Hormone replacement therapy (HRT) medications that include oestrogen are sometimes recommended for women with osteoporosis. 
• HRT has been shown to reduce bone loss and may increase bone density. While HRT has obvious benefits in the treatment and prevention of osteoporosis, recent research has indicated that there are risks with long term HRT use.
• It is therefore important that the patient and their practitioner discuss the benefits and risks of taking the medication.

Selective Oestrogen Receptor Modulators (SERMs):

• This class of medications, most commonly used in the treatment of cancer, is showing promising results when used in the treatment of osteoporosis.
• A medication called raloxifene is currently available as an osteoporosis treatment and has been shown to reduce the number of fractures in the spinal column.
• It works by mimicking the effects of oestrogen on bone, thus increasing bone density. Whist not as effective as HRT, it has minimal side effects and may be considered for use in post menopausal women who cannot tolerate oestrogen.
• Other medications that may be considered in the treatment of osteoporosis include calcitonin, fluoride and thiazide diuretics. Their use, however, may be limited by cost and/or side effects.

 

SURGICAL TREATMENT

Fractures are the main consequence of osteoporosis. Most tend to heal without the need for surgery. Sometimes however, a fracture may be severe enough to require surgery to correct it.

Hip fractures are common in elderly people with osteoporosis.

Prevention

Prevention is better than treatment and evidence suggests that maximising bone density in early and middle life helps to reduce the risk of osteoporosis in later life. Steps that can be taken to help prevent osteoporosis include:

·         Not smoking

·         Limiting alcohol intake

·         Undertaking regular weight bearing exercise

·         Maintaining a healthy body weight

·         Considering HRT for women during menopause