Yahoo Lifestyle Osteoporosis
The Smart Woman’s Medical Guide is produced with the assistance of NPS MedicineWise.
When bones lose minerals, such as calcium, more quickly than the body can replace them, osteoporosis can result. Bones may become so thin that even a minor bump or accident can cause a serious fracture (known as a ‘minimal trauma fracture’). Because of this, osteoporosis can have a serious effect on your quality of life – so it’s important to take steps from a young age to help to prevent it later in life.
Your risk of developing osteoporosis is based on lots of things such as diet, exercise, lifestyle, age, gender, family history and other medical conditions. It may also be caused by long-term use of some medicines, such as corticosteroids – a type of steroid hormone used for some rheumatic conditions and asthma (for example, prednisolone) – and some medicines for epilepsy.
Menopause is another contributing factor in osteoporosis, which is one reason why women are at higher risk than men. Menopause causes a marked drop in oestrogen (the female sex hormone), which plays an important role in maintaining the strength of bone tissue. Still, it’s important to be aware that osteoporosis will also affect around one third of all Australian men.
SIGNS AND SYMPTOMS
Osteoporosis is often dubbed a ‘silent disease’, because there are generally no symptoms until a bone actually fractures. Sometimes, even when there is a fracture, you’ll experience no symptoms – meaning the condition can go undetected for years.
The most common osteoporotic fractures, however, happen in the hips, spine and wrists and can cause long-term pain, disability and loss of independence. Osteoporotic fractures can also lead to changes in posture (e.g. stooped back), height loss and muscle weakness.
MORE:
- BEST BUYS FOR YOUR HEALTH
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DIAGNOSIS
The most reliable way to diagnose osteoporosis is to measure bone mineral density (BMD) using a DEXA scan. This test is quick and painless, like an x-ray, and involves minimal radiation.
A BMD scan compares the density of a person’s bones with that of an average young adult. The result of the test is called a T-score. A ‘normal’ T-score is minus 1, or higher. The lower your T-score, the greater your risk of fracture. A person has osteoporosis if their T-score is minus 2.5 or lower. (In other words, minus 3 is worse than minus 2.5.)
There is another type of bone test called a ‘heel ultrasound’, that is available at many pharmacies. As the name suggests, these involve taking an ultrasound measurement of the heel. Heel ultrasounds may be of some use in indicating your risk of osteoporosis, but they are not nearly as accurate as DEXA scans, and not recommended to diagnose osteoporosis
TREATMENT
Treatment for osteoporosis involves important lifestyle changes, interventions to prevent falls and medicines to help prevent further bone loss and fractures.
Complementary medicine and lifestyle approaches
Lifestyle changes
A healthy lifestyle is important to help to prevent and manage osteoporosis.
Recommended lifestyle changes include:
• Increasing your calcium intake
About 3–4 serves of dairy products each day are recommended. One serve is:
• 250 mL glass of reduced-fat milk (or calcium-fortified alternative, such as soy)
• 200 g tub of reduced-fat yoghurt, or
• 40 g piece of cheese.
Canned fish, tofu, soy beans, other beans and green leafy vegetables such as broccoli and bok choy also contain good amounts of calcium. If you can’t get enough calcium through your diet alone, it’s worth talking to your doctor about taking a supplement.
• Increasing your amount of exercise
Improving fitness, strength and balance can help strengthen bones and help prevent falls at the same time. Suitable exercises can include brisk walking, tai chi, dancing, aqua aerobics and gentle weight exercises. Recommendations may differ from person to person, so talk to a doctor or a physiotherapist about what suits you.
Osteoporosis sufferers should avoid exercises that involve twisting, sudden movements or bending forward from the spine.
• Quitting smoking
Smoking can cause the gradual loss of bone tissue and worsen osteoporosis. Call Quitline on 131 848 if you want help to quit.
• Decreasing your alcohol intake
Excessive alcohol intake can increase the risk of fracture by reducing bone mineral density (BMD), and potentially increase the risk of a fall. Both men and women should restrict their alcohol intake to no more than two standard drinks on any one day, and are encouraged to include at least two alcohol-free days each week.
• Managing your vitamin D intake
Vitamin D helps the body to absorb calcium, so it’s an especially important vitamin for maintaining healthy bones. Our bodies make vitamin D via exposure to sunshine, so the best way to ensure you get enough is by exposing around part cent of your body (eg your arms, legs and face) to sun for a short period each day.
Some foods also provide vitamin D, such as oily fish (for example, salmon or mackerel), eggs and some fortified products. However, the average Australian diet only does not meet the your vitamin D requirements your body needs – so changing your diet is not enough on its own. If you suspect you may be vitamin D deficient, talk to your doctor. He or she can advise of ways to increase your vitamin D intake, or may recommend having a blood test to check your vitamin D levels and/or suggest a supplement.
Other Approaches
• Reducing your risk of falls
Lowering your risk of falling may help to lower your risk of fractures. A doctor, physiotherapist or occupational therapist can help you work out your risk of falling, and advise you on steps you can take to reduce your risk.
• Assessing your medications
Some medications, such as corticosteroids, can cause, or contribute to osteoporosis. Talk to your doctor about any medicines you’re taking – you may be required to change treatments, reduce your dosage, or take some other action.
Traditional medicine-based treatment
As well as lifestyle changes, a doctor may recommend medicine for osteoporosis. There are several different kinds available, and you’ll need to speak to your doctor about the right medication for you.
Most medicines for osteoporosis work by slowing bone loss, which in turn reduces your risk of fracture. These medicines, called anti-resorptives, act in different ways and include:
• Bisphosphonates
These bind strongly to cells in the bone, to slow its breakdown. Bisphosphonate tablets include the following active ingredients:
o Alendronate (brand names Adronat, Alendrobell, Dronalen, Fosamax and Ossmax),
o Etidronate (Didrocal), and
o Risedronate (Acris, Actonel).
Some are taken daily, while others can be taken weekly or monthly. Zoledronic acid (brand name Aclasta) is another bisphosphonate, but instead of being taken in tablet form, it’s administered via a drip, once a year.
People who have problems with their stomach, oesophagus, kidneys, eyes, or who have low calcium levels in their blood, might not be able to use a bisphosphonate. A doctor will advise if this is the case.
Rarely, use of a bisphosphonate might lead a potentially serious problem that causes weakening of the jawbones (called osteonecrosis of the jaws), especially if you have dental work done after starting treatment. You should speak to your doctor about your risk of developing this problem and what can be done to help prevent it.
• Denosumab
Denosumab (brand name Prolia) is a new type of medicine for women who develop osteoporosis after menopause. It is a particular type of protein, called a ‘monoclonal antibody’, that slows down bone loss by attaching itself to another protein in the body. It is given as an injection under the skin once every 6 months.
Like bisphosphonates, people shouldn’t receive denosumab if their blood calcium levels are low and, rarely, it has caused osteonecrosis of the jaws.
• Raloxifene
Raloxifene (brand name Evista) is a tablet that prevents bone loss in a similar way to the hormone oestrogen. It is used to prevent and treat osteoporosis in women who have passed menopause. It can only be prescribed through the Pharmaceutical Benefits Scheme (PBS) – ie, at subsidised cost – for women who have already had an osteoporosis-related bone break.
One uncommon, but serious, side effect of Raloxifene is blood clots, and it may also increase the risk of stroke. If you’ve had any blood clots in the past, have previously suffered a stroke, or are at high risk of a stroke, raloxifene is not recommended for you.
• Strontium
Strontium (brand name Protos) slows the thinning of the bones and allows new bone to rebuild and strengthen. It is used for women who develop osteoporosis after menopause. Strontium comes as a powder that is dissolved in water and is taken once a day at bedtime. It needs to be taken at least two hours after eating or drinking milk, as some foods, particularly calcium-rich foods, can interfere with absorption.
Strontium may increase the risk of clots forming in the legs or lungs. You’ll need to discuss your potential risk of this with your doctor, before taking strontium.
• Teriparatide
Teriparatide (brand name Forteo) works differently to the anti-resorptive medicines mentioned above (which work by slowing bone loss). Instead, Teriparatide increases bone formation. It is given as an injection once a day under the skin of the thigh or abdomen, to women and men with severe osteoporosis.
Teriparatide can only be prescribed through the PBS for people who have already had two or more broken bones caused by osteoporosis. They must also have a very low BMD (T-score of minus 3 or less), and have previously taken an anti-resorptive medicine for at least a year but despite this have suffered at least one or more fractures. A doctor needs to obtain informed consent from people before they can prescribe teriparatide for them. This is because teriparatide has been known to cause osteosarcoma (a type of bone cancer) in animal studies, although the risk to humans is currently unknown.
If you are prescribed any medication for osteoporosis, it’s really important to take it exactly as directed, and for as long as your doctor prescribes. Bone mineral density improves very slowly, especially around the hip, so the benefits of your medicines may only occur after taking them for many months. Your doctor may also need to monitor the effect of your treatment, by repeating DEXA scans and other tests at various stages.
ADDITIONAL RESOURCES & INFORMATION
- The Victorian Government’s Better Health Channel has a useful article on hay fever. Visit: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/hayfever
The Australasian Society of Clinical Immunology and Allergy (ASCIA) offers patient information on hay fever. Visit:
http://www.allergy.org.au/content/view/119/133/
The Smart Woman’s Medical Guide is produced with the assistance of NPS MedicineWise.
Independent, not-for-profit and evidence based, NPS MedicineWise enables better decisions about medicines and medical tests.
Funded by the Australian Government Department of Health and Ageing, NPS helps health professionals keep up to date with the latest evidence and provides individuals with the tools and knowledge to make better decisions.
To find out more visit nps.org.au
Disclaimer: Medical information provided on this website is not intended as a substitute for advice from a registered physician or other healthcare professional.
Last updated June 26 2011
