Centro Medico Excel

Bone is made of collagen fibers and minerals. Bone is a living tissue and contains cells that make and mould bone. After about the age of 45, you lose a certain amount of bone material. The bones become less dense and less strong. The amount of bone loss can vary. If you have a lot of bone loss, then you have osteoporosis. If you have osteoporosis you have bones that will break more easily than normal, especially if you have an injury such as a fall.

Women lose bone material more rapidly than men especially after the menopause when the level of estrogen falls. Estrogen is a female hormone and helps to protect against bone loss. By the age of 70 some women have lost 30% of their bone material.

All men and women have some risk of developing osteoporosis as they become older, particularly over the age of 60. Women are more at risk than men.

The following situations also increase the risk of developing bone loss and osteoporosis. If you:

• are a woman who had your menopause before the age of 45.
• have already had a bone fracture after a minor fall or bump.
• have a strong family history of osteoporosis.
• have a body mass index (BMI) of 19 or less. (That is, you are very underweight.) For example, if you have anorexia nervosa. In this situation the level of estrogen is often low for long periods of time and, combined with a poor diet, can affect the bones.
• are a woman and your periods stop for a year or more before the time of your menopause. This can happen for various reasons.
• have taken, or are taking, a steroid medicine (such as prednisolone) for three months or more. A side-effect of steroids is to cause bone loss.
• smoke
• lack calcium and/or vitamin D (due to a poor diet and/or little exposure to sunlight.)
• have never taken regular exercise, or have led a sedentary lifestyle (particularly during your teenage years).
• have, or had, certain medical conditions that can affect the bones. For example, an overactive thyroid, Cushing’s disease, and any condition that causes poor mobility.

How is it diagnosed?

Your doctor may ask you questions, to see how many of the risk factors listed above apply to you. If you may be at risk you may then be referred for a DEXA scan. DEXA stands for Dual Energy X-ray Absorptiometry. It is a scan that uses special X-ray machines that can check the bone density and confirm or discard osteoporosis.

Osteoporosis usually develops slowly over several years without any symptoms. However, after a certain amount of bone loss, the following may occur:

• A bone fracture after a minor injury such as a fall

If you have osteoporosis, the force of a simple fall to the ground is often enough to fracture a bone. (A simple fall to the ground from standing does not usually cause a fracture if you do not have osteoporosis.) The fractures are most commonly of the hip, wrist, and vertebrae (the bones that make up the spine). A fractured bone in an older person can be serious. For example, about half the people who have a hip fracture are unable to live independently afterwards.

• Loss of height, persistent back pain and a stooping (bent forward) posture

These symptoms occur if you develop one or more fractured vertebrae which become ’squashed’ with the weight of the body. A vertebra with osteoporosis may fracture even without a fall or significant force on it.

Prevention

The following helps to prevent, or slow down, bone loss. This advice is for everyone. But, it is particularly important if you have an increased risk of developing osteoporosis, or already have it.

• Exercise

Regular weight-bearing exercise throughout life is best, but it is never too late to start. This means exercise such as brisk walking, aerobics, dancing, running, etc. For older people, a regular walk is a good start. However, the more vigorous the exercise, the better. For most benefit you should exercise regularly – at least 30 minutes of moderate exercise or physical activity at least 4-5 times per week.

Exercise helps because the pulling and tugging on the bones by the muscles helps to stimulate bone-making cells and strengthens the bones. It also gives strength to the supporting muscles around bones. This helps to increase tone, balance, etc, which may help to prevent you from falling.

Research studies have shown that moderate levels of activity, including walking, decreases the risk of having a hip fracture in older women.

• Food and Diet

Calcium and vitamin D are important for bone health. The recommended daily intake for calcium in adults is 700 mg, but more may be required for people with osteoporosis.

Calcium – you can get 700-1000 mg of calcium most easily by drinking a pint of milk a day, plus eating 2 oz hard cheese such as Cheddar or Edam, or one cup of yogurt.

Bread, calcium-fortified soya milk, some vegetables (curly kale, okra, spinach, and watercress) and some fruits (dried apricots, dried figs, and mixed peel) are also good sources of calcium.

Vitamin D – there are only a few foods that are a good source of vitamin D. Cooked salmon, tuna fish and sardines are an example of these. Vitamin D is also made by your body after exposure to the sun. (The ultraviolet rays in sunshine trigger your skin to make vitamin D.) For most people over 65, an adequate amount of vitamin D can only be achieved by taking vitamin D supplements. A dietary supplement of vitamin D is commonly recommended for people over the age of 65 and for others who may lack vitamin D such as people who have a poor diet and people whose exposure to sunlight is limited.

If you are unsure about whether you should have calcium or vitamin D supplements, ask your doctor.

• Smoking and drinking

Chemicals from tobacco in the bloodstream can affect the bones and make bone loss worse. If you smoke, you should make every effort to stop. Also, cut down on alcohol if you drink heavily.

Treatment

Medication and/or lifestyle changes may be advised if you develop osteoporosis.

• Medication to prevent and treat bone loss

Various drugs are available. Once medication for osteoporosis is started, it is likely that you will need it for the rest of your life.

• Calcium and vitamin D tablets

These dietary supplements are commonly prescribed. The body needs plenty of calcium and vitamin D to make bone.

• Lifestyle

Medication will not restore all lost bone. Therefore, in addition to medication, lifestyle measures are also important (exercise, not smoking, etc, as described above).

Preventing falls

You can take measures to help prevent you from falling. This can reduce your risk of breaking a bone.

• Check your home for hazards such as uneven rugs, trailing wires, slippery floors, etc.
• Regular weight bearing exercise may help to prevent falls.
• Are your vision and hearing as good as possible? Do they need checking? Do you need glasses or a hearing aid?
• Beware of going out in icy weather.
• Do you take any drugs that can make you drowsy? Can they be changed?

If you have had a fall, or have difficulty walking, you may be advised to have a formal ‘falls risk assessment’. This involves various things such as a physical examination, checking your vision, hearing, and ability to walk and reviewing your medication. All of these services are offered at Centro Médico Excel.