OSTEOPOROSIS
YOU PROBABLY KNOW SOMEONE WHO led a fairly normal life until an accidental fall caused a hip fracture. Suddenly, this vital person became an invalid. Other people you know may seem to be shrinking as they get older, not from weight loss, but from height loss. And occasionally you'll see an older woman gradually becoming hunched over with a so-called dowager's hump. All of these are hallmarks of the brittle-bone disease known as osteoporosis.
It's estimated that three million people in the United Kingdom have osteoporosis. The disease affects one in three women, and at least one in twelve men. Every three minutes someone has a fracture as a result of this disease.
Osteoporosis is a gradual decrease in bone density that leads to weakness in bone structure. Far from being just the framework for your body, bone is a dynamic living tissue that is constantly changing. Throughout your life, calcium is continually added to and subtracted from your bones. Cells called osteoclasts absorb old bone tissue, while cells known as osteoblasts lay down new bone tissue. Ideally, this process is kept in equilibrium by a number of hormones and other substances that maintain the bones in maximum strength and health.
With age, bones tend to lose an excessive amount of protein and minerals. Over time, this can lead to osteoporosis, litreally 'porousbone', a condition of low bone mass and density. People with osteoporosis are susceptible to broken bones and fractures, including severely painful fractures of the vertebrae. Fractures of the spine are most common, but any weak bone can break. Hip fractures are dangerously debilitating, and recovery is often long and uncertain.
A woman is most likely to lose bone, and lose it most rapidly, in the first five to nine years after menopause. By taking early measures to build bone mass, even people with significant risk factors - male or female - can minimise the effects of ageing on their bones.
SHOULD YOU PROTECT YOUR BONES Now?
Who gets osteoporosis? There are several risk factors that suggest a significantly
greater likelihood of developing brittle bones. Women with these risk factors
may want to begin watching their bone density while still in their forties.
Smokers
are 40 to 50 per cent more likely than non-smokers to experience osteoporosis-related
hip fractures. Even if you've smoked for a long time, quitting can improve
your health.
Caucasian and Asian women are at greater risk for osteoporosis than Hispanic
or African women.
Small-statured, thin-boned women, regardless of race, are more likely to
develop osteoporosis than other women.
Having a mother or grandmother with osteoporosis increases your risk.
Taking drugs that contribute to loss of bone mass and density raises risk. The most damaging are glucocorticoids or corticosteroids such as cortisone, prescribed for inflammatory diseases such as rheumatoid arthritis, asthma or certain lung diseases.
Those who have had diseases that interfere with
digestion or the absorption of nutrients are more susceptible to osteoporosis.
Such disorders include Cushing's disease, diabetes, anorexia nervosa, bulimia,
Crohn's disease, irritable bowel syndrome, hyperthyroidism, hyperparathyroidism,
liver disease, multiple myeloma and kidney failure.
CHOOSING THE RIGHT CALCIUM FOR YOU
Many studies prove that taking calcium supplements prevents bone loss. One
study from the University of Auckland in New Zealand found that, when women
who were at least three years past menopause took 1,000 milligrams of calcium
per day, they cut their expected bone loss in half.
There are limits, however, to how well calcium supplements can work, and
some forms of calcium are more effective than others for some people. Some
supplements even have risks or side effects. What form should you take? There
are many different forms.
Calcium carbonate, found in many supplements including Rennie and Turns, requires plenty of stomach acid to break it down. Studies show that about 40 per cent of menopausal women have a shortage of stomach acid and can absorb only about 4 per cent of this form of calcium. In fact, a study of 241 people found that the use of Turns as a calcium supplement was associated with a higher risk of upper-arm fracture.
Calcium citrate, on the other hand, is very absorbable, even for those with low stomach acid, because it is an acid. With sufficient stomach acid, calcium gluconate, lactate, malate and aspartate are also absorbable forms.
On the other hand, one poorly absorbed form is the increasingly popular calcium hydroxyapatite, derived from bone meal. Moreover, calcium from bone meal, as well as from oyster shell and dolomite, can contain large amounts of lead.
Clearly, charting your path among a wilderness of supplements can be a challenge. Here's what many health care practitioners recommend:
Calcium (as calcium citrate, gluconate, lactate, malate or aspartate): up to 1,000 milligrams per day for premenopausal women; up to 2000 milligrams per day for postmenopausal women, taken in two doses per day with meals (and not at the same time as any iron supplements). Caution: consult your doctor before taking such supplements if you have kidney conditions, are prone to kidney stones or have hyperparathyroidism.
Vitamin D: 400 to 800 IU. Caution: consult your doctor before taking vitamin D if you have heart disease or a circulatory condition.
Magnesium: the appropriate dosage of magnesium is controversial, but what is known is that people who develop osteoporosis are more likely than others to be deficient in this mineral. Some nutritionists recommend that patients take twice as much magnesium as calcium; if you have risk factors for osteoporosis or are entering menopause, check with your doctor or nutritionist to calculate how much magnesium you should take.
DRUG TREATMENT
Hormone Replacement Therapy (HRT)
Conjugated oestrogens (Premarin), dienestrol (Ortho Dienoestrol, others),
estradiol (Ovestin), others. Function: replace dwindling oestrogen and thereby
maintain bone density. Side effects: increased risk of uterine and possibly
breast cancer, breast pain, water retention, increased blood pressure and
blood clots.
Selective oestrogen -receptor modulators such as raloxifene (Evista).
Function: create oestrogen-like effects on bone tissue without stimulating
breast or uterine tissue. Side effects: hot flushes, sinusitus, weight gain,
muscle pain, leg cramps, blood clots.
Other Drugs
Combination oestrogen plus progesterone (Premique, Prempak C). Function:
decrease rate of bone breakdown and increase bone density. Side effects:
similar to oestrogen replacement therapy with a decreased risk of associated
cancers.
Bisphosphonates such as alendronate (Fosamax). Function: decrease the amount of bone loss. Side effects: stomach pain, diarrhoea, constipation and headache.
Disodium etidronate (Didronel). Function: increases bone density. Side effects: stomach pain, constipation, diarrhoea, muscle aches, headache.
Salcatonin (Calsynar as injection, Miacalcic as a nasal spray). Function: reduces the amount of bone reabsorption. Calsynar side effects: nausea, flushing, skin rash and redness at site of injection. Miacalcic side effects: runny nose, nosebleeds, headache.
HERBAL REMEDIES
Stinging Nettle (Urtica dioica)
Herbalists call this plant nature's multivitamin pill because it contains
iron, calcium, magnesium, phosphorus and good-quality protein. The leaves
do sting, but drying or cooking removes the stinging compound from their
fine hairs. Nettles are often recommended in cases of anaemia, which can
also be a problem for older women. Typical dosage: up to six 500-milligram
capsules of dried leaf products per day; up to 3 cups of tea daily (steep
1 teaspoon of dried herb in % litre of hot water for 10 to 15 minutes).
Horsetail (Equisetum hyemale, E. arvense)
This traditional diuretic has long been thought to help the body process
calcium. It's also nature's source of silica, a compound that helps strengthen
bones, nails and hair. Standardised horsetail products - certified to contain
a certain amount of silicic acid, the natural, organic form of silica -
are available in capsule form. Typical dosage: up to six 400- to 500-milligram
capsules per day; or up to
6 cups of tea per day (steep 2 teaspoons of dried herb in 4 litre of hot
water for 10 to 15 minutes); or 15 to 30 drops of tincture three times per
day.
Red Clover (Trifolium pratense)
Commonly grown as cattle fodder, this red-blossomed clover contains compounds
called isoflavones that act as a mild form of oestrogen. Isoflavones have been
getting a lot of notice lately for their ability to help combat symptoms of perimenopause
and early menopause; red clover is the richest herbal source of these compounds. Typical
dosage: up to five 500-milligram capsules per day; or up to 3 cups of tea per
day (steep 1 tablespoon of dried herb in % litre of hot water for 10 to 15 minutes).
Alfalfa (Medicago sativa)
Another herb that might seem to offer more benefits to livestock than to
people, alfalfa has actually been used for decades as an appetite booster,
an aid in the absorption of nutrients and a general vitality builder. Alfalfa
is rich in vitamins and minerals and, like nettle, is considered ablood builder'.
Typical dosage: up to nine 400- to 500-milligram capsules per day; or 15
to 30 drops of tincture four times per day; or tea as directed by the manufacturer.
Siberian
Ginseng (Eleutherococcus senticosus)
This herb is one of the most commonly used general tonics, or overall health
boosters, available. It helps many body systems function and respond to stress.
So why use it for osteoporosis? One of the best lifestyle changes a woman
at risk for osteoporosis can make is to exercise more; Siberian ginseng helps
the body adapt to the increased physical workload. It also helps increase
alerthess, which may help prevent falls and other mishaps. Typical dosage:
up to nine 400- to 500-milligram capsules per day; or 20 drops of tincture
up to three times per day.
A REASON TO SAVOUR SOYA
Soyabeans and many other beans contain natural oestrogen-like compounds called
phytoestrogens. In one study of soya products, researchers examined 80
postmenopausal women who ate 100 grams of tofu every day. Early results
found that the rate of bone loss among the women slowed down.
Phytoestrogens from soya products may be the reason why women living in Asian
countries have a much lower rate of hip fractures than women in Western countries.
Asian women also eat more seaweed and fish - both rich in minerals.
KEEPING ACTIVE: THE BEST MEDICINE
For women of all ages the best preventive measure against osteoporosis is
exercise. In young adulthood exercise builds bone density. In later years,
exercise not only prevents bone loss but also helps retain the coordination
and balance that may help avoid a fall or minimise injury when one occurs.
What's more, exercise enhances agility, strength and mood. Fear of falling
causes many older women to reduce their activity levels, so gaining strength
and balance and improving mood can be a real benefit.
For older women, walking is an especially helpful type of exercise. Bones need weight-bearing exercise to build new bone tissue. Studies prove that weight-bearing exercise for 30 minutes daily, or for up to an hour several times a week, slows bone loss.
Strengthening exercises such as weight-training are as important as calcium for strong bones, and they can be started at any age. Even someone age 80 or older can be helped by weight-training or isometrics - a form of exercise that involves contracting and releasing specific muscles. Your local hospital, gym or community centre may have more information on this exercise technique.
