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Osteoporosis

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Osteoporosis
Summary
  • Osteoporosis is a condition that occurs when the bones decrease in mass and strength.
  • Oestrogen deficiency, which affects many post-menopausal women, is a major cause of accelerated bone loss.
  • There is no cure for Osteoporosis; however, it can be prevented.
Description

Osteoporosis is a condition that occurs when the bones decrease in mass and strength1. It is associated with low bone mineral density (BMD), caused by a reduction in the mineral content of the bones.

Throughout life, new bone is continuously added to the skeleton and old bone is taken away. Normally, this process is tightly regulated so that a healthy bone mass is maintained. In Osteoporosis, the rate of bone breakdown is greater than the rate of bone formation2.

Maximum bone mass is reached by the mid 20s and after the mid 30s, bones begin to lose their mineral content. One of the most important bone minerals is calcium. As you get older, more minerals are taken from the bones than are put into the bones, meaning that the bones become weaker3. Age-related Osteoporosis is the most common cause of decreased bone density4. After the mid 30's , the outer shell of the bones becomes weaker and holes develop in the inner material5.

Oestrogen deficiency, which affects many post-menopausal women, is a major cause of accelerated bone loss6. Age-related testosterone deficiency in men is also associated with the development of Osteoporosis7. The effects of both oestrogen and testosterone deficiencies are worsened by low calcium levels in the body8.

When the bones are fragile, there is an increased risk of fracture, particularly of the hip, spine and wrist9. Many cases of Osteoporosis are not detected until there is a bone fracture. In some cases of Osteoporosis, there may be no symptoms at all. In other cases, there may be pain in bones or muscles, especially in the back region10.

Osteoporosis can be either primary or secondary. Primary Osteoporosis is the most common type and occurs as a result of age-related loss of skeletal bone. Seconday osteoporosis may result from surgical removal of a young woman's ovaries or certain medications such as loop diuretics, anti-convulsants and glucocorticosteroids11.

Cause

Age is not the only risk factor associated with Osteoporosis. Other risk factors include gender (women are more likely to develop Osteoporosis than men are), high alcohol intake, smoking, poor diet,12 little or no exercise, stroke, hyperthyroidism and some medications13. Ask your Pharmacist if you are concerned about the effects of medication that you are currently taking.

Other risk factors for Osteoporosis include; inadequate calcium and vitamin D intake, lack of exercise, prolonged bed rest, excessive intake of salt and caffeine. Thyroid, kidney and bowel disorders along with some medications such as loop diuretics, anti-convulsants and glucocorticosteroids can aslo increase a person's risk of developing Osteoporosis14.


Prevention

There is no cure for Osteoporsosis, however, it can be prevented. Methods for preventing Osteoporosis include;

  • Nutrition. Foods that are rich in calcium and vitamin D are important for the prevention of Osteoporosis. Calcium rich foods include dairy foods, tinned salmon and sardines, dried beans, kale, broccoli and bok choy. Vitamin D rich foods include cod liver oil, fatty fish or fortified foods such as milk and cereal15.
  • Phytoestrogens. This group of plant-based compounds have an oestrogenic effect on bone tissue and should be consumed by women to help prevent Osteoporosis. Flaxseed and soy protein found in soy milk, tofu, tempeh and soy beans are an excellent source of phytoestrogens16.
  • Exercise. Regular weight-bearing exercise that helps to improve balance, co-ordination and muscle strength has a preventative effect. Walking, swimming and Tai Chi are some examples. It is advisable for elderly people to seek medical advice before beginning a new exercise regime. This may help to prevent over-straining17.
  • Management

    Always consult your Doctor for the diagnosis and treatment of Osteoporosis. The diagnosis of Osteoporosis is usually made using a non-invasive test called a Bone Density Test. This technique uses x-ray beams to determine bone mineral density18.

    The treatment for Osteoporosis varies according to its cause. In most cases, lifestyle changes such as dietary modification, exercise and the avoidance of certain substances such as excess alcohol are required19. Your Doctor may also recommend dietary supplements such as calcium and vitamin D, which help maintain bone strength if dietary intake is inadequate.

    Various medications are available to restore oestrogen or progesterone levels or mimic the effects of these hormones to prevent the breakdown of bone. Other classes of drugs, such as the bisphosphonates and calcitriol, reduce the activity of the cells that are responsible for the breakdown of bone tissue20.


    Lifestyle

    Diet Hints

    Several dietary factors affect the passage of calcium in and out of the bones. There is a constant turnover of calcium and up to the mid 30's, deposition of calcium tends to outweigh the loss of calcium.

    The diet should be rich in:

    • Calcium. Sources: dairy products, green leafy vegetables, seaweed, beans whole grains and cereal grasses21.
    • Magnesium. Sources: green leafy vegetables, almonds, avocado and nuts.
    • Vitamin D. Sources: sunlight acting on the skin, egg yolk, cod liver oil and cold water fish22.
    • Silica. Source: porridge23.


    The diet should be low in:

    • Phosphorus (soft drinks).
    • Caffeine. Avoid tea and coffee.
    • Alcohol.
    • Salt.

    Studies show that dietary soy supplementation may increase bone mineral content in post menopausal women, and protect against bone loss24.
    Improving digestion with a little apple cider vinegar or lemon juice in water before meals may help to increase the excretion of digestive juices and the absorption of nutrients.


    Vitamins/Minerals/Herbs

    See the topic Osteoporosis - Supplements.


  • Pharmacist's Advice
    1. Try to stop smoking. Ask your Pharmacist for suggestions. Smoking may reduce bone density25.
    2. Excessive intake of alcohol, salt and caffeine can increase the risk of Osteoporosis26. Ask your Pharmacist for advice about reducing these in your diet.
    3. Have regular exercise e.g. walking, swimming, Tai Chi or jogging. Studies have shown this should increase the density of bone mass27. NOTE: Try to play a load bearing sport e.g. basketball, when you are young, as it is thought to help prevent the onset of Osteoporosis in later years.
    4. Excessive thyroid hormone use reduces bone density in women. Thyroid hormone use is more common in women, who also have a greater incidence of Osteoporosis28.
    5. Patients with high blood pressure are known to have increased urinary calcium excretion, and high blood pressure may be one factor that may increase the likelihood of Osteoporosis29.
    6. If the diet is inadequate, consider some supplements. A supplement of calcium is suggested if the person cannot or does not consume the recommended daily sources of calcium30. Vitamin D is necessary for strong bones. The body synthesises this vitamin from sunlight. A nutritional supplement of vitamin D may be required by people who have little exposure to sunlight31.
  • Notes

    Organisations & Support Groups

    Osteoporosis Australia - http://www.osteoporosis.org.au/


    References

    1. Iqbal MM. Osteoporosis: Epidemiology, Diagnosis, and Treatment. Southern Medical Journal 2000 Jan; 93(1): 2-18.
    2. Beers, M. et al. The Merck Manual of Diagnosis and Therapy. 17th ed. USA; Merck Research laboratories: 1999.
    3. Osteoporosis Australia. URL at http://www.osteoporosis.org.au.
    4. Prince, R. Osteoporosis: a billion-dollar health problem. Australian Pharmacist 2000; 19(8):486-96.
    5. Taylor S. Preventing osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
    6. Beers, M. et al. The Merck Manual of Diagnosis and Therapy. 17th ed. USA; Merck Research laboratories: 1999.
    7. Prince, R. Osteoporosis: a billion-dollar health problem. Australian Pharmacist 2000; 19(8):486-96.
    8. Prince, R. Osteoporosis: a billion-dollar health problem. Australian Pharmacist 2000; 19(8):486-96.
    9. Siddiqui NA et al. Osteoporosis in older men: Discovering when and how to treat it. Geriatrics 1999 Sep; 54(9): 20-34.
    10. Beers MH, et al, editors. The Merck Manual of Diagnosis and Therapy. New Jersey: Merck Research laboratories; 1999.
    11. Taylor S. Preventing osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
    12. Iqbal MM. Osteoporosis: Epidemiology, Diagnosis, and Treatment. Southern Medical Journal 2000 Jan; 93(1): 2-18.
    13. Ullom-Minnich P. Prevention of Osteoporosis and Fractures. American Family Physician 1999 July; 60(1): 194-202.
    14. Taylor S. Preventing Osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
    15. Taylor S. Preventing Osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
    16. Taylor S. Preventing Osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
    17. Taylor S. Preventing Osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
    18. Prince, R. Osteoporosis: a billion-dollar health problem. Australian Pharmacist 2000; 19(8):486-96.
    19. Prince, R. Osteoporosis: a billion-dollar health problem. Australian Pharmacist 2000; 19(8):486-96.
    20. Prince, R. Osteoporosis: a billion-dollar health problem. Australian Pharmacist 2000; 19(8):486-96.
    21. Gursche S. Encyclopedia of Natural Healing. Burnaby (Canada): Alive Books, 1997.
    22. Gursche S. Encyclopedia of Natural Healing. Burnaby (Canada): Alive Books, 1997.
    23. Gursche S. Encyclopedia of Natural Healing. Burnaby (Canada): Alive Books, 1997.
    24. Wahlqvist M. Phytoestrogens - emerging multifaceted plant compounds. Med J. Aust 1997.
    25. Wolinsky-Friedland M. Drug-induced metabolic bone disease. Endocrinol-Metab-Clin-North-Am. 1995 Jun; 24(2): 395-420.
    26. Taylor S. Preventing Osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
    27. Karlsson MK, et al. Indicators of bone formation in weight lifters. Calcif-Tissue-Int. 1995 Mar; 56(3): 177-80.
    28. Schneider DL, et al. Thyroid hormone use and bone mineral density in elderly men. Arch-Intern-Med. 1995 Oct 9; 155(18): 2005-7.
    29. Antonios TF, et al. Deleterious effects of salt intake other than effects on blood pressure. Clin-Exp-Pharmacol-Physiol. 1995 Mar; 22(3): 180-4.
    30. Haines CJ, et al. Calcium supplementation and bone mineral density in postmenopausal women using oestrogen replacement therapy. Bone. 1995 May; 16(5): 529-31.
    31. Taylor S. Preventing Osteoporosis. Australian Pharmacist. Vol 22. No 2. Feb 2003
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