Osteoporosis

Osteoporosis – how to get stronger bones

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Every 5-6 minutes, someone is admitted to an Australian hospital with an osteoporotic fracture. Osteoporosis is a weakening or thinning of the bones, and literally means ‘porous’ bones. It is considered the ‘silent disease’, causing no symptoms until a fracture occurs. Bone is living tissue that is always in flux. Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, leading to a loss of bone density and mass. As a result, bones become thinner and less dense. This leads to fracture, the most common fracture sites being the wrist, hip, spine, ribs, pelvis and upper arm.

Osteopenia is a condition where bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis. In healthy individuals who get enough calcium and physical activity, bone production exceeds bone destruction up to about age 30. After that, destruction typically exceeds production. [1] The loss of bone with aging is the result of several factors, including genetic factors, physical inactivity, and lower levels of circulating hormones (estrogen in women and testosterone in men) [2].

The good news is that certain lifestyle choices can decrease your risk of getting osteoporosis.

  • Lifestyle- Some lifestyle factors deplete the stores of calcium in the bones by affecting the physiological processes involved in bone mineralization. It is good to avoid excessive alcohol consumption, soft drink, caffeine and protein in the diet.
  • Calcium – Ninety-nine percent of the calcium in the human body is stored in the bones and teeth. The remaining 1 percent is found in the blood and other tissues. Calcium can be sourced from the diet or supplementation. Good dietry sources include dairy products, which have the highest concentration per serving of highly absorbable calcium, and dark leafy greens or dried beans, which have varying amounts of absorbable calcium. [4]
  • Vitamin D – a high intake of vitamin D reduces fractures in the elderly. Evidence supports the use of calcium in combination with vitamin D supplementation to help prevent osteoporosis in in people aged 50 years or older. For best therapeutic effect, minimum doses of 1200 mg of calcium, and 800 IU of vitamin D a day are required when taken together. [4]
  • Exercise – The benefits of weight bearing and resistance exercises have been well established in the literature to improve and maintain bone mineral density (BMD), particularly in post menopausal women. [5] According to one study at the University of Arizona, it was found that a series of weight bearing exercises including the squat, military press, lat pull down, leg press, back extension, seated row performed at 3 sessions a week, of 2 sets of each at 4-8 reps (moderate to heavy work) provided the best improvement in BMD at 1 year and 4 years post intervention in post menopausal women. [5]
  • Other exercises found in the literature that appear to increase BMD include aerobic exercise such as walking, running, jumping, stepping and gymnastic training, with one study finding all improve BMD of the L2-4 vertebrae in osteopenic postmenopausal women [6 ] Falls prevention training has been found to reduce the risk of fracture as a result of osteoporosis. [6][7]

If you have already been diagnosed with osteoporosis there are treatments available.

The good news is that, there are several medications used to treat osteoporosis. Medications fall into categories of antiresorptive or bone anabolic agents. Antiresorptive agents work primarily by reducing bone resorption, while bone anabolic agents build bone rather than inhibit resorption. Lifestyle changes are also an important aspect of treatment. Talk to your doctor to discuss ways in which medication can benefit you. Your physiotherapist can design a program to assist with your specific lifestyle and exercise requirements. [8]

APMA would like to thank the Fortus Health for permission to reprint this information.

References:

1. http://www.osteoporosis.org.au/

2. “Calcium & Milk”. Harvard School of Public Health. 2007. Retrieved 2008-01-28.

3. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysisLancet .2007, 370 (9588): 657–66. doi:10.1016/S0140-6736(07)61342-7. PMID 17720017

4. Sato, Y; Kanoko T, Satoh K, Iwamoto J. Menatetrenone and vitamin D2 with calcium supplements prevent nonvertebral fracture in elderly women with Alzheimer’s disease. Bone.2005;36 (1): 61–8. doi:10.1016/j.bone.2004.09.018. PMID 15664003

5. Houtkooper, LB, Stanford, VA, Metcalfe, LL, Lohman, TG, and Going, SB. Preventing osteoporosis the Bone Estrogen Strength Training way. ACSM’s Health & Fitness Journal. 2007;11 (1): 21–27. doi:10.1249/01.FIT.0000257708.14987.38

6. Bonaiuti D, Shea B, Iovine R, et al. (2002). Bonaiuti, Donatella. ed. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane database of systematic reviews (Online) (3): CD000333. doi:10.1002/14651858.CD000333. PMID 12137611

7. ^ Cheng S, Sipilä S, Taaffe DR, Puolakka J, Suominen H Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women. Bone. 2002; 31 (1): 126–35. doi:10.1016/S8756-3282(02)00794-9. PMID 12110425.

8. ^ a b Davis S, Sachdeva A, Goeckeritz B, Oliver A. Approved treatments for osteoporosis and what’s in the pipeline. Drug Benefit Trends. 2010; 22 (4): 121–124.

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