Feel it in your bones

Osteoporosis is more common than you think. It is estimated that more than 30% of women over 65 and as many as 70% of over 75’s could be osteoporotic – many remain unaware of it. Known as the ‘silent disease’, osteoporosis has no symptoms and is usually only discovered by chance when investigating other things.

This blog aims to set out the background to the condition and the steps we can take to help prevent it.

What is it?

Osteoporosis literally means ‘porous bone’ It weakens the bones and makes them more likely to fracture or break. Bone is a living tissue. Cells known as osteoblasts are responsible for building new bone, and osteoclasts for the breakdown and absorption of existing bone. They work together and it is an ongoing process. Take a look at them in action in this fascinating video:

 

Peak bone density occurs in our 20’s when remodelling exceeds breakdown. By the time we are in our 40’s and 50’s that is reversed. For post-menopausal women, this is even more marked due to lower levels of oestrogen which has an important role in musculo-skeletal health. One of its main functions is to slow down the natural breakdown of bone.

Who is at risk?

Women are at a higher risk than men of getting osteoporosis and especially older women, for the reasons outlined above. Ethnicity, family history, how many children you have had and whether they were breastfed can all play a part, as can lifestyle and various medications such as steroids, anti-coagulants and some cancer treatments. Low body weight and eating disorders like bulimia and anorexia are also a factor.

What are the consequences?

Osteoporosis in itself is not life-threatening but its consequences can be debilitating and some can indirectly lead to death. The chances of suffering a fracture, especially of the wrist, hip and spine is increased due to the brittleness of the bones. It’s estimated that in Europe, women over 45 spend more time in hospital due to osteoporosis than from heart attacks and breast cancer. What’s more, people with hip fractures have a 24% increase in mortality rate in the following year.

Fractures of the spine leave it unable to support the body weight leading to a rounded upper back (kyphosis). This position compromises lung function capacity. It also causes pain and postural instability. Amazingly, only a third of vertebral fractures come to clinical attention.

Fascinating fact: the head gets heavier the more out of line it is. With good posture the head weighs around 12lb. That load is increased to the equivalent of 42lb with severe kyphosis!

How is osteoporosis diagnosed?

A FRAX questionnaire will help to work out your risk of fracture. A DEXA scan will measure your bone mineral density (bone strength). You will be given a T score which compares your results to that of a healthy adult.

A score of -1 or higher is considered normal. Between -1 and -2.5 indicates osteopenia, the stage before the onset of osteoporosis. It is worth noting that osteopenia does not automatically lead to osteoporosis, especially if preventative action is taken. Below -2.5 is defined as osteoporosis.

What can be done?

Aside from the medication that may be prescribed once osteoporosis is diagnosed, there are a number of areas where we can all take action independently:

1. EXERCISE

Exercise has a critical role to play in the management and prevention of osteoporosis. Different types of exercise bring different benefits. If your current regime consists mainly of non weight bearing exercise eg swimming, cycling and little or no strength work, it is definitely worth reconsidering.

Fascinating fact: it is estimated that a week of bed rest can cause a reduction muscle strength by around 20% and a 1% loss of bone density.

Strength

Loading bones stimulates growth. Whether using body weight, dumbbells, bands or other methods, the extra resistance will build muscle which in turn pulls on the bone to encourage growth. Aim to target areas that are know to be vulnerable such as wrists, hips and backs.

As always, good technique is of the essence. Correct alignment and an appropriate selection of exercises is key. Working with an instructor who can offer suitable alternatives is imperative, especially if you already have osteoporosis otherwise the risk of fractures increases – not what you want!

 

Weight bearing

Weight bearing exercise, defined as an activity which forces you to work against gravity, is helpful in combatting osteoporosis. Walking is good, Nordic walking even more so, but the importance of loading beyond what the body is used to can’t be underestimated. Research carried out in 2006 showed that standing on one leg increased the load on the head of the femur more than 52 minutes of walking!

Impact

Contrary to what is often reported, unless you have a spinal fracture, moderate impact, and in some cases even higher impact exercise, can be helpful. It is the impact that stimulates the bone to grow.

Balance

Working on balance is important as it helps to prevent falls, the main cause of fractures. Simple daily habits like cleaning your teeth on one leg all help.

Agility and reflexes

Drills which require you to change direction suddenly and while moving are also good, as is keeping your reflexes sharp. Both help to prepare the body to deal with unexpected events without falling over.

2. DIET

Calcium has a number of key functions, one of which is bone health. The recommended dose is 700mg/day. Milk, cheese, yoghurt, leafy green vegetables, tofu, and nuts, especially almonds, are all good sources.

Fact: our body contains around 1kg of calcium, most of which is in our bones!

If we are low on calcium, it can stimulate the breakdown of the bone in order to provide what is required.

Vitamin D helps the absorption of calcium. The recommended daily amount is 10 micrograms which, in spring/summer, can usually come from being out in the sunlight (without sunscreen). Ten minutes once or twice a day is sufficient. Oily fish and eggs are good sources of vitamin D but it is difficult to get everything we need just from food.

At times of the year when sunshine is at a minimum, it may be appropriate to supplement but always check with a doctor or registered health professional

3. LIFESTYLE

There are also a number of factors that directly increase your chances of getting osteoporosis. Aside from diet and exercise as mentioned above, how much alcohol you consume, smoking, and a sedentary lifestyle are the biggest culprits. The good news is that these are all modifiable!

 

In conclusion, osteoporosis is a debilitating condition that eventually not only causes pain and discomfort, but also increases anxiety, lowers self-esteem and impacts on confidence. By taking the preventative action suggested, those effects can be minimised. That’s got to be worth it?!