Building better bones

“Osteoporosis is what we call a ‘silent crippler’ and many people don’t realise that they have the condition until something goes wrong,” said Dr Joel Dave, a Cape Town endocrinologist from the University of Cape Town’s Endocrinology Department at Groote Schuur Hospital. Those with the condition may not know they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a hip to fracture or a vertebra to collapse.

A few myths about osteoporosis have recently come under the spotlight, with some interesting results.

For years, it was believed that obese women were at lower risk for developing osteoporosis, and that excess body fat actually protected against bone loss. However, a recent study found that having too much internal abdominal fat may, in fact, have a damaging effect on bone health. Says the study author, Dr Miriam A. Bredella from Harvard Medical School in the US: "...abdominal obesity needs to be included as a risk factor for osteoporosis and bone loss."

It has also been found that osteoporosis is on the increase among African woman – a group long-believed to have higher bone mineral density which offers natural protection against the disease. Although no formal statistics exist for the South African population, it was widely known that white, Asian and coloured women were at highest risk for developing the disease.  However, in recent years, figure-conscious females from the African population have been adapting their diets to lower their body weight, so impacting negatively on their bone density and therefore increasing their risk of developing bone diseases.

Important news for South African Doctors and patients to take note of, is that the New South African Osteoporosis Guideline has recently been updated by the National Osteoporosis Foundation of SA (NOFSA). This new Guideline has highlighted the importance of screening patients for osteoporosis and ensuring that those patients who are “at risk” for developing the disease, receive a bone mineral density/DXA test. This Guideline has also reinforced from previous guidelines,that those patients diagnosed with osteoporosis, engage in appropriate lifestyle changes and receive treatment to reduce their risk of fractures.

This new Guideline has also seen the inclusion of a number of new therapeutic options, for the prevention and treatment of osteoporosis. In addition to the inclusion of new treatment options, this Guideline has also recommended that patients who have been taking bisphosphonate therapy – a common treatment for osteoporosis – for longer than 5 years, should consult their Doctor to be re-evaluated. Following this re-evaluation, it is suggested that patients either be considered for a “drug holiday” - where they stop their bisphosphonate therapy for a period of time, or be considered for an alternative therapy. This however, would need to be discussed with their Doctor.

Here is a list of risk factors that may increase your risk of developing osteoporosis:  

• Women have a greater chance of developing osteoporosis than men.
• The older you are, the greater your risk of osteoporosis because your bones become weaker as you age.
• A family history of the disease can pre-dispose you to developing the condition.
• Smoking and alcohol consumption increase your risk of developing osteoporosis
• Small, thin-boned women are at greater risk for the disease.
• Anorexia nervosa increases your risk for osteoporosis.
• Abnormal absence of menstrual periods (amenorrhea), low oestrogen levels (menopause), and low testosterone levels in men can bring on osteoporosis.
• Long-term use of certain medications such as glucocorticoids and some anticonvulsants can lead to loss of bone density.

 But it’s not all bad news. Osteoporosis is not only treatable, but also preventable. Here are some lifestyle changes you can take to ensure the health of your bones:  

1. Get enough calcium in your diet and remember that calcium needs change during your lifetime. Discuss these with your doctor.
2. Watch your salt intake. The more salt you eat, the more calcium your body needs.
3. Vitamin D helps withcalcium absorption. Consult your doctor about how much vitamin D you should be taking. 800 and 1000 IU (International Units) of vitamin D is the recommended daily dose.
4. Cessation of smoking and limit youralcohol intake.
5. Bone is living tissue and just like muscles, it becomes stronger through exercise. Weight-bearing exercises like walking, running or skipping are best for bones.
6. Stop smoking. It’s bad for your bones (and your heart, lungs, skin, etc.).

Certain medications can help prevent or slow the development of osteoporosis, whilst newer treatments are able to rebuild and improve bone.

If you are unsure about the health of your bones, speak to your doctor.

Take control of your health today and make building better bones a priority.

TOP OSTEOPOROSIS FACTS: 

1. Up to 99% of all calcium is stored in our bones and teeth.
2. As women, we have a 40% lifetime risk of developing osteoporosis.
3. 1 in 3 postmenopausal women will suffer from osteoporosis.
4. Half of all women develop osteoporosis after age 50. However, it can and does occur in younger women and men.
5. A woman's risk of sustaining a hip fracture is equal to the combined risk of developing breast, uterine and ovarian cancer.
6. Osteoporosis is treatable. There are many pharmacological drugs available, such as strontium ranelate, bisphosphonates, SERMs, and others.
7. Osteoporosis can be detected via a bone mineral density (BMD) test, which can identify the condition, determine your risk for fractures, and measure your response to osteoporosis treatment.