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When Shirley’s period stopped for a year during a particularly stressful time in her life, she didn’t give it much thought. She had always struggled to maintain an ideal weight, after having battled with anorexia during her late teens and early twenties, but had since then felt that her health was generally good.
A minor fall when she was 30 resulted in a broken arm and leg, and when doctors did a bone density scan on her, they found that she had lost half her bone mass, and in addition to the broken arm and leg, there were other fractures in her pelvis. She was diagnosed with osteoporosis.
The first course of action was placing her on hormone replacement therapy and calcium supplements, although they did not do anything to reverse the condition, and merely slowed the deterioration. She found herself one of the growing number of statistics, where young women were suffering from this disease previously only associated with elderly women. She soon established that because she had stopped menstruating due to her low body weight, her oestrogen level had dropped to the point where it could not protect her bones. Unfortunately for her, the legacy of her past had impacted her body irreversibly.
What is Osteoporosis?
Osteoporosis is the term for brittle bone disease, and it generally manifests with fractures, severe back pain, dowager’s hump (curvature of the spine) and a loss of height. Amongst the elderly, hip fractures are the most common and the most serious, where up to 20 percent of patients die within a year and half are no longer able to lead an independent life. According to the South African National Osteoporosis Foundation, the fracture rate has increased during the past ten years in both women and men.
They attribute lifestyle choices as the biggest problem, identifying the following as the most predictable sources: incorrect diet, whereby calcium intake is reduced; lack of exercise, specifically weight-bearing exercise; the abuse of alcohol; high animal protein intake (which leaches calcium from the bones); smoking; and taking drugs like cortisone, which is extremely bone toxic.
The body carries on building bone until about the age of 35, making it essential during that time that a person takes a pro-active stance, and realises that an ounce of prevention makes a lot of sense when a pound can’t buy any cure.
Bad news for Women
Women have always been considered at most risk of this disease, because of having a lower bone mass to begin with. After menopause, the ovaries no longer produce oestrogen, which is a hormone which works towards protecting bone density. Therefore, if a woman has had an early-onset menopause, or a history of eating disorders (specifically bulimia and/or anorexia), has a small frame and a light bone structure, she is automatically more at risk. Her lifestyle choices become the critical denominator here - if she drinks or smokes heavily, and does not exercise – that can tip the scales towards this crippling and devastating disease.
If a woman is in a high-risk category, it is important that she receive a bone density measurement, which can be done with a bone densitometer at most hospitals. There are tests that have been developed to detect bone loss before it becomes too severe, including a urine test. Dual energy X-ray absorptiometry (DXA) tests density in the spine, hip and total body.
Treatment
Once a positive diagnosis has been made, there are a number of treatment options available, the most common being HRT (hormone replacement therapy), which replaces the oestrogen which is no longer being supplied, or supplement it. This has been shown to slow the rate of deterioration, but the chances of increasing bone density are slim. Oestrogen replacement therapy also protects against cardiovascular disease.
Drugs such as alandronate (Fosomax) are said to increase bone density, and raloxifene (Evista) provides oestrogen’s heart and bone protection factors without increasing the risk of breast and uterine cancer. If a woman has had breast cancer, the option of HRT becomes controversial, because of health risks posed. The breast cancer drug, Tamoxifen, can be prescribed, because it has oestrogen effects and thus decreases the risks of osteoporosis.
Introducing drug therapy without the benefit of lifestyle changes would be self-defeating, and changes to diet and exercise regimes are important. Certain substances are known to inhibit calcium absorption, including salt, alcohol, caffeine and cigarettes. Gentle weight-bearing exercise is something that should have been incorporated from childhood, but it is never too late to start. Increasing calcium intake can reduce the odds of getting a fracture, and sources are dairy, fish (like salmon, with soft edible bones), soy and dark leafy vegetables. Vitamin D must be taken in conjunction, either in supplements or just time spent in the sun.
Men need to be aware of the risk factors too, and take all the above steps and precautions, as it is no longer safe to assume (like with breast cancer) that they are immune from the ravages of this disease. Anyone who has been taking cortisone for longer than 3 months increases considerably the risk of bone mass loss, as this drug is very toxic to bone and prescribed commonly for various illnesses, like asthma or psoriasis. Remember that early detection always enhances the odds of survival, and knowing your genetic family history can be an important indicator of your risk status.
National Osteoporosis Foundation of South Africa
PO Box 481
Bellville
7535
Tel. (021)-931 7894
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