Most women have heard of osteoporosis and know that they should do something to prevent it. But when asked what that “something” is, women are generally not as well informed as they should be.

What is osteoporosis?
Osteoporosis is a disease characterised by rapid deterioration of the bones. Even before the age of 40, the bones of the skeleton start to atrophy or deteriorate, so that the size and weight of the skeleton shrinks. In advanced old age, the skeleton of most men and women will have shrunk to only about 70% of its size in the prime of life.

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This loss of bone mass is a part of the normal ageing process. In women there is a sharp decline in bone density at the time of the menopause, while in men this process occurs more slowly. Unfortunately these brittle bones are much more likely to break than normal, strong bones. Even trivial injuries can cause fractures.

We all know that older women (and men) are prone to breaking bones, particularly hip bones which require extensive surgery and often cause a great deal of suffering and disability.

How can osteoporosis be prevented?
Because osteoporosis is part of the ageing process and many more women live much longer than was previously the case, it is important for all women to be aware of what they can do to slow down bone loss as much as possible.

Researchers have identified a number of factors that can delay the onset and severity of osteoporosis, namely:

• use of hormone replacement therapy (HRT)
• high intakes of calcium and other bone minerals
• adequate vitamin D intake
• regular exercise

HRT needs to be prescribed and monitored by your medical doctor. So let’s consider the other three prevention strategies.

High calcium intake
The most important strategy to slow down bone loss is to ensure that women have an adequate to high calcium intake for their entire lives.

Start in the teens
The importance of taking sufficient calcium to lay down a large, strong supply of calcium in the skeleton cannot be overemphasised. The time to lay down these stores for future bone strength is during the teenage years. Young women should all take in at least 1 000 to 1 500mg of calcium a day. This translates to three to four cups of milk, yoghurt or cottage cheese daily. Unfortunately most young women are so concerned about gaining weight that they neglect protective foods like milk and dairy products. The trick is to use low-fat or skim milk, yoghurt and cottage cheese which give you the calcium, protein and vitamins you need, without the fat.

Older women
Older women need to keep up their calcium intake at levels of up to 2 000mg a day to prevent osteoporosis. Once again, it is a good idea to use low-fat milk and dairy products because you want to obtain the calcium without the fat which could make you gain weight now that your body is slowing down. From the age of 40, through the menopause and into old age, women should also consider taking calcium supplements on a regular basis.

Calcium supplements
Not every calcium supplement is able to provide the large quantities of calcium women require after the menopause to keep their bones strong and elastic to prevent factures. Ask your chemist which of the many supplements contain the highest amount of bioavailable calcium. My favourite is Calcium Sandoz which provides 500mg of elemental calcium per tablet.

Check the labels and avoid calcium supplements that require you to take handfuls of tablets a day to achieve a high calcium intake. The chances are good that such supplements contain calcium in a form that is not fully available to the human body. They may be cheaper, but if you have to take so many tablets a day then it works out to about the same prices as a more expensive supplement that delivers what it promises on the label. Remember it’s a better idea to spend some money on calcium intake, than to have to pay for expensive bone operations!

Vitamin D
The human body is capable of making vitamin D under the skin when it is exposed to sunlight. Generally speaking, most women in South Africa get adequate exposure to sunlight. However, older women may not go out into the sun as often as they should or may be forced to stay indoors because of illness or disabilities. If this is the case, then chat to your doctor or chemist about vitamin D supplementation. Nowadays foods like margarine contain added vitamin D. Check the kind of margarine you buy to ensure that it contains this vitamin which helps the body to maintain strong bones.

Exercise
Exercise strengthens the skeleton and prevents the progression of osteoporosis. Women of all ages should be encouraged to participate in some kind of exercise. If your X-ray examination has identified signs of bone loss after the menopause, then try to be as physically active as possible, without of course exposing yourself to accidents which could cause fractures!

Join a gym, or a water aerobics class, or Walk for Life. A combination of brisk walking, or swimming to mobilise the skeleton and muscles, with weight-bearing exercises in a gym which strengthen the bones, can make all the difference in preventing bone loss and fractures.

The most important dietary factor before, during and after the menopause, which will help you to avoid the danger and debilitation of osteoporosis, is therefore calcium. Drink that low-fat/skim milk, eat that low-fat/skim yoghurt and cottage cheese, and use a good calcium supplement to ensure that your bones stay strong and supple, and you will keep osteoporosis at bay. - (Dr I.V. van Heerden, DietDoc)

Any questions? Ask DietDoc
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