What is Osteoporosis?

With more than four million potential osteoporosis sufferers in South Africa, it’s time we stood up and paid attention.

Osteoporosis is more serious than you think, affecting over 200 million women worldwide; most women don’t know they have the disease until they’ve fractured a bone. And, by the time a fracture occurs, the disease is in its advanced stages and damage is severe. These fractures are common and an important cause of disability and death globally. You might not have osteoporosis at the top of your list of health concerns, but this is why you should.

Osteoporosis: Explained

According to the National Osteoporosis Foundation of South Africa (Nofsa), osteoporosis is a systematic disease where the bone mass and quality of bone are diminished to such an extent that it can lead to fractures of the spine, hip, ribs and wrist. Bone is a living tissue; new bone is continuously being formed and old bone chewed away. In osteoporosis, the bone is chewed away more rapidly than it is formed. Throughout youth, your body uses both calcium and phosphate to produce bones. If you do not get enough calcium, or if your body does not absorb calcium from the diet, bone production and bone tissues may suffer. As you age, calcium and phosphate may be reabsorbed into the body from the bones, which makes the bone tissue weaker. This can result in brittle bones that are more prone to fractures (which increase with age), which is why it is important to get an adequate intake of vitamins from a young age.

Osteoporosis is called the silent epidemic, because there are usually no signs until you fracture a bone. While it is a disease generally affecting postmenopausal women, it is increasingly becoming a problem affecting men too. Doctor Stan Lipschitz, a Johannesburg-based physician who specialises in geriatric medicine, comments: “Men and women lose bone as they age. Women lose additional bone for the first few years after menopause. Therefore women develop osteoporosis earlier – but men also develop this disease in later life, and the outcome after a fracture is worse.”Research: The latest

Osteoporosis treatments, such as bisphosphonates and strontium ranelate, came under the international spotlight recently, when the results of the world’s largest-ever bone biopsy study in menopausal women was presented at the European Congress on Oesteoporosis and Osteoarthritis (held in Spain).

The global study compared the efficiency of the osteoporosis treatment stronium ranelate with the commonly prescribed bisphosphonates, finding it to be 17 times more effective. Ranelate has a higher bone-forming activity and is the only treatment to stimulate bone formation and prevent reabsorption. Lipschitz agrees, “ranelate is a significant treatment. The aim for this disease is to have a drug that reduces bone loss and stimulates bone formation. Ranelate is the only drug currently available able to achieve this.”Strontium ranelate has a greater effect on improving bone density in the long run too. “In a dose of 2mg/day, ranelate reduced fracture at all sites. It is the first treatment that has been shown to reduce hip fractures at five years,” says Lipschitz.

According to Dr Jean-Yves Reginster, chairperson of the European Osteoporosis Foundation, ranelate has also recently been shown to have sustained anti-fracture efficacy over 10 years, making it a first-choice treatment for postmenopausal osteoporotic women.

Bisphosphonates are taken to prevent fractures related to postmenopausal osteoporosis, but researchers have linked long-term use with a small risk of unusual fractures of the thigh bone and death of the jawbone. Dr Elizabeth Shane, past president of the American Society of Bone and Mineral research, comments on the findings of unusual fractures: “Extremely rare, when considered in the context of how many people take bisphosphonates for osteoporosis.” She says the benefits of this drug outweigh the risks. Doctors should review the long term treatments of people on this type of drug after four to five years of use.

According to Nofsa, both strontium ranelate and bisphosphonates are first-line treatments for people suffering from osteoporosis. Your doctor will decide which treatment will suit you, based on your profile and the stage of the disease.Bone Health: Prevention is better than treatment

You cannot change the fact that you might be predisposed to osteoporosis due to gender, age and genetics, but you can prevent further bone loss. Recent research on calcium shows that not only does it prevent further calcium losses, but it has also been shown to help improve bone density. “Without calcium supplementation, further losses of bone density will occur,” explains Andrea du Plessis, a qualified dietician.

It is also important to make sure that the calcium supplement has vitamin D and magnesium to metabolise the calcium in your body, to prevent heart attacks and strokes.

Exercise, such as walking, jogging and playing tennis, can reduce the likelihood of bone fractures in people with osteoporosis. Exercise can also make the bones stronger. Each time a muscle contracts, it stimulates the bone cells to produce more bone density in the bone. “The slower and more controlled the movement, the more benefit to muscle tone and greater gain to bone density,” adds Dr Guy Ashburner, a Cape Town-based osteopath.

Risk factors: The leading cause of osteoporosis is a drop in oestrogen in women and a drop in testosterone in men, but there are other factors. These include:Family history of osteoporosisExcessive alcohol intakeHistory of hormone treatment for prostate cancer and breast cancerSmokingLow body weightToo little calcium in the dietVitamin D deficiencyLack of exerciseMalabsorption

Tips to protect health

Osteoporosis is on the increase, and the longer you live, the greater the likelihood of this disease and fractures. But here are practical tips to ensure strong bones:Watch your salt and coffee intake as this can increase the risk of urinary excretion of calcium.Dried prunes are one of the best food sources of calcium intake.Vitamins such as phosphate, magnesium, fluoride, vitamin C, D and K, combined with calcium, all play a part in strong healthy bones.Smoking and drinking can contribute to loss of bone density and strength.Gentle exercise.

It’s all in the bones

Back pain is on the increase due to lifestyle, poor posture and lack of exercise. Ashburner says that bad posture results in increased tension in your back and spine, leading to discomfort and pain gradually affecting the neck, which can result in headaches and the inability to concentrate.Simple rules for posture, to prevent pain and discomfort, have to do with the spinal curve. Always sit correctly using a simple chair with a space at the back big enough to put your bottom through, as this helps support your upper back. “Sitting in the chair, bend forward to a 45-degree angle, wiggle your bottom back as far as possible, then sit up.”

He continues. “It is essential for the health of the spine, and indeed the body, to have normal curves. This begins with the foundation of the lumbar spine. If this is in the wrong position, the rest of the spine will follow.”

Osteoporosis is one of the main reasons why people are admitted to nursing homes.A woman’s risk of sustaining a hip fracture is equal to the combined risk of developing breast, uterine and ovarian cancer and up to 20% of people die after a hip fracture.It accounts for more days spent in hospital than any other disease. This is why it is important to start looking after your bones now.SymptomsThere are no symptoms in the early stages, but symptoms occurring later include:Bone pain or tendernessFractures with little or no traumaLoss of height over timeLow back and neck pain due to fractures of the spinal bonesStooped posture

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