Health and Wellbeing

Osteoporosis - Giving ‘the silent disease’ its voice

Osteoporosis is the most prevalent bone disease worldwide. World Osteoporosis Day, which falls on 20th October 2009, provides an opportunity to inform and educate the general public and policy makers about the management and prevention of osteoporosis.

‘The Silent Disease’

Osteoporosis is defined as ‘a progressive systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture’. Bone is a living tissue which is continuously turned over throughout life - in simple terms, old bone is broken down and replaced by new bone. This is a natural process, but if the rate of bone loss exceeds renewal, bones can become weakened. Osteoporosis is termed ‘the silent disease’ as it is often not diagnosed until a bone has been broken; it is estimated that only 15% of cases are diagnosed. The most common fracture sites are the hip, wrist and spine; although any bone can be affected. The early stage of osteoporosis is known as osteopenia, and it is a warning sign of an increased risk of osteoporosis. Upon diagnosis of osteopenia, it is essential to identify the cause and implement the appropriate treatment to reduce further bone loss.

Signs and symptoms of osteoporosis include:

• Breaking a bone easily from a fall
• A height loss greater than 2cm
• Development of a hump on the upper back
• Sudden and severe upper, middle or lower back pain

Bone Density Scans

A DXA (Dual Energy X-ray Absorptiometry) scan is recognised as the most accurate means of assessing bone strength and fracture risk. It is a simple and painless scan which measures the density of bones. The patient is required to lie still for approximately 8-10 minutes while the scanning arm passes over the area of the body being scanned. This service is available in a number of hospitals and clinics nationwide. Contact the Irish Osteoporosis Society to find your nearest centre (see above), or alternatively, a DXA scan may be organised through your GP.

Risk Factors

Osteoporosis is often considered an ‘old lady’s disease’, but men and women of any age, even children, may be affected. Recent statistics show that one in five men and one in two women over the age of 50 years will be affected by osteoporosis. The good news is that, although genetics largely determine the development of osteoporosis, simple modifications of both diet and lifestyle habits can help prevent or delay the onset or progression of osteoporosis.

Some of the main risk factors for osteoporosis are highlighted below:

• A strong family history of the disease
• Abnormal sex hormone levels
• Poor calcium and vitamin D intakes
• Inadequate levels of physical activity (especially weight-bearing activity)
• Insufficient calorie and/or protein intakes
• Past or present eating disorders
• Certain medications and illnesses
• Smoking and excessive alcohol intakes

Importance of Dairy

A healthy, well-balanced diet providing adequate calories and nutrients is essential at all stages of life. Calcium is the most abundant mineral found in our skeleton. Milk, cheese and yogurt are among the best dietary sources of calcium, and additionally are among the most bioavailable sources i.e. easily absorbed by the body. Dairy foods also contain other essential nutrients which help contribute to optimum bone health e.g. phosphorous. The early years (particularly the pubertal years), menopause and older age are critical life-stages for bone health; research shows that dairy foods may play an important role in bone development/ maintenance during these stages*. Vitamin D is essential for the absorption of calcium. Sunlight is the best source of this vitamin, via synthesis in the skin in the presence of UVB light. Dietary sources of vitamin D are limited but include oily fish, eggs and fortified milk.

• * Moore LL et al. J Pediatr. 2008; 153: 667-673.
• Bonjour J-P et al. Br J Nutr. 2008; 100: 866-874
• McCabe LD et al. Am J Clin Nutr. 2004; 80: 1066-1074.

Weight-bearing Exercise

Participation in physical activity is an important part of a healthy lifestyle for people of all ages. Research indicates that weight-bearing exercise enhances bone strength, especially during childhood. Weight-bearing exercises are activities during which our bones carry our weight, such as running, walking at alternating speeds, dancing and most team sports. Guidelines published earlier this year recommend that children and young people should be active at a moderate to vigorous level, for at least 60 minutes every day, and that muscle-strengthening, flexibility and bone-strengthening exercises are included three time per week.

Fall Prevention

Those with osteoporosis are more susceptible to breaking a bone from even a simple fall and most of these falls occur in the home.

To help reduce the risk of falls:

• Wear good walking shoes in the home.
• Never stand on a chair to reach a shelf.
• Keep the most frequently used foods and utensils in easy to reach places.
• Use the hand-rail on stairs for support and take one step at a time.
• Ensure all carpeting, tiles and steps are in good condition.
• Remove all throw rugs.
• Avoid wet surfaces and wet grass.

Did you know?

It has been estimated that up to 70-75% of peak bone mass is attained by post-puberty. Therefore, a ‘bone-friendly’ lifestyle, which includes adequate dairy intake and engagement in weight-bearing exercises, is essential during childhood and adolescence.

NutriMyth of the month

Myth:

There are no treatments for osteoporosis.

Truth:

Treatments for osteoporosis have developed considerably over the last number of years. Adults diagnosed with osteoporosis should be prescribed an appropriate treatment plus calcium, vitamin D and appropriate weight bearing/strengthening exercises. A different course of treatment may be prescribed for younger people.

 

If you have any suggestions or ideas, we would be delighted to hear from you via email at feelinggood@ndc.ie or write to us at The National Dairy Council, 28 Westland Square, Dublin 2.

Don't miss our next edition ‘Healthy eating on a budget’ - available online from Monday 22nd November 2009