What’s the Score?
When you’re young, your bones get longer and denser until you reach your full height. Even as you grow, your bone tissue is constantly being broken down and rebuilt. Then, in your early 30s if you’re a woman and about 40 if you’re a man, your skeleton naturally begins to slowly lose bone faster than your body can replace it and very gradually thins as you age.
If you have osteoporosis, it’s a different story. By the time you’re diagnosed, your bones will already have lost significant density, making them fragile and easy to break – often in a very minor accident or, in some cases, even spontaneously. You’ll face a higher risk of fracturing wrists or suffering painful compression fractures of the spine, causing your upper back to curve forward. The major danger, however, is the possibility of a hip fracture, which can cause permanent disability; even worse, studies show that 20 percent of people over age 50 who break a hip die of complications within a year.
Bone loss is caused partially by a depletion of the mineral calcium. It affects more women than men because oestrogen plays a crucial role in the female body’s ability to use dietary calcium to build new bone. As a result, when you approach or are in menopause, the reduction in the body’s oestrogen production deprives bones of calcium. Some 20 to 30 percent of bone loss in women occurs in the first five years after menopause, a critical time when a precondition called osteopenia often develops.
Bone loss can also occur in younger women whose oestrogen levels have dropped due to the removal of their ovaries, and in athletes whose ability to produce oestrogen may be hindered by low levels of body fat. Hormonal changes can also contribute to osteoporosis in men (see box on p92), as can long-term use of medications such as anticonvulsants and corticosteroids.
- Back pain and, less commonly, pain in the chest, hip, wrist and pelvic area.
- Pain that is mechanical in nature, although it may appear spontaneously or be caused by effort or trauma.
- Loss of height (due to the compression of the spinal column).
- Increased tendency to suffer fractures after relatively minor falls.
To begin, treatment for osteoporosis will focus on medications to slow bone loss and reduce the risk of fractures, as well as lifestyle changes to improve general wellbeing. Your doctor may recommend the same approach if you’ve got osteopenia. For severe cases and fractures, surgery may be an option.
Medications: You already know that calcium is important for helping your body make bone tissue, but how much do you need? Adults up to age 50 require 1000mg of calcium daily; postmenopausal women (and men over age 65) should get 1200 to 1500mg a day. If dietary sources aren’t enough, add calcium supplements. You’ll find a variety of calcium compounds on pharmacy shelves; the two with the highest levels of calcium are calcium carbonate (take it with food) and calcium citrate (which can be taken without food). For best absorption, don’t take more than 500 to 600mg at a time.
Calcium needs a partner in its bone-protection work: vitamin D. Most adults need 400 IU daily. With osteoporosis, you may require 600 to 800 IU daily. Or your doctor may suggest a prescription for calcitriol (Rocaltrol). Rocaltrol is particularly useful for osteoporosis induced by corticosteroid use.
You’ll also need medication to slow bone loss and increase bone mass. The first choice for many patients are drugs called bisphosphonates: alendronate (Fosamax) and risedronate (Actonel). Both drugs have been shown to lower the incidence of fractures.
If you are a postmenopausal woman, your doctor may recommend HRT. Because HRT replaces lost oestrogen, it prevents rapid bone loss and increases bone density in the hip and spine. Long-term treatment with HRT is controversial, however, because it carries increased risk for blood clots, breast cancer and other problems. For oestrogen’s protective benefits without some of its side effects, ask about tibolone (Livial) and a new class of drugs called selective oestrogen receptor modulators (SERMs), such as raloxifene (Evista). SERMs prevent bone loss throughout the body, but they carry an increased risk of blood clots so they are not right for everyone.
Strontium ranelate (Protos) is another new drug proven to reduce the risk of fracture and increase bone formation. Teriparatide (Forteo) has been shown to reduce the incidence of spinal fractures by 65 percent in postmenopausal women with prior spinal fractures; however, the drug needs to be given by injection.
Lifestyle changes The best treatment for osteoporosis is prevention. Lifestyle changes can make a big difference, even if you’ve already been diagnosed with osteoporosis. Keep these bone-building and safety tips in mind:
- Ensure the family eats calcium-rich foods on a daily basis. Anyone who is at risk should also consider taking a calcium supplement (choose one with important co-factors such as vitamin D and the minerals magnesium and silica).
- Avoid inactivity Walk regularly, or work out. Weight-bearing exercise throughout life is especially important because it offers some protection against osteoporosis. Be sure to ask your doctor for guidelines on what and how much exercise is safe for you.
- Limit beverages that leach calcium from your bones. Restrict alcoholic drinks to one a day if you’re a woman, two if you’re a man. Draw the line at two cups of caffeinated coffee per day.
- Quit smoking. Tobacco interferes with your normal bone metabolism, contributing to osteoporosis.
- Make alterations to your home and office to prevent falls. Tack rugs down or use a slip-proof backing to lessen the chances of falls. Install handrails in key places, such as in the bath or shower.
- Don’t run for buses or trains. Rushing increases your chances of tripping.
- If you think you may be at risk of osteoporosis, discuss the possibility of bone density scanning with your doctor and health care professional.
- Amenorrhoea (absence of menstrual periods) is associated with reduced oestrogen levels and increased risk of osteoporosis. If you are affected, work with your doctor to identify the cause of the problem.
Your doctor will check your progress with bone density tests called dual energy X-ray absorptiometry, or DXA. If you have a severe break or other problems such as osteoarthritis, joint replacement is an option. This operation replaces part of a hip or knee with man-made materials. If you have a collapsed spinal vertebra, a new therapy called vertebroplasty may relieve pain. Vertebroplasty involves injecting a cement-like substance into the fractured body of the vertebra, which stabilises the bone as it sets.
Diuretics: Diuretics are making a major comeback. Recently, a panel of experts designated these urination-promoting medications as the first-choice treatment for high blood pressure. Now, a new study has shown that taking diuretics may help to protect against hip fractures.
Dutch researchers studied the records of nearly 8000 men and women over the age of 55 and concluded that those who’d been taking the diuretic thiazide for at least a year had, on average, a 50 percent lower risk of hip fractures.
The finding makes sense because some diuretics are thought to reduce calcium loss by cutting down on the amount of calcium excreted in urine. Although the study’s authors consider long-term diuretic use to be safe under a doctor’s supervision, they say further study is needed before diuretics can be recommended as an osteoporosis treatment for people who don’t have high blood pressure.
Vitamin B12: Here’s another reason to make sure you take a multivitamin every day: the B vitamins it contains could help you avoid debilitating fractures. One of the 11 members of the B-vitamin family, vitamin B12 has recently been shown to play a bigger role than previously thought in keeping bones strong as you grow older.
Research from the University of California, San Francisco, looked at how much vitamin B12 was circulating in the bloodstreams of 83 volunteers aged 64 and over. Measurements taken over a six-year period yielded a clear finding: those people who had the highest blood levels of vitamin B12 showed the least loss of density in their hips over that period, while those with the lowest levels of B12 showed the most bone loss.
At this stage, no-one is really sure why a lack of B12 speeds bone loss. But the finding is important because B12 deficiency is more common in women over 60 – the people most at risk of osteoporosis and hip fractures. Vitamin B12 deficiency is sometimes due to pernicious anaemia, a serious condition that requires medical treatment. It’s also possible that you’re simply not getting enough shellfish, milk, cheese, eggs, organ meats and other sources of vitamin B12 from your diet. Even more likely, your digestive system isn’t absorbing the vitamin B12 from these foods the way it used to, which means you may benefit from a supplement.
All in the genes: Researchers have now discovered a gene variation that triples the osteoporosis risk of anyone who has it. All of us carry the gene BMP2, but it exists in several different variations, three of which signal high osteoporosis risk. Although these high-risk variations are rare, if you discover you have one, you will have all the motivation you need to start taking preventive measures.
Two factors were key in connecting the BMP2 gene with high osteo-porosis risk: the completion of the human genome map and the easily traceable genealogy of Iceland’s population. By scanning the genomes of 207 Icelandic families, scientists were able to isolate genes common to the osteoporosis patients (living and long dead) who were analysed.
The finding does not mean that BMP2 is the osteoporosis gene, since researchers suspect that several other genes have variants that also contribute to osteoporosis risk. Nor does it doom its owners to brittle bones and certain fractures. It does, however, issue a loud wake-up call to people with any of the high-risk variations of the gene, the most significant genetic risk for osteoporosis yet discovered.