Q I am a healthy woman in my late 30s. My mother was recently diagnosed with osteoporosis at 68 years old. She is not surprised as her mother had a hump on her upper back and always complained of back pain, so we suspect she had it too. What can I do to keep myself from getting it? I have two young children and wonder if there is anything I should be doing for them?
A Bone is an amazing organ that is both relatively strong and light-weight. Bone has a complex internal and external structure. Internally, it consists of a honeycomb-like flexible matrix that account for about 30pc of internal bone. Bone tissue is continually undergoing remodelling due to the activity of various bone cells (e.g. osteoclasts, osteoblasts, osteocytes) and under the influence of many hormones and other important regulatory molecules (e.g. calcium, vitamin D, cytokines, growth factors). It is bone mineralisation that gives bone its rigidity.
Bone mass peaks around 16-25 years of age. This is one of the many reasons why children need to have healthy balanced diets and be engaged in plenty of exercise, particularly weight-bearing activities like tennis, gymnastics, soccer etc. This will help them achieve their maximum bone density before full skeletal maturity occurs. The recommended amount of weight-bearing exercise to prevent bone loss is 60 minutes per day for children and 30 minutes per day for adults.
Thereafter, we enter that gradual decline phase in life, including gradual bone density loss. From about 35 years onwards, it is estimated that bone mass decreases by 0.3pc to 0.5pc per year. From 6-10 years post menopause, bone loss decreases even further by 2pc-3pc per year for women (not on any treatment), partly due to the loss of oestrogen. That is why Hormone Replacement Therapy (HRT) can be used to treat osteoporosis. Healthy women, without risk factors, taking HRT need not worry about osteoporosis screening until they decide to stop taking it.
Osteoporosis is a common disease that is characterised by low bone mass, microarchitectural disruption and skeletal fragility, making your bones more easy to break or fracture. The prevalence of osteoporosis is higher in white/fair-skinned people.
Risk factors for osteoporosis include: advancing age, previous low-trauma fracture, long-term oral steroid treatment, parental history of hip fracture or osteoporosis, low body weight (Body Mass Index less than 19kg/m2), current cigarette smoking, rheumatoid arthritis and excessive alcohol consumption (more than three units per day). Excessive alcohol may cause dietary and liver problems and low levels of hormones, which can affect bone. Excessive caffeine consumption (more than 300mg-400mg per day) can also increase bone loss by increasing calcium excretion in urine, resulting in the body taking calcium from the bone.
Secondary causes of osteoporosis include: premature menopause (before 45 years old), low testosterone levels, inflammatory bowel disease, gastro-intestinal malabsorption syndromes like coeliac disease and chronic liver or kidney disease, past or present eating disorders. Being immobile, bedbound or wheelchair bound for six weeks or longer means you are unable to weight-bear. Bone loss occurs as your bones are not put under routine daily stress, which is necessary for bone remodelling in order to stay strong and healthy. Long-term use of certain medication can increase bone loss. Dietary deficiency of calcium, vitamin D or protein can increase bone loss.
What you can do to ensure optimal bone health at any age is two-fold. Firstly, assess your diet for your consumption of dairy products, which are one of the best sources of calcium, especially the fortified milks. Not only do they have calcium, but also have vitamin D. The best sources of calcium are milk, cheese and yoghurt. Bread, nuts and any oily fish (e.g. salmon, sardines, tuna) also contain calcium and vitamin D, as do some dark green vegetables.
Secondly, make sure you are getting regular weight-bearing exercise such as walking, hiking or any of those listed above.
Dr Jennifer Grant is a GP with the Beacon Hospital HealthCheck
Weekend Magazine
Excerpt from:
Ask the doctor: Is there anything I can do to prevent osteoporosis? - Independent.ie
