Osteoporosis is a natural part of ageing, but it is much more common in women than men. It is also far more common in Caucasians than in oriental or black people. Women are particularly vulnerable to osteoporosis after the menopause, especially if this occurs before the age of 45, because their ovaries no longer produce oestrogen which helps to maintain bone mass. Removal of the ovaries has the same effect. In the U.K. one in three women and one in twelve men will suffer from osteoporosis, and it is responsible for 150,000 fractures each year. More women die of hip fractures than cancer of the womb, cervix or ovaries. A longer life expectancy means that the disease is becoming more common, and it currently costs the NHS £750 million per annum.
Predisposing factors and causes of osteoporosis include thin stature, calcium deficiency, kidney failure and certain hormonal disorders such as Cushing’s syndrome or prolonged corticosteroid therapy. Drugs such as Tamoxifen and antacids are implicated too. In men, osteoporosis is sometimes due to lack of testosterone, but excess consumption of alcohol is the main cause. Prolonged immobility and sedentary lifestyle is also a factor. Osteoporosis is more common in smokers and heavy drinkers and is often associated with chronic bronchitis and emphysema. Other factors to bear in mind are a history of over-dieting, anorexia nervosa and a family history of osteoporosis. Diabetes mellitus can lead to secondary osteoporosis. Vitamin D deficiency and over-prescription of thyroxine for hypothyroidism also predisposes towards the disease. The incidence of osteoporosis is lower in vegetarians, while it has been established that high meat consumption can inhibit calcium metabolism.
In many cases, osteoporosis is a ‘silent disease’, without any particular symptoms, and often the first sign is a fracture after a fall that would not have caused any damage in a young person. Typical fracture sites are at the top of the femur and just above the wrist. There may also be spontaneous fracture of one or more vertebrae, causing the bones to crumble and leading to a progressive loss of height, or pain due to spinal nerve compression. Symptoms include aching back pain, and the spine may be markedly curved (known as a dowager’s hump).
Bone tissue that has already been lost cannot easily be replaced, and preventative measures should be taken early on. There are many ways to limit the damage. Orthodox medicine encourages the use of hormone replacement therapy, although as soon as this is stopped, bone mass has been shown to decrease even more rapidly. Black cohosh, which attaches to oestrogen receptors in the bones, should help maintain bone density and delay or slow the progression of osteoporosis. Regular weight-bearing exercise is to be encouraged, and this includes brisk walking and perhaps using stairs instead of the lift. Calcium intake can be increased with milk products, lots of leafy green vegetables, nuts, soya products, pulses, and sardines. Cod liver oil increases bone elasticity. High coffee intake is known to reduce bone mineral density in women. A two-year study of healthy older women treated with a 500mg calcium supplement daily showed an increase in bone density in those whose dietary intake of calcium was in excess of 400mg daily, but had virtually no effect on those whose dietary intake was less than 400mg. The herb Fenugreek also has known osteoprotective effects.
If you are seriously overweight, a sensible diet regime should be introduced. Bran and wholemeal bread should not be consumed as they contain calcium-binding phytic acid. Salt intake should be reduced as it can increase calcium and phosphate loss through the kidneys. Stopping smoking and reducing alcohol and coffee consumption are advisable.
Heat and gentle massage may be of benefit is there is muscle spasm in association with back pain, and an orthopaedic support for the back may prove helpful. Regular exercise such as walking or dancing is beneficial, while squeezing a tennis ball hard for a few minutes three times a day can reduce the risk of wrist fracture.
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Christine Haughton, MA MNIMH MCPP FRSPH
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Last updated 27th November 2014 ©Purple Sage Botanicals