Download Osteoporosis

What is Osteoporosis?
The bones in our skeleton are made of a thick outer shell and a strong inner
honeycomb mesh of tiny struts of bone. Osteoporosis means some of these
struts become thin, which makes the bone more fragile and prone to break
after a minor bump or fall. These broken bones are often referred to as
fragility fractures. Although fractures can occur in different parts of the body,
the wrist, hip and spine are most commonly affected.
Your bones
Bones contain collagen (protein), calcium salts and other minerals. Each bone
is made up of a thick outer shell known as cortical bone and a strong inner
mesh of trabecular bone which looks like a honeycomb. Bone is alive and
constantly changing throughout life. Old, worn out bone is broken down by
cells called osteoclasts and replaced by bone building cells called osteoblasts,
in a process of renewal called bone turnover. In childhood, osteoblasts work
faster enabling the skeleton to increase in density and strength. During this
period of rapid bone growth, it takes the skeleton just two years to completely
renew itself. In adults the process takes seven to ten years.
Bones stop growing in length between the ages of 16 and 18, but bone
density continues to increase slowly until a person is in their mid 20s. At this
point the balance between bone demolition and bone construction stays
stable. After the age of 35, bone loss increases very gradually as part of the
natural ageing process. This bone loss becomes more rapid in women for
several years following the menopause and can lead to osteoporosis and an
increased risk of broken bones, especially in later life.
Who is at risk of osteoporosis and broken bones?
You cannot see or feel your bones getting thinner and many people are
unaware of any problems until they break a bone or start to lose height. If you
think you have risk factors for osteoporosis and fractures then you can
discuss this further with your GP.
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Author - Pulmonary Rehabilitation Service
Date of issue 2014
Date of review April 2017
Version 2
ID number RESPIRATORY – 001-osteo – 2012
The factors that can put people at risk of osteoporosis and fractures include:
Genes - Our bone health is largely dependent on the genes we inherit from
our parents. In fact, if one of your parents has broken a hip, you may be more
susceptible to developing osteoporosis and fragile bones.
Age - Bone loss increases in later life so by the age of 75 about half of the
population will have osteoporosis. As we get older bones become more fragile
and more likely to break.
Gender - Women have smaller bones than men and they also experience the
menopause which accelerates the process of bone turnover. The female
hormone oestrogen has a protective effect on bones. At the menopause
(normally around the age of 50) the ovaries almost stop producing this
hormone reducing the protection it gives to bones.
Race – People who are Black Afro Caribbean are at a lower risk because they
have bigger and stronger bones.
Low body weight – If you have low BMI (body mass index) below 19g/m2
you are at greater risk of developing osteoporosis.
Previous fractures - If you have already broken bones easily, including in the
spine, then you are much more likely to have fractures in the future
Can osteoporosis be prevented?
Our genes decide the potential height and strength of our skeleton but the
way we live our life can also play a part in the amount of bone we invest in our
bone ‘bank’ during our youth and how much we save in later life.
During childhood, adolescence and early adulthood, when the skeleton is
growing, it is vitally important to maximise bone strength. By ‘banking’ plenty
of bone in these years, it puts the skeleton in a better position to hold out
against the natural bone loss that occurs later in life. You can do this by
taking plenty of weight bearing exercise and eating a well balanced, calciumrich diet.
Consequences of osteoporosis
Having osteoporosis does not automatically mean that your bones will break;
it just means that you have a ‘greater risk of fracture’. Thin, fragile bones in
themselves are not painful but the broken bones that can result, can cause
pain and other problems. Osteoporosis does not generally slow or stop the
healing process. Bones that break because of osteoporosis will still heal in the
same way as they do in people who do not have osteoporosis, which is
usually about six to eight week
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Parts of the body most affected
Wrists
Broken wrists can be the first indication that you have osteoporosis. They
often occur in middle aged women who have put out their arm to break a
fall. Healthy bones should be able to withstand a fall from standing height so a
bone that breaks in these circumstances is known as a fragility fracture.
Hips
Hips broken because of osteoporosis occur most commonly in our late 70s or
80s. They happen as a result of a fall and can affect all aspects of life. Full
recovery is always possible but will often depend on how well someone is
before the broken hip occurs. Getting back to being fully mobile and
independent can be difficult and physiotherapy and social care services are
often essential. Breaking a hip when you are older can have a major impact
on your independence. This can create a real fear of falling among older
people which makes them cautious of everyday activities.
Spinal bones
Fractures due to osteoporosis of the bones in the spine (vertebrae) usually
occur in the lower back (lumbar) or upper area (thoracic) of the spine. They
are often referred to as spinal or vertebral fractures. Bones become squashed
or compressed because of their reduced strength. Sometimes they are
referred to as ‘crushed’, ‘collapsed' or ‘wedged’ depending on how the bone is
affected. A ‘compression fracture’ is a good way of describing what happens.
These fractures do not interfere with the spinal cord or result in paralysis or
loss of sensation except in very unusual cases. Although bones heal they do
not return to their previous shape which can mean height loss or spinal
curvature.
Can fragility fractures be prevented?
The older we get, the greater our risk of breaking a bone. Osteoporosis
becomes more common as the density of bone decreases and bones become
generally less strong and more fragile. Falling is also much more common
because of poor balance and co-ordination leading to a higher risk of breaking
a hip. Lifestyle changes and keeping active can help to prevent falling. Drug
treatments, to strengthen bones, are available for those at highest risk of
fracture.
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Healthy bones
What can I do to build healthy bones and to prevent fractures?
We think our skeleton will provide a solid framework for life but it needs tender
loving care just like our skin, hair or heart. There are many steps you can take
to help build healthy bones, which are all linked to leading a healthy lifestyle.
Keeping Active
Your skeleton grows stronger if you do regular weight-bearing exercise. This
is any kind of physical activity where you are supporting the weight of your
own body, for example walking, taking the stairs.
Keeping active will ensure you have good balance and co-ordination and will
also help to develop muscle strength.
Eat your way to healthy bones
The body contains 1kg of calcium, 99 percent of which is stored in our bones.
While it is important to eat plenty of calcium to help build or maintain healthy
bones, other vitamins and minerals are also important. If you enjoy a wide
variety of food you will get a mix of all the vitamins and minerals you need.
The Food Standards Agency advises that a healthy balanced diet has:
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plenty of fruit and vegetables (at least 5 portions of a variety every day)
plenty of starchy foods, such as bread, rice, potatoes and pasta
wholegrain varieties whenever possible
some milk and dairy foods
some meat, fish, eggs, beans, and other non-dairy sources of protein
just a small amount of food and drinks high in fat and/or sugar.
Advice on a healthy balanced diet, please refer to ‘the eat well plate’ which
can be found at the following link:
www.eatwell.gov.uk/healthydiet/eatwellplate/
What about dietary supplements?
If we eat a healthy, varied diet then we should be able to get all the vitamins
and minerals we need from food. This is certainly a lot tastier than pills!
However, as we get older, we absorb nutrients less efficiently. Many older
people also have smaller appetites so may benefit from supplements if they
are getting insufficient nourishment from food.
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The importance of vitamin D
Vitamin D is vital to help the body absorb calcium. The main source is the sun
through our skin which the body converts into vitamin D and stores in our fat.
Most of us will get enough sun to help our bones if we get out and about in the
summer without even thinking about it.
However, older people, those who do not go out much and people who cover
up for religious or cultural reasons may become deficient and 400 iu
(international units), or 10micrograms, a day is recommended.
Studies have also shown that vitamin D and calcium supplements can help to
cut the risk of broken hips in frail, older people so supplements may be
prescribed.
Quit smoking
Smoking has a toxic effect on bone by stopping the construction cells from
doing their work. It's another good reason to try to give up.
Reduce your alcohol intake
Enjoying the odd glass of wine could actually help your bones. But drinking
too much alcohol is damaging to our skeleton and increases your risk of
fracture. Bear in mind that drinking alcohol can also make you unsteady and
increase your risk of falling, and therefore breaking a bone.
The current daily recommended limit, as recommended by the Food
Standards Agency, is 2 to 3 units for women and 3 to 4 units for men.
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Falls prevention
Many older people fall in the home, so it is important to try and reduce the
hazards that could cause you to trip and fall. For instance:
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Take your time using stairs and hold onto the rail
Loose rugs or carpets, trailing wires, slippery floor surfaces and poor
heating and lighting can increase your risk of falling
Other health problems such as Parkinson’s disease, arthritis or stroke
are common causes of falls and some medications can increase your
risk of falling by affecting your balance
It is a good idea to have your eyesight and hearing checked because poor
eyesight can increase the risk of falling and some forms of deafness can
also affect your balance.
Ask your doctor to review all the medications your take. Taking lots of different
medications can sometimes heighten side effects such as dizziness or
drowsiness. If your tablets are causing these problems let your GP know.
If you are concerned about falling and particularly if you tend to fall, you could
talk to your local GP and ask for a referral to your local falls clinic. Help the
Aged also offers useful information on preventing falls.
Hip protectors
For older people who may be at risk of falling, hip protector pants are
available which can help to cushion the force of a fall. These underwear
garments have two protective hard shells built into cotton pants covering your
hips to absorb the impact of the fall. However, research studies have not
conclusively proved that they prevent broken bones.
Source http://www.nos.org.uk/NetCommunity/Page.aspx?pid=466&srcid=234
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