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News
Spring 2004 Vol 1 Issue 1
W
elcome to the
first issue of IOS
News, the new Irish
Osteoporosis Society
newsletter. We hope
that the contents of the
newsletter will be of
interest to you. The IOS has been
involved in a lot of activities over the
past year. Our new National
Coordinator started last September.
The first Annual Gala Dinner was held
in Dublin Castle in October, and we
would like to thank Minister Ivor
Callely for attending the dinner and
organising Dublin Castle as the venue.
The dinner helped to raise necessary
funds for the Society.
The new IOS website is up and
running at www.irishosteoporosis.ie –
an online shop has just been launched,
where you can order leaflets, buy
books, join the society or renew your
membership, and make a donation.
We have a new logo (see above),
which illustrates the fact that
osteoporosis is not an ‘old woman's
disease’ but can affect anybody – male
and female, young and old.
This issue of IOS News reports on a
very successful medical conference
and fundraising lunch held in the Royal
Hospital, Kilmainham in Dublin. The
conference brought speakers and
delegates from Ireland, the UK,
Europe, Israel and Australia to discuss
the prevention and treatment of
osteoporotic fractures. Mrs Camilla
Parker Bowles, President of the British
National Osteoporosis Society,
attended the fundraising lunch and
launched a new osteoporosis video
and workbook for secondary schools.
Future issues of IOS News will bring
you up-to-date information on
osteoporosis treatments, diet and
exercise as well as news and events
from the IOS. We would love to hear
your views and comments, so please
write to or email us.
Professor Moira O'Brien FRCPI
President, Irish Osteoporosis Society
Irish Osteoporosis Society,
33 Pearse Street, Dublin 2
Tel. 01-6774267 Fax. 01-6351698
www.irishosteoporosis.ie
[email protected]
Irish Osteoporosis Conference
T
he Irish Osteoporosis Society
organised a conference entitled
“An Integrated Approach to the
Prevention and Treatment of Osteoporotic
Fractures” on February 10th and 11th
2004. The conference, held in the
beautiful surroundings of the Royal
Hospital, Kilmainham in Dublin, was the
inspired idea of Prof David Marsh,
Professor of Trauma and Orthopaedics,
Queens University Belfast. The conference
was made possible by the cooperation and
support of the International Osteoporosis
Foundation, National Osteoporosis
Society, Irish Orthopaedic Association,
British Orthopaedic Association and the
Irish Osteoporosis Society. The major
sponsor was Aventis and P&G
Pharmaceuticals.
The conference brought together
speakers from the fields of bioengineering,
general practice, geriatrics, nursing,
orthopaedics and rheumatology from
Australia, Israel, Italy, the UK and Ireland.
In her welcome to the delegates, Prof
Moira O’Brien, President of the Irish
Osteoporosis Society, emphasised the
importance of an integrated approach in
the fight against osteoporosis, stating that
“Osteoporosis is a silent disease. The first
sign of osteoporosis is usually a minimal
trauma fracture, which is seen by an
orthopaedic surgeon. Early identification
and treatment of osteoporosis is
imperative to preventing further fractures
occurring.”
Minister Ivor Callely, Minister of State
with responsibility for older people at the
Department of Health & Children,
opened the conference, stating that the
“inter-disciplinary team-based approach
to primary care provision… has
application to the prevention and
treatment of osteoporotic fractures. In this
way Ireland will, I hope, be in a position
to ensure that known ways of reducing the
risk of this disease are widely promoted.”
The conference ended with a charity
lunch in aid of the Irish Osteoporosis
Society. The IOS was delighted that Mrs.
Camilla Parker Bowles, President of the
National Osteoporosis Society, attended
Greeting Mrs Parker Bowles on her arrival at the
Royal Hospital Kilmainham were (from left):
John McLaughlin, Managing Director, Aventis;
Mary Anderson, Board Member, IOF; Síle De
Valera,TD, Minister of State at the Department of
Education & Science; and Prof Moira O'Brien,
President, IOS.
Above: Mrs Camilla Parker Bowles, President of
the NOS; Mrs Geraldine Byrne, Patron of the
IOS; and Prof Moira O'Brien, President of the IOS.
the lunch and launched a new
osteoporosis video and workbook for
secondary schools in Ireland. The video
and workbook project was a collaborative
initiative between the Health Promotion
Units of the Northern Area, South
Western Area and East Coast Area Health
Boards, the Department of Education &
Science and the Irish Osteoporosis
Society. It was funded by the Women’s
Health Unit of the Northern Area Health
Board. The lunch was also attended by
Minister of State Síle De Valera of the
Department of Education & Science,
Mary Anderson, board member of the
IOF, Geraldine Byrne, Patron of the IOS,
and the Presidents of the Irish, British and
Scottish Orthopaedic Associations.
O
Treatment of Osteoporosis
steoporosis is the commonest bone
disease worldwide and is now a
major health problem. It is a ‘silent’
disease – the first sign is usually a broken
bone, which in many cases could have
been prevented. Osteoporosis can occur
at any age in both males and females and
may be the result of many different
causes. The commonest cause is due to
the lack of the sex hormone oestrogen in
females and testosterone in men.
Treatment of osteoporosis should have a
multidisciplinary approach. It is
important to determine and treat the
cause as well as the osteoporosis.
Treatments should be individualised,
based on the patient’s medical and
surgical history, such as menstrual and
dietary histories as well as the history of
exercise, as too little, or too much exercise
can increase bone loss. The result of a
DEXA scan helps to indicate the risk of
an osteoporotic fracture.
Thirty minutes of weight bearing
exercise a day is very important to help
prevent and treat osteoporosis. The
exercise should be enjoyable People
should be cleared for exercise by their GP
and/or be assessed by a Chartered
Physiotherapist. Weight bearing exercises
such as brisk or power walking, running,
going up and down the stairs, jumping,
dancing, result in a greater increase in
bone density than non-weight bearing
exercise such as swimming or cycling.
However, not every exercise is suitable for
all age groups. When muscles work, they
pull on bones increasing muscle strength,
which improves bone density and helps
to prevent falls.
Every patient should be given lifestyle
advice. Regardless of what medication
they are on, all patients should have a diet
containing adequate calories and take at
least 1000mg calcium and 800
international units of vitamin D daily.
This can be obtained through their diet,
particularly from fortified milk or
calcium and vitamin D supplements.
They should also reduce excessive caffeine
and alcohol intake and decrease/if
possible quit smoking.
There have been many advances in the
prevention and treatment of osteoporosis
in the last ten years. Most medications
used in the treatment of osteoporosis act
mainly by preventing bone loss.
Osteoporosis treatments include:
n Hormone Replacement Therapy (HRT)
n SERMS (Evista)
n Bisphosphonates (Fosamax or Actonel)
IOS News
Testosterone in Males
Parathyroid Hormone (Forsteo) acts
mainly by forming new bone.
n Physiotherapy to increase strength,
endurance and balance, fall prevention
and hip protectors also have a role.
There are contraindications for most of
the medications. HRT and SERMS are
not suitable for patients with a history of
thrombosis or pulmonary embolism;
SERMS tend to increase hot flushes and
should not be given until after the
menopause.
n
n
Hormone Replacement Therapy
There are a variety of preparations
available. Oestrogen on its own should
only be prescribed for patients who have
had a hysterectomy. Otherwise
combinations of oestrogen and
progesterone should be given. HRT or
the Pill is suitable for young females with
low oestrogen and progesterone levels,
who have lost their periods due to
anorexia or bulimia, or over-trained
athletes. HRT is still the first choice for
menopausal symptoms provided there are
no contraindications.
Selective Estrogen Receptor Modulators
Evista is a SERM and has some properties
which are similar to oestrogen, but unlike
oestrogen, it increases hot flushes. It has a
protective effect against the common form
of cancer of the breast (oestrogen positive).
Patient should be postmenopausal, i.e. no
periods for at least one year.
Bisphosphonates
Bisphosphonates only act on bone. They
are suitable for people who have marked
osteopenia or osteoporosis, or have
suffered a low trauma fracture, to prevent
further fractures, provided they are not
pregnant or likely to become pregnant.
They are also used to prevent
osteoporosis in patients who are on high
doses of cortisone, e.g. asthmatics.
Bisphosphonates are not suitable for
people with indigestion or stomach
problems. They are poorly absorbed and
therefore must be taken on an empty
stomach as prescribed. Alendronate
(Fosamax) 70mg, or Risedronate
(Actonel) 35mg both can be taken once
weekly with water, 30 minutes before
breakfast, making sure you stay upright
to ensure it enters the stomach.
Parathyroid Hormone
Parathyroid Hormone or PTH is a new
medication that builds bone. It is only
prescribed for patients who meet with a
certain criteria, e.g. those with established
osteoporosis who have suffered a vertebral
fracture. The patient must have normal
kidney function. It is given by daily
injections just under the skin for 18
months and can only be prescribed by a
consultant physician.
By Prof Moira O’Brien FRCPI,
President, IOS
Forsteo – new hope for the future
In September 2003 I went to Istanbul as the Irish
delegate to the International Osteoporosis
Foundation Worldwide Conference of Osteoporosis
Patient Societies. One of the speakers talked about
the treatments available and those expected to
become available in the near future. Parathyroid
hormone was mentioned as one of those treatments.
Little did I know that I would soon come to know that
new treatment, called Forsteo, on a personal basis.
My mother has been diagnosed with osteoporosis
for over 10 years - she then had three vertebral crush
fractures - and has been on treatment for that length
of time. In October she came to Dublin to see her
doctor and when I met her at the station, I could see
that she was in dreadful pain. As it happened, one of
the tests she needed to have was a repeat DEXA scan.
It showed additional vertebral fractures. Her doctor
decided that she is an ideal candidate for Forsteo.
Mother was taught how to give herself a Forsteo
injection each day and was provided with everything
she would need to do this – an instruction book, the
container in which to keep the Forsteo ‘pen’ in the
fridge, the Forsteo ‘pen’ itself, which contains enough
of the drug for a month’s daily injections, the
disposable injection needles, a container in which to
put the used disposable needles and a carrying bag
incorporating coolbags in order to keep the Forsteo if
she is travelling away from home. Although she is in
her 80s, Mother is well able to administer her
injections every day and she is now getting on very
well with it.
Because Forsteo actually stimulates the osteoblast
cells (the bone builders) it is different from previous
treatments. As a person with osteoporosis myself, I
take bisphosphonates, which suppress the
osteoclasts (the cells that break down old bone), but
don’t stimulate my lazy osteoblasts. Forsteo does
nothing to the osteoclasts, which therefore remain
involved in the process of normal bone renewal.
The new treatment has given my mother hope that
she will be able to do things like gardening again and
she says that even after three months she is feeling
stronger and able to lift things more easily.She is not
conscious of any side effects of the treatment. The
main message,so far as I can see,is that there is,with
this new treatment,hope for those with osteoporosis,
particularly those who have already had fractures,
that their bone can be rebuilt and they will be
enabled to do the normal things of life for much
longer, despite their illness.
By Mary Kennedy
O
The Role of the Physiotherapist
steoporosis affects an estimated 200 million people
worldwide. There are now medications available that can
prevent further bone loss and prevent fractures. New
medication can also build up bone. Prevention aims to increase
peak bone mass, which is usually reached by the age of 20 years,
and also to reduce subsequent bone loss.
Many of the risk factors for osteoporosis are modifiable and
reducing or eliminating these in early life plays an important
role in prevention. One study on young females indicated that
a 10% increase in peak bone density results in a 50% reduction
in fractures later in life.
Lifestyle changes that can reduce the risk of osteoporosis
include:
n Performing regular weight-bearing exercises (e.g. aerobics or
running) and strengthening exercises
n Having a well balanced diet that does not contain excessive
fibre but does contain adequate calcium and vitamin D
n Stopping smoking and reducing alcohol intake
n Working with other health professionals including doctors
and dieticians, chartered physiotherapists can advise people how
to incorporate such lifestyle changes into their daily routine,
Chartered physiotherapists have the expertise to give advice
regarding appropriate exercise to increase and maintain your
bone density. Research has indicated that both weight-bearing
as well as strengthening exercises can have a positive effect on
bone density. Different types of exercise affect different parts of
the body. In prescribing exercise, a physiotherapist will take into
account factors such as your age, fitness, general health and
bone density, thus ensuring that the exercise programme suits
your particular needs.
A chartered physiotherapist also has the expertise to assist
people with osteoporosis to manage their condition. Advice can
be given regarding ways to reduce the risk of an individual
falling. Gentle exercise may be carefully prescribed to assist in
increasing a person’s balance and maintain their muscle
strength, keeping them as active as possible. Gentle exercise in
water can be a good way to help with mobility and muscle
strength. Physiotherapists can also assist in treating pain
associated with osteoporosis related fractures. In summary the
message is: Exercise today, keep those fractures away!
By Elizabeth Culleton-Quinn MISCP
A series of articles written by chartered physiotherapists will be
included in future IOS newsletters. These articles will discuss
topics including the following:
Osteoporosis – Guidelines for exercise
Osteoporosis and the older person
Osteoporosis and the female athlete
Prevention of osteoporosis in the younger generation
Physiotherapy, pain relief and osteoporosis
Diet and Osteoporosis
Of all the risk factors for developing osteoporosis, what we eat is
one we can definitely consider. No matter what our age, ensuring we
have a well-balanced diet is one of the cornerstones to keeping us
well and healthy.
There are several risk factors associated with the development of
osteoporosis. Some of these, for example being female or a family
history of the condition, cannot be changed. However there are
several lifestyle-related risk factors which can be influenced – these
include what we eat, how much activity we take, and other habits
such as smoking or drinking alcohol.
Most people know that a well-balanced diet is necessary for good
health. However, the main nutrient concerned with bone health is
the mineral calcium. Bone is a living tissue, and so making sure the
diet provides adequate calcium (as well as other nutrients, including
vitamin D which is essential for the absorption of calcium) is
important throughout life.
Dairy products are the richest calcium providers in the diet, and
we all need to include them in our daily diet. However, this message
can very often be forgotten. For example, research has shown that
the consumption of milk is down by 40% compared to twenty years
ago, becoming displaced by the soft drinks available on the market.
As well as this, some of the dietary claims in the media suggest the
avoidance of dairy foods, which gives out very conflicting advice to
the average consumer; one Irish study found that 68% of teenage
girls perceived milk to be a fattening food. Is there any wonder that
36% of Irish women do not take enough calcium in their diet?
Dairy products provide the most readily available source of
calcium to the body, and also contain valuable amounts of other
essential nutrients including protein, B vitamins and other minerals.
The calcium content of skimmed or low fat milk, or low fat cheese,
for example, is higher than that of the full fat milks and cheeses – so
there is no excuse for cutting out these foods at any stage, dieting
or not.
The current recommendation for calcium intake is 800-1000mg
per day in children (not infants), adults and the elderly. However,
adolescents, and pregnant or lactating women need 1200mg per day.
This translates into taking three to four servings of dairy produce
every day, or five servings for those times of life that demand a little
extra. A serving translates into the following portion sizes of dairy
foods:
1 X 200ml glass of milk (whole, low fat or skimmed)
28g (1oz) - matchbox size - of hard cheese
1 X 125g carton of yoghurt (any variety)
It really doesn’t make any difference whether different foods make
up the servings or not – the point is that they need to be taken
every day. Milk varieties fortified with calcium and vitamin D contain
even more calcium per glass than regular milk.They are also low in
fat, which makes them an even better choice as a dairy calcium
provider.There are lots of ways to get these foods in your diet:
n Take a cereal for breakfast to get at least one serving of milk
n Make milkshakes or smoothies (better than fizzy drinks)
n Have a yoghurt as a snack or after a meal with some fruit
n Make a white sauce, or cheese sauce, instead of gravy
n Try cheese grated in a jacket potato, or in a sandwich
n Add some milk to mashed potatoes instead of a knob of butter
In addition, dishes which contain cheese can be useful; so foods like
pizza or lasagne can form part of an overall balanced diet. The
yoghurt drinks and milkshakes available on the market can be a great
source of calcium – however they tend to contain sugar as well, so
they should be taken at mealtimes, instead of between meals, to
reduce the risk of dental caries.With 99% of the calcium in our body
being found in the skeleton, there really is no doubt that everyone
needs calcium in their diet, regardless of age. Taking the
recommended three or more servings of dairy foods each day will
pave the way to building and preserving a strong skeleton for a
lifetime.
By Siân Caldwell BSc (Hons), INDI
Health Promotion Dietician, Northern Area Health Board, Dublin
IOS News
IOS Membership Form
Westmeath
Next meetings: March 29, April
26, May 31 in St. Francis’ Private
Hospital, Mullingar. Contact
Maureen Murphy 044-64178
Clare
Plans are being made to start a
Clare Support Group. If you are
interested in becoming involved
This plan is a full A-Z for bone strength from ‘junior infants
to PhD level’ so it is ‘gain and maintain’ for all of us. The secret
is in a little and often. It also explains that we need to be doing
other exercise as well for a full health programme. This is
something that will never get boring. However it does require
some personal discipline. It advises you on setting realistic goals
and listening to your body at all times. You make it your own
and read the ‘small print’. Pay attention to the details given and
you will make the perfect programme for youself.
Exercising independently is not everyone’s ‘cup-of-tea’, so
some of you might like to do this with friends or in an exercise
class in a more formal setting. A well-informed gym instructor
is a good ally to the fit and to the not-so-fit person. You should
exercise in the setting you find best and, most importantly, do
so as recommended to get the best benefit. It is very important
that when you are diagnosed with osteopenia/osteoporosis, you
are guided through this book by a Chartered Physiotherapist
with a special interest in this subject. They will give you the best
physiotherapy advice regarding your particular exercise needs. It
is my own experience that many need to work, in a special way,
on single leg standing balance and on back care.
This is an excellent little book of less than 100 pages and the
new spiral bound book is a useful addition. It is big in
information, advice, recommendations and precautions. It is a
super ‘recipe book’. However you have to do the baking
yourself! It reads very positively and I have no hesitation in
recommending it!
Reviewed by Helen Moore, MISCP, Chartered Physiotherapist
in a support group in Co. Clare,
please call the IOS office at 016774267.
in
Dungloe
Community
Hospital. Contact Helen Moore,
074-9561230 or 074-9521796
Longford
For upcoming meetings, contact
Mary Jo Tyrrell 043-22171
East Donegal
First meeting to be held in
Letterkenny on March 22nd.
Contact Catriona McGee for
more information on 0749123582.
West Donegal
Next meetings: March 6, May 10
Events
This book is designed to
help healthy women
adopt a lifestyle that will optimise bone strength and so reduce
their risk of developing osteoporosis. Its emphasis is on activities
that promote bone strength and reduce the risk of fracture. Its
target group include all healthy women up to 70 years of age.
In the introduction we learn about bone density, osteoporosis.
the normal process of growing and ageing bone, and how we
can influence our own individual bone strength. We also read of
some of the risk factors that affect bone health, the particular
weak spots in our skeleton and how we can reduce some of these
risks to prevent osteopenia/osteoporosis with a very specific and
researched exercise programme. There is very good advice
regarding your posture, back care and pelvic floor. ‘Getting
Started’ gives everyone a daily stretch plan followed by the
home exercise Plan which you ‘make-to-measure’ for yourself.
Each section has detailed explanations. There are excellent
illustrations with short notes on the purpose, cautions and
adaptations. We are told how to progress as we develop strength
and endurance. At times we are advised what to do if we are
either pre or post menopausal.
Support Groups
Book Review
EXERCISE FOR
STRONG BONES
By Joan Bassey PhD
and Susie Dinan
ISBN 1-903258-38-3
€15 (available from IOS)
Payment Details
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Expiry Date
March 8
Women’s Health Information Day,
City Hall, Cork.Visit the IOS Stand.
April 3rd and 4th
Over 50s Show, Silver Springs
Hotel, Cork. Visit the IOS stand
and attend the Osteoporosis
seminars.
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Please send completed form to:
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Irish Osteoporosis Society, 33 Pearse St, FREEPOST, Dublin 2
Or alternatively call 01-6774267 or fax us with your credit/debit
card details at 01-6351698
Telephone
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Date of Birth:
Type of Membership:
New
Renewal
Diagnosed Osteoporosis Sufferer €15
Health Care Professional
€30
OAP €15
Regular Member €20
In addition, I would like to make a donation to the Irish Osteoporosis Society in
the amount of
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Other
The Irish Osteoporosis Society is an Irish charity dedicated to
eradicating osteoporosis and promoting bone health. The IOS
provides information to the public and health professionals on all
aspects of the disease and offers support to people with
osteoporosis and everyone at risk from the disease.
The aims of the Society are: to prevent the growing incidence of
osteoporosis; to increase awareness of the problem of
osteoporosis in Ireland; to provide support, advice and information
for people suffering from osteoporosis; to establish a network of
local groups; to distribute up-to-date information to doctors and
healthcare workers on current methods of prevention and
treatment; and to encourage research into osteoporosis in Ireland.
All rights reserved. The views, opinions and policies expressed in IOS News do not necessarily reflect those of the Irish Osteoporosis Society.
Whilst all reasonable efforts have been made to ensure the accuracy of the contents of this publication, no responsibility can be accepted
for any error, inconsistency, or omission and readers should, where necessary, obtain appropriate independent advice.