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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 Cheque Postal Order Name: Company: Card number: Address: 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. Visa Mastercard / Total Amount (membership plus donation, if any): Town: Laser € Please send completed form to: County: 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 Email 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 €5 €10 €25 €50 €100 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.