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HEALTH


By Dr. Eithne Brenner - The Brenner Clinic Understanding osteoporosis


This scan assesses bone strength in the hips and spine, two of the main areas at risk from osteoporotic fracture. The scan helps doctors to decide whether treatment is needed, and follow-up scans can be useful in monitoring the condition.


What is osteoporosis? Osteoporosis is a condition where the bones, particularly the spine, wrist and hips, become thinner and more liable to fracture. Bone is a living tissue, made up of collagen fi bres and minerals such as calcium. There is a delicate balance between new bone cells being made and old cells being broken down. After about 45 years, we lose a certain amount of bone material, and the bones can become less strong and dense, and more likely to break. A milder degree of bone loss is known as osteopaenia.


How common is osteoporosis? About one in three Irish women and one in 12 men over 50 years of age are thought to have osteoporosis. Women are more at risk, especially when they lose the protective benefi ts of oestrogen hormone after the menopause.


By age 70 some women have lost 30% of their bone material. You cannot see or feel the bones getting thinner, so many people are diagnosed only when they fracture a bone after a minor injury. Many will slowly develop thinner bones over several years, and may notice loss of height, a stooping posture, or persistent back pain.


How can osteoporosis


be diagnosed? The best way to measure bone density or strength is by a special scan called a DEXA scan. This is a simple procedure and takes about 15 minutes and costs approx €100. It can be arranged locally via your GP.


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Who should have a DEXA scan? Individuals over 50 years of age should consider having a DEXA scan, particularly if they have any of the following conditions: • Arthritis, kidney, or thyroid disease, • Those who have already broken a bone • After a minor fall or bump, • People taking steroid medication • Smokers • Women who experience menopause before 45 years of age • Men with low testosterone levels • Those with a family history of osteoporosis, especially women whose mothers have broken their hip • People who are underweight or have a history of eating disorders


What treatments are available


for osteoporosis? Tailored calcium and vitamin D tablets are the cornerstone of therapy. They are the building blocks essential for bone strength, and are usually prescribed by a doctor to ensure the dose is adequate.


A recent study by The British Medical Journal analysed the results of 15 trials, and found that calcium supplements (without vitamin D) were associated with an increase risk of heart attacks. However all people taking calcium for osteoporosis should automatically be taking vitamin D in the same tablet, so that there are no extra risks then. The Irish Osteoporosis society has endorsed the safety of combined calcium and vitamin D tablets.


A group of medicines called bi- phosphonates slow the rate of bone loss, and are very effective in strengthening bone density, and reducing fractures.


Hormone treatments like HRT (hormone replacement therapy) and SERMs also have a role, under medical supervision.


What can I do to prevent


osteoporosis? Exercise: Regular weight-bearing exercise helps to stimulate new bone cells, and strengthens the muscles supporting the bones. It also improves balance and tone,


which makes falls less likely. This includes walking, running, aerobics, dancing etc.


Healthy diet: A well-balanced diet should provide enough calcium to protect your bones. Calcium is found in dairy products, cereals, and dried fruit and nuts. The recommended daily intake for adults over the age of 50 is at least 1000mg per day.


Everyone over 50 should also aim for adequate daily amounts of vitamin D daily (800 iu).


You can get 700-1000mg of calcium daily by drinking a pint of milk (this includes semi-skimmed or skimmed milk), and eating two ounces of cheese, or one pot of yoghurt, or three oz of sardines. In osteoporosis, extra calcium is prescribed to protect the bones.


Vitamin D is also essential to help the body to absorb calcium effi ciently. The main source of vitamin D is from sunlight. Fifteen minutes of daily exposure of the face and hands to sunlight is suffi cient. Dietary sources of vitamin D include oily fi sh, egg yolks, margarine and green leafy vegetables.


Preventing falls: By taking measures to prevent falls, you can reduce your risk of breaking a bone. Check your home for hazards such as uneven rugs, trailing wires, slippery fl oors, etc. Does your vision or hearing need to be checked? Review any medicines with your doctor that may make you drowsy or affect your balance.


Smoking: Chemicals in cigarettes damage the cells that renew bone structure, increasing the risk of developing osteoporosis, so if possible stop smoking - easier said than done, I know!


It's very important for children and teenagers to have a healthy diet, as much of the bone strength is built up during these years. Yoghurt or soya products are also a good source of calcium.


Where can I get more


information? Useful websites are: www.patient.co.uk www.irishosteoporosis.ie www.nos.org.uk (National Osteoporosis Society)


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