OSTEOPOROSIS


probability of hip fracture and a ten0- year probability of a major fracture in the spine, hip, shoulder or forearm.


DEXA SCAN


Another option is a DEXA or DXA scan, which measures bone mineral density. This is a short, painless procedure that takes about five minutes, depending on the part of the body being scanned. The patient’s bone mineral density is assessed and then compared to that of a healthy young adult and someone of the same age. The difference is then calculated as a standard deviation (SD) and is called a T score.


Standard deviation is a measure of variability based on an average or expected value. A T score of:


• above -1 SD is normal


• between -1 and -2.5 SD is defined as decreased bone mineral density compared with peak bone mass


• below -2.5 is defined as osteoporosis


In some cases, a patient may be diagnosed with a condition called osteopenia, which happens if tests decreased bone density, but not enough to be classed as osteoporosis.


TREATING OSTEOPOROSIS


Treatment for osteoporosis is based on treating and preventing fractures, and using medication to strengthen bones. The decision as to whether treatment is needed and, if so, the type of treatment required is predicated on the patient’s risk of fracture.


Medication


A number of different medications are used to treat osteoporosis.


BISPHOSPHONATES


Bisphosphonates slow the rate that bone is broken down in body. This maintains bone density and reduces the risk of fracture. The most commonly-prescribed bisphosphonates are alendronate, ibandronate, risedronate and zoledronic acid, all of which are given as a tablet or injection.


Bisphosphonates must always be taken on an empty stomach with a full glass of water and the patient should wait between 30 minutes and two hours before eating food or drinking any other fluids. In terms of efficacy, bisphosphonates can take between six and twelve months to have an effect


42 - SCOTTISH PHARMACIST


and may need to be taken for five years or longer. The main side effects associated with bisphosphonates include: irritation to the oesophagus, swallowing problems (dysphagia) and stomach pain.


One rare side effect that is linked with the use of this medication is osteonecrosis of the jaw. In osteonecrosis, the cells in the jaw bone die, which can lead to problems with healing, so, if the patient has a history of dental problems, they may need to see a GP prior to beginning to take bisphosphonates.


SELECTIVE OESTROGEN RECEPTOR MODULATORS (SERMS)


These are medications, which have a similar effect on bone as the hormone oestrogen, and which may help to maintain bone density and reduce the risk of fracture, particularly of the spine. Raloxifene is the only type of SERM that is currently available for treating osteoporosis and it is usually taken as a daily tablet.


Side effects associated with this medication include: hot flushes, leg cramps and a potential increased risk of blood clots.


PARATHYROID HORMONE (TERIPARATIDE)


Parathyroid hormone, which is produced naturally in the body, regulates the amount of calcium in bone. Treatments involving this hormone are used to stimulate cells that create new bone (osteoblasts) and are given by injection. Parathyroid hormone can increase bone density, although it only tends to be used for patients whose bone density is very low and when other treatments aren’t working. Common side effects are nausea and vomiting.


HORMONE REPLACEMENT THERAPY (HRT)


HRT is sometimes recommended for women who are experiencing the menopause, as it can help control symptoms. While it has been shown to maintain bone density and reduce the risk of fracture during treatment, it isn’t specifically recommended for treating osteoporosis and isn’t often used for this purpose. HRT can also increase the risk of developing certain conditions such as breast cancer, endometrial cancer and stroke more than it lowers the risk of osteoporosis and so it may carry more risks than benefits.


TESTOSTERONE TREATMENT


In men, testosterone treatment can be useful when osteoporosis is caused by insufficient production of male sex hormones (hypogonadism).


CAN OSTEOPOROSIS BE PREVENTED?


A person’s genes are responsible for determining their height and the strength of their skeleton, but certain lifestyle factors, such as diet and exercise, can also influence how healthy their bones are. If they are in the ‘increased risk’ group, then they should be advised to do the following.


TAKE REGULAR EXERCISE


It is essential that adults aged between 19 and 64 do at least 150 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, every week.


Weight-bearing exercise and resistance exercise are also particularly important for improving bone density and helping to prevent osteoporosis. High-impact weight-bearing exercises, such as running, skipping, dancing and aerobics are excellent ways of strengthening the muscles, ligaments and joints.


As well as aerobic exercise, adults in this age bracket should do muscle- strengthening activities on two or more days a week by working all the major muscle groups, including the legs, hips, back, abdomen, chest, arms and shoulders.


Resistance exercises use muscle strength, where the action of the tendons pulling on the bones boosts bone strength. Examples include press-


ups, weightlifting or using weight equipment at a gym.


HEALTHY EATING AND VITAMIN SUPPLEMENTS


Eating a healthy, balanced diet can help prevent many serious health conditions, including heart disease, diabetes and many forms of cancer, as well as osteoporosis. Calcium is particularly important for maintaining strong bones. Adults need 700mg a day, which can be obtained from calcium-rich foods, such as:


• leafy green vegetables • dried fruit • tofu • yoghurt


Vitamin D is also important for healthy bones and teeth because it helps the body absorb calcium. All adults should consume ten micrograms (mcg) of vitamin D a day. Good dietary sources are:


• oily fish – such as salmon, sardines, herring and mackerel


• red meat • liver • egg yolks


• fortified foods such as most fat spreads and some breakfast cereals


• dietary supplements.


It can be difficult to get enough vitamin D from foods alone, so a daily supplement containing 10mcg of vitamin D should be recommended. •


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