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| Friday May 08, 2009 |
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| Osteoporosis - What you should know |
English | 中文 |
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| WHAT IS OSTEOPOROSIS? |
Osteoporosis is a common age-related condition in which the bones become porous and thin,
leading to increase in bone fragility and risk of fracture. It causes pain, loss of mobility,
and increased mortality in the elderly.
Approximately 1 in 4 women over the age of 50 develop osteoporosis, compared to 1 in 8 men.
With the aging of the population, osteoporosis is a rising and serious medical problem which
affects millions of people.
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| WHAT ARE THE SIGNS OF OSTEOPOROSIS? |
Osteoporosis is initially a silent disease until an advanced stage when fractures occur.
Fractures occur mainly at the spine, the wrist, and hip, and can occur with minor falls or
minimal trauma such as coughing or lifting.
Other signs are loss of height and a hunched back due to collapsed vertebrae in the spine.
These are called compression fractures and can cause severe back pain.
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| WHO IS AT RISK? |
Osteoporosis affects mainly the elderly, especially postmenopausal women. The chance
of developing osteoporosis later in life is related to the level of peak bone mass
reached in young adulthood (which is usually lower in women compared to men), and the rate
of bone loss which occurs steadily after the age of 40. In women, bone loss is most rapid
during the first 10 years after menopause due to decreased levels of the hormone
estrogen.
Risk factors for osteoporosis
- advanced age
- Caucasian or Asian race
- family history of osteoporosis
- early menopause (before 45) or surgical removal of ovaries before menopause
- longterm use of steroid medication
- lifestyle factors, including smoking, excessive alcohol or caffeine intake
- lack of calcium in the diet (including as a child)
- hyperthyroidism (including excessive dose of thyroid medication)
- prolonged immobility or bedrest
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| DIAGNOSIS |
Ordinary X-rays can detect fractures, but are not very sensitive in detecting osteoporosis,
which is not usually seen until already at an advanced stage. A bone density test
("Dual Energy X-Ray Absorptiometry" or "DEXA") gives the most accurate
measure of bone density. It is best to discuss with your doctor whether a test is
necessary.
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| HOW CAN I REDUCE MY RISK? |
Osteoporosis is now a treatable and preventable condition. Prevention is by far more effective,
since bone loss is mostly irreversible.
- Lifestyle
- weight-bearing exercise, such as walking, dancing, or low-impact aerobics, is extremely important. Bone loss occurs much faster with complete inactivity.
- adequate calcium intake. The recommended daily intake of calcium is: 1200 mg/day for adolescents 1000 mg/day for men and premenopausal women 1500 mg/day for postmenopausal and pregnant women, and men over 65 years.
- Dairy products such as milk, cheese, and yogurt are the best sources of calcium.
- Seafood including bones (e.g. sardines, canned salmon with bones), dark green leafy vegetables (e.g. broccoli), dried beans and tofu (processed with calcium sulfate) are also calcium-rich sources.
- Calcium from the diet is best, but when not sufficient, then use calcium supplements (calcium carbonate, or calcium citrate).
- In childhood and adolescence, adequate calcium intake and exercise are important in building bone and achieving optimal peak bone mass (reached between the age of 20 to 30).
- Vitamin D helps your body absorb the calcium - 400 IU/day, or 800 IU/day (over 65 years or with low sun exposure)
- Stop smoking
- Reduce alcohol and caffeine intake
- Drug Treatment
In people at high risk for developing osteoporosis or those already showing significant bone loss, modifying lifestyle risk factors (exercise, calcium, etc) is important bu not sufficient, and drug therapy is needed to stop further bone loss and prevent fractures.
- Estrogen-based Hormone Replacement
- This is the treatment of choice in prevention and treatment of osteoporosis for women after menopause. It is most effective when started at the time of menopause (or within the first 10 years). Longterm use is needed to prevent bone thinning.
- Additional benefits include relief of menopausal symptoms (such as hot flashes) and protection against heart disease. Some studies have shown a mild increase in breast cancer in those women taking longterm estrogen, however the true risk of breast cancer associated with postmenopausal estrogen remains unknown.
- Bisphosphonates: Etidronate (Didronel or Didrocal), Alendronate (Fosamax)
- This is a nonhormonal treatment for osteoporosis, and is effective in stopping further bone loss and reducing the risk of spine and hip fractures. Longterm use is needed.
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| IF THERE IS OSTEOPOROSIS: |
Preventing falls in elderly people with osteoporosis is of utmost importance. Factors which predispose to falls such as problems with balance, vision, muscle weakness, and side effects from medications need to be addressed.
Other tips
- Continue to exercise e.g. walking daily.
- Use a cane or walker if needed.
- Do not stoop to pick up things, since bending can cause painful compression fractures of the spine if there is advanced bone loss. Instead, bend the knees and keep the back straight.
- Put hand grips and safety mats in the bathtub or shower.
- Stop smoking. Smoking makes osteoporosis worse.
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