Osteoporosis: The Big Steal

Osteoporosis is often called the silent thief. It robs calcium and steals support from bones causing them to break or fracture more easily than normal bones. Often, the first sign of problems is a broken bone from seemingly minimal trauma.

Together with arthritis and other musculoskeletal conditions, osteoporosis is the seventh National Health Priority Area set by the Commonwealth Government in 2002. $11.5 million has been committed over the next four years to focus on the research, prevention and treatment of osteoporosis and associated diseases.

Can this silent thief be stopped? While there is no cure for osteoporosis, new research suggests that there is much we can do to improve our bone health.

Causes of osteoporosis

• Bone is a living tissue, with new bone continually being made and old bone being replaced. The balance between these two processes can vary throughout life.
• During childhood, the rate of bone growth is greater than bone removal
• Many factors affect this bone turnover including: good nutrition especially calcium, adequate exposure to vitamin D, (primarily from sunlight) maintaining adequate levels of oestrogen and testosterone and getting plenty of exercise.
• Between the ages of 20-35 bone gain and loss is quite stable, however after the age of 45 bone loss starts to increase, especially in women. For women, this increase in bone loss is related to lower levels of oestrogen, which occurs during the menopausal years. Women who go through early menopause (before the age of 40) experience this bone loss at an earlier age.
• An increase in bone loss is also part of the ageing process. In both sexes the older you are the more likely it is that your bones will become brittle and fracture.

Risk Factors

While everyone should follow good bone habits, those at risk should be extra vigilant. The aim should be to reverse risk factors that we have some control over such as, diet, smoking, exercise and caffeine intake and consult with health professionals on the risk factors beyond our control.

Risk factors include:

• Advanced age
• Small or thin build
• Family history
• Low levels of oestrogen (women) and testosterone (women and men)
• Early menopause
• Certain medications such as glucocorticosteroids (ie prednisolone), excess thyroid hormone, anticonvulsants and anticoagulant medications
• Chronic diseases of lung, kidney and bowel
• Rheumatoid arthritis
• *Low calcium and vitamin D intake and/or absorption
• *Physical inactivity or excessive exercise
• *Smoking
• *Excessive caffeine and alcohol

*indicates risk factors that can be reduced

What can be done?

A balanced diet rich in calcium is important throughout life. 2-3 serves per day of dairy products ie a glass of milk and a tub of yoghurt should provide most of your daily requirements.

Weight bearing and strengthening. Any activity that requires the bones to fully support the body’s weight, such as jogging, dancing and weight training. Using weights on your arms and legs while doing exercise increases the beneficial effect on bones. Exercise should be regular and ongoing, aiming for at least 30 minutes of exercise on most days of the week.

Stop smoking.

Limit alcohol and caffeine intake.

Discuss oestrogen therapy with a physician where appropriate.

A small number of foods such as fortified dairy products, egg yolks, saltwater fish and cod liver oil contain some Vitamin D, but the levels are quite low. We also need exposure to sunlight to ensure we get a sufficient amount. Vitamin D deficiency is very common in Australian women, especially during winter. Sun exposure on the hands and face for 10 – 15 minutes each day, avoiding the hours between 11am – 3pm, is all that is needed to maintain Vitamin D levels.

Managing osteoporosis

There are medications available to help slow down bone loss and reduce the incidence of fractures. Many of the prevention tips are also important in the treatment of osteoporosis.

Exercise

Bones, like muscle, need exercise to gain strength. Exercise is important not only for good bone health but also helps prevent falls. A regular exercise program can improve posture, strength and coordination. For those who have not exercised recently or have osteoporosis, it is a good idea to develop a program with a health professional such as a physiotherapist.

Is osteoporosis an inevitable part of ageing?

Breaking a hip or shrinking in height used to be accepted as simply part of ageing. We now know there are measures that can be taken to improve our bone health, both in the prevention and treatment, of osteoporosis.

Prevention of osteoporosis should be a life long commitment, with healthy bone habits starting in early childhood. A person’s peak bone density is usually achieved at about 20 years of age. The higher the person’s bone density at this stage, the greater protection they will have against osteoporosis later in life.

While it is optimal to start these habits at an early age, it is never too late. The aim for those past peak bone mass is to maintain bone mass and slow further loss.

With an ageing population, osteoporosis is on the rise. But we no longer have to accept it as a natural part of ageing. By improving our bone health from a younger age and throughout our lives, we can prevent, or at least slow down, osteoporosis.

The Jean Hailes Foundation has recently set up a support group for women with osteoporosis.

For further information please call Nikki McGrath on 03 9562 6771 or Toll Free on 1800 151 441.

Six ways to increase calcium consumption

1. Have yoghurt for a mid morning snack

2. Add cheese to salads: shaved parmesan and rocket, parmesan in caesar salads, cubes of gruyere or emmental in mixed salads

3. Eat canned salmon and sardines, bones and all

4. Put cheese on toast instead of jam for breakfast

5. Use yoghurt in cucumber salads

6. Add freshly grated parmesan to pasta and vegetable soups

Did you know?

Not all cheese is a good source of calcium. Cottage cheese is not, neither is fetta. Best sources are harder cheeses, such as gruyere, cheddar, emmental, gouda and parmesan. Italian parmesan is the best of all: because of the way it is made, it is one of the richest sources of calcium. Its fat content is roughly similar to that of reduced fat cheddar.

Vitamin D and calcium

Vitamin D is essential in the metabolism of calcium and phosphorous, and in that way may prevent osteoporosis. Vitamin D can also be classed as a hormone because it can be made in our skin under the influence of ultraviolet light from the sun. Even in Australia, people can be at risk of vitamin D deficiency if they have less than 15 minutes daily sun exposure.

There are only a few food sources. Cod liver oil is best. Fish, particularly oily fish, are good sources. These are the fish that come from cold waters, in areas of the world where sunlight can be limited. Eggs are good sources and so are margarine and butter.

Be careful of vitamin D supplements. Too much in a supplemented form can be toxic.

Color Me Healthy: Why you should eat almost everything

by Rita Erlich and Dr Alice Murkies

Available for purchase from The Jean Hailes Foundation

RICOTTA AND SILVERBEET TORTE	METHOD
Silverbeet, also known as Swiss chard, is more robust in texture and flavour than spinach. It is an excellent source of folic acid. Ingredients (for 6 – 8 wedges) 1 bunch silverbeet (about 450 g leaf weight when trimmed) 400 g ricotta 6 tablespoons grated parmesan 3 eggs 1 large onion 2 tablespoons olive oil sprig fresh tarragon (optional) salt, pepper, nutmeg	Wash the silverbeet thoroughly. Trim the stalks. Cook the leaves in an abundance of boiling salted water until just done, then drain. When cool, squeeze dry and chop finely. Dice the onion finely and cook gently in two tablespoons of the olive oil until very soft and golden. Allow to cool. Mash the ricotta with a fork and whisk well, before adding cooled chopped onion and chopped silverbeet. Add chopped tarragon (or other herbs), then beat in the 3 eggs. Add 5 tablespoons of parmesan and mix well. Put in a round baking tin well oiled with the remaining olive oil and bake in moderate oven for about 50 minutes, until cooked. It will cook like a cake, rising and with the edges pulling away when it is ready. Leave to cool enough to unmould, then serve, cut into wedges. As good warm as it is cold.

The Jean Hailes Foundation magazine is designed to be informative and educational. It is not intended that The Jean Hailes Foundation magazine provide specific medical advice or replace advice from your health professional. The Jean Hailes Foundation does not accept any liability to any person for the information or advice (or the use of information or advice) which is provided in this magazine or incorporated into it by reference. Information is provided on the basis that all persons reading the magazine undertake responsibility for assessing the relevance and accuracy of its content. 

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Note: This article is an archive. Whilst the Jean Hailes Foundation for Women’s Health has made every effort to ensure this information was accurate at the time of publication, the article content has not been updated since the date listed below.

Content updated November 05, 2003