Osteoporosis - the Skeleton in the Cupboard

  • 1 Mar 2021
  • Reading time 47 mins
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LADY HOLDING HAND

The ability to keep your bones strong depends to a large extent on how your body makes use of calcium, magnesium and phosphorus, all of which are incorporated into bone. Of these, calcium is the most abundant mineral in bone. However, more and more evidence is accumulating to show that dietary calcium intake is only one of a number of factors that influence the proper use of calcium in the body. Your intake of magnesium, vitamin D and protein, plus weight bearing exercise, play a significant role. Although our calcium intake has stayed relatively constant, the incidence of osteoporosis has rocketed. Consequently, one in three women, and one in 12 men, has a fracture by the age of 70, most commonly of the hip. In the UK, 50,000 people fracture a bone as a result of osteoporosis every year – that’s one every three minutes.

Four-fifths of fractures occur after the age of 50 and the risk becomes quite significant from 70 onwards. One in two women and one in five men will suffer a fracture after the age of fifty. It is estimated that the cost of treating all fractures resulting from osteoporosis in postmenopausal women is £2 billion.

BONE MASS TESTING

However, before a diagnosis of osteoporosis is made, often following a fracture, bone mass starts reducing. This can be measured and if your bone mass is low you’ll be diagnosed with osteopenia – not as bad as osteoporosis but potentially heading that way. If measured and your T score is -1 to -2.5 then osteopenia is diagnosed. This is based on a bone mass density scan, the most common type called a DEXA scan (Dual energy X-ray absorptiometry) which is a bit like having an x-ray. It’s 96-98 percent accurate in detecting osteoporosis at moderately advanced stages but does not capture all the risk factors for osteoporosis so also having a bone turnover test is really helpful.

Research has shown that in postmenopausal women osteoporosis levels of bone resorption markers, measured in urine, above the upper limit of the range are associated with an increased risk of hip, vertebral (spinal) and nonvertebral fractures, independent of bone mineral density.[1] Markers of bone turnover can also be used to predict the rate of bone loss in post-menopausal women and also be used to assess the risk of fractures. Research suggests that markers of bone turnover appear even more strongly associated with fracture risk than bone mineral density.[2]

The test I like is the NTx test which can be arranged for home testing, the urine sample then sent to the lab by Glenville Nutrition headed by Marilyn Glenville PhD. They can also arrange a DEXA scan for you and provide guidance regarding osteoporosis reversal using a nutritional approach.

About half of people over 50, if tested, have osteopenia. Many, but not all will go onto develop osteoporosis over time.

Yet osteoporosis is far from inevitable. In fact, in some communities, there is no apparent loss of bone density after the menopause. Even though we have a better diet, analyses of skeletal remains show less bone loss in the 18th century than the late 20th century. So what has changed? It seems to be a case of too much of some things and too little of others.

OSTEOPOROSIS RISK FACTORS

Before we look at the treatments on offer to restore bone mass what are the risk factors?
Women are more at risk than men of developing osteoporosis. The female hormones oestrogen and progesterone are protective to women’s bones, just as the male hormone testosterone is protective to men’s. But, from the age of 35, women regularly fail to ovulate, minimising their production of progesterone, the major hormone for bone strength. Women at most risk for developing osteoporosis are those that have had an early menopause (before the age of 45), either naturally, or surgically by removing the womb and one or both ovaries.

Major Well Known Risk Factors:
• Early menopause
• Previous fracture from slight injury
• Anorexia
• Significant corticosteroid use
• Bulimia
• Lost several inches in height
• Over-dieted
• Close relatives with brittle bones
• Over/under exercised
• Heavy intake of alcohol and drugs
• Many missed periods
• History of heavy cigarette smoking
Osteoporosis is mostly a ‘silent’ disorder and a fracture is often the first indication of a problem. Loss of height, back pain, tooth loss and a bent posture are indicators for osteoporosis, particularly after the age of 50.

DOES HORMONE REPLACEMENT THERAPY (HRT) WORK?

The interplay of hormones is fundamental for preventing osteoporosis. Oestrogen works by removing old damaged bone and when oestrogen levels decline at menopause bone loss is accelerated. Progesterone is the bone builder as it works on bone cells that rebuild new bone to replace the old bone. The stress hormone cortisol, when chronically elevated, can contribute to bone loss. The balance of parathormone and calcitonin help control calcium balance between the blood and bones. Thyroid hormones, testosterone and growth hormone also affect bone health.

Osteoporosis is a slow, progressive disease: bone loss starts in most women from the mid-thirties. It does not happen overnight with the last menstrual period. Children and young adults are generally building bones, between 30 and 40 the balance between bone growth and bone loss is about equal and after 50 bone growth decreases and bone loss increases. Developing, supporting and maintaining bone health is a lifelong commitment.

Treatment strategies have largely been focused on HRT, bisphosphonate drugs, e.g. Fosamax, and calcium and vitamin D supplementation. Although, as mentioned earlier, the Women’s Health Initiative trial showed a small decreased risk of hip fracture, [3] there is now a substantial body of evidence that HRT should not be recommended to women to prevent or treat osteoporosis, and that the risks outweigh the benefits. It seems that bone mass is only preserved in those who take HRT for seven years or more[4] and, even when you take it for that long, bone mineral density rapidly declines once you stop taking it. Following a European-wide review of the balance of risks and benefits of HRT, it is no longer recommended as first choice of therapy for prevention of osteoporosis, according to advice from the Medicines and Healthcare products Regulatory Agency (MHRA) in 2003. [5] HRT does, however, remain a treatment option for those who cannot use other osteoporosis prevention therapies or for whom other therapies have been shown to be ineffective, although the decision must be made with care.

Younger women who use short-term HRT will probably gain little ......

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