Get close to your bones
Each time I return home, my mum looks a little bit shorter. I don’t think I am getting any taller, so I am pretty sure that she is very slowly shrinking. My mum has osteoporosis (OP), and as a result has lost almost 4 centimetres off her height over the past few years. My grandma had it, and I too have an early form of the condition known as osteopenia.
Luckily for my mum, it doesn’t seem to cause her any pain at all, and now she is on treatment the progress seems to have slowed considerably. However, for thousands of other people living with OP it is a debilitating and disabling problem, and can even be fatal.
Our bones are continually ‘‘turning over’’ – this means that old bone is resorbed, and new bone is made constantly. We reach our peak bone density, when our bones are at their strongest, in our 20s. Later in life, when the rate of bone resorption overtakes the formation of new bone, our bones become increasingly weak, making them prone to fractures or breaks. For women this is more likely to happen after they have had the menopause, as the hormone oestrogen promotes bone density. For men, it is related to older age and tends to occur in the over 70s.
Osteoporosis is a massive problem, and will only get bigger as our population ages. Osteoporosis New Zealand (osteoporosis.org.nz ) estimates that by 2020 the numbers of osteoporotic fractures per year will have risen to 116,000 (from a figure of 84,000 in 2007) and the cost of managing these fractures will be more than $400 million.
The total cost of caring for people with osteoporosis is much greater than that – we spend more than $1 billion a year managing OP and the consequences of it – and if you consider that half of people who suffer a hip fracture will never live independently again, and around a quarter will die early as a result of their hip fracture, it is easy to see that the impact on society, as well as the cost, is huge.
So how do you tell if you or your loved ones are at risk, and what can you do to minimise the chances of osteoporosis affecting you?
Firstly, it is important to figure out if you fall into a ‘‘high risk’’ group for OP. If you do, discuss with your doctor about getting a bone density scan (to assess the strength of your bones), and whether or not you need any specific treatment to try to slow down the progression of bone loss as you age. High risk groups include:
Anyone, male or female, over 50 who has had a fracture from a relatively minor ‘‘bump’’ or fall. We know that if you have already had one fracture, you are twice as likely to have another compared with someone who hasn’t, so getting assessed immediately if you fall into this group is the best way to minimise the future impact. Osteoporosis most commonly affects the bones in the spine, wrist and hips, but can cause a fracture anywhere in the body.
Family history. If, like me, you have other members of your family who you know or you suspect had OP, ask your doctor for a bone density scan to check your bone health. Previous generations didn’t always know about OP, but if an elderly relative either lost a lot of height, or became very stooped in older age, that is a pretty good indicator that OP was the cause.
Smoking and drinking – any smoking will affect your bone density, and drinking over 3 units of alcohol a day will do the same.
Prolonged immobility or bedrest – bones respond well to weight-bearing exercise, so anyone who can’t do this for any reason is more at risk. This includes people with chronic illness or disabilities, as well as elderly people in rest homes who may lead very sedentary lives.
Half of people who suffer a hip fracture will never live independently again, and around a quarter will die early as a result of their hip fracture, so the impact on society is huge.
Medications – certain medicines can affect your bone density and lead eventually to osteoporosis, or its precursor known as osteopenia. The biggest culprit is probably steroids such as prednisone (used to treat asthma, arthritis and other inflammatory conditions) but there are plenty of others, so check with your doctor or pharmacist if you are taking regular medicines of any sort.
Co-existing medical conditions – some diseases make you more prone to OP, including diabetes, Cushings disease, Crohns, chronic kidney or liver disease, and untreated premature menopause (menopause before the age of 45).
Even if you don’t fall into one of those higherrisk categories, unfortunately it doesn’t mean your bones are necessarily healthy. We know that one in three women and one in five men will have a fracture from OP in their lifetime, and many of them won’t fall into the groups mentioned above.
OP doesn’t cause any symptoms at all, until the first fracture, so if you can afford it and would like to know for your peace of mind I would suggest requesting a bone density scan (known as a Dexa scan).
It is not cheap, at about $150, but is considered the gold standard test for picking up OP, and a good investment in terms of your health. Sadly at present I don’t think this test is available free of charge, but hopefully that is something that may change in the near future.
If you do find out that your bone density isn’t what it should be, some lifestyle changes can make a big difference, including minimising smoking and drinking, increasing your weight-bearing exercise, and reducing your risk of falls by ensuring your home environment is safe.
Upping your intake of calcium and vitamin D can help, too – calcium is usually well absorbed from food, but vitamin D requires sunlight so taking a supplement during the winter months, or all year round if you don’t get outdoors much, is a good idea. Lastly, discuss with your doctor about whether you would benefit from a specific OP medication – there are several available that halt the loss of bone, and in some cases will even improve your bone density.
For more information, visit the Osteoporosis NZ website.