THE MOST VISIBLE SIGN OF AGEING
Not wrinkles or grey hair… but the little old lady round-shouldered stoop! And it’s not only the biggest age giveaway, but can also be a sign of something more sinister: osteoporosis. We believe all women need to know how to protect themselves against thi
Many of us don’t make the connection between a gradual loss of height and an increasingly curved spine and the bone-thinning disease osteoporosis, which affects half of women and one in five men over 50. And it can happen without you even realising that damage is being done, because until you break a bone, osteoporosis has no warning signs. You won’t see or feel your bones getting weaker but, once they reach a critical point, even a minor fall or jolt can leave you with a fracture.
And while you can’t ignore a broken hip or wrist, you may not be aware that you have fractured a bone in your spine. In fact, one in three people have spinal fractures that are never diagnosed, and up to 70% have so-called silent fractures that cause no pain but will eventually lead to bone loss and curvature. ‘Spinal fractures are the ones you are least likely to notice,’ says David Reid, Emeritus Professor of Rheumatology at the University of Aberdeen. ‘Some people develop back pain, but for others the fractures are asymptomatic. It’s not unusual for me to see women who are surprised to discover they have several fractures, because they can’t remember anything happening to cause them.’
HOW DOES IT HAPPEN?
You don’t need to do anything dramatic to break a bone. When bones are brittle, even everyday activities, like bending to lift something, missing a step or just coughing, can result in a vertebral fracture. A series of these small breaks can cause a vertebra to collapse – it’s called a compression fracture. If the osteoporosis that has caused the fracture isn’t treated, it can then lead to more fractures. As vertebrae collapse, your spine gets shorter, so you
lose height. As more bones break, the spine becomes curved, eventually resulting in the classic dowager’s hump. The consequences can be devastating. ‘We get lots of calls from women who have lost their confidence along with inches in height, and have developed curvature of the spine,’ says Sarah Leyland, nurse consultant at the National Osteoporosis Society. ‘They hate the fact that they look old, can’t find clothes to fit and feel that they look pregnant because their tummy is pushed out.’ Spinal fractures can cause significant physical problems. Some people suffer from severe back pain, and when your internal organs become squashed because your spine is collapsing, it has a knock-on effect. Breathlessness and digestive problems affect a third of people. It can become hard to eat without heartburn or vomiting and, when there is less room for your bladder, you may find yourself constantly rushing to the loo, or developing incontinence.
PREVENTIVE STEPS
Getting bone in the bank in your teens, 20s and 30s with a balanced diet and regular exercise is vital for bone health in later years, but it is post menopause that the crunch really comes. Oestrogen plays a key role in keeping bones strong by inhibiting bone breakdown, so when oestrogen levels fall, bone loss increases dramatically.
‘After menopause, you lose bone at the rate of 1%-3% a [continued over page]
Until you break a bone, osteoporosis has no warning signs
[continued from previous page] year. If your bones aren’t strong when you reach menopause, you are starting from a lower base, so the risk is even greater,’ says Professor Reid. ‘If you are over 50 and have back pain or a family history of osteoporosis, don’t wait until you break something – see your GP. If you have had a symptomatic vertebral fracture, you have a 20% risk of having another one within a year.’
Your doctor can assess your risk of having a fracture over the next 10 years using FRAX, a tool that looks at risk factors including your age, family history, medication and previous fractures. You may then be offered a bone density (DXA) scan if the assessment shows that your risk is close to the level at which treatment might help. The National Institute for Health and Care Excellence recommends all women 65 and over, and all men 75 and over, should have an assessment of fracture risk. It also says the assessment should be made in younger people if they have specific risk factors, for example a family history of fracture or having taken steroids. Check your risk using the National Osteoporosis Society’s online tool stopatone. nos.org.uk/online check, and try the Stop At One quiz. The Society also has a free helpline on 0808 800 0035.
Start now to build up your bones TALK TO YOUR MUM
❖ The biggest risk factors for osteoporosis are being female, getting older and having a family history of the condition – up to 80% of bone health is genetically determined. Risk is also higher if you had an early menopause or hysterectomy (before 45) and weren’t prescribed HRT to protect your bones, if you had an eating disorder that caused severe weight loss, have rheumatoid arthritis, Type 1 diabetes, inflammatory bowel or coeliac disease or thyroid problems. Certain drugs weaken your bones, particularly steroid tablets (taken for more than three months) and treatments for breast cancer that stop the ovaries working – specifically aromatase inhibitors like anastrazole or letrozole, which reduce the amount of oestrogen circulating in the body. Taking one of these drugs can double the normal rate of bone loss after the menopause and women who are prescribed these drugs should be offered a bone density scan within 3-6 months of starting treatment.
CHOOSE THE RIGHT WORKOUT
❖ A combination of weight-bearing exercises, with resistance routines that involve lifting your body weight or free weights, help to load bones and stimulate remodelling – the process by which mature bone tissue is removed and new bone is formed. Think brisk walking, step aerobics, stair climbing and tennis – alternate high and low intensity exercise (five minutes’ brisk walking, five minutes’ slower) and change direction – move from side to side or around in circles. Dancing like tap, ballet or Irish traditional dancing, which involves moving weight between feet and changing direction as well as balance and coordination, makes ideal bonestrengthening exercise. Lifting weights or using stretch bands will help build muscle, which in turn strengthens bones. For exercises to strengthen your spine and other vulnerable areas, download the free booklet from the National Osteoporosis Society at nos.org.uk/resources.
EAT FOR STRONG BONES
❖ Calcium – found in tinned fish with bones, beans, green vegetables and dairy and soya products – is important, but can only be used effectively by your body if you are also getting enough vitamin D. The best source of this vitamin is sunshine, but half of us have low vitamin D levels, and one in six is severely deficient in the Winter months. You could add vitamin D-rich foods (egg yolks, for example) and consider taking a supplement. Go easy on salt, which can lead to calcium loss from the bones, fizzy drinks, as well as too much alcohol, which damages bones by interfering with your body’s absorption of calcium and vitamin D, and may also deplete oestrogen levels. Over two units a day increases your risk, and over four units is definitely in the danger zone as far as osteoporosis is concerned.
STUB IT OUT
❖ As well as being linked with decreased bone density, smoking may also increase your risk of fracture. The longer and the more you smoke, the greater the risk of fracture, but stop now and your bone mass and fracture risk start to improve.
KEEP YOUR WEIGHT STABLE
❖ Think slim, not skinny, when it comes to bones – in fact, you’re better off being a bit overweight rather than underweight. If your BMI is 19 or less, you are more likely to suffer from fragile bones.
It’s good to alternate high and low intensity exercise