What is osteoporosis?

As is often the case the term 'osteoporosis' implies that it is a disease like tuberculosis or epilepsy, namely, a condition that you either have or don't have. In fact osteoporosis is shorthand term and describes a condition in which the bones of an individual are deemed by doctors as being so thin that they are at increased risk of fracture. Our bones can be made stronger throughout the days of childhood and development, until the age of about thirty. Then bones start to get thin and almost everybody, at least until recently, has assumed this to be due to ageing, but we now know that much of this is due to the modern environment and lifestyle. It you spend forty years sitting down it is not surprising that the bones of the lower limbs get thinner.
The process of thinning is accelerated in women by the menopause but it is also accelerated in men by hormonal changes.
There is no sharp decline in the level of male hormones, testosterone being the principal hormone, analogous to the menopause, there is no 'manopause' but there is a decline in testosterone. In the United States of America we have seen the growth of an industry treating Low T, namely low testosterone, but in the United Kingdom most people would not regard this as a condition that would benefit from testosterone, although it certainly would benefit from fitness training that concentrates on strength and power because this can slow or reverse the rate at which bone thins. The thinning of bone is one factor that leads to a fracture, and some fractures do occur spontaneously, but most fractures are due to falls and most falls occur in the home. It is therefore important to think about the risk of falling and not only take action not only to increase bone strength and prevent bone strength being lost but also to maintain and increase strength, stamina and skill, for example the ability to recover from a trip or stumble. Everyone in the United Kingdom should take Vitamin D and ensure they get enough calcium in the diet. 25 micrograms is enough Vitamin D to cope with the grey skies which prevent vitamin D being formed naturally by our skin. However, everyone should take action to increase strength, skill and suppleness. Weights are vitally important for increasing strength, and dancing and other similar activities which require good co-ordination are vitally important for improving skill and suppleness.

Why is osteoporosis important?

As our bones become thinner they lose their strength. Sometimes they become so thin that they may fracture, and some people who are very badly affected by osteoporosis sometimes suffer a spontaneous fracture and fall as a result of the fracture.
However, for most people the problem is the other way round and the fact they fall causes the fracture, sometimes called a fragility fracture.
Increasingly, therefore, health services are looking at osteoporosis, fractures and falls as part of the one problem and it is therefore very important not only to try and keep your bones as strong as possible but also to reduce your risk of falling by keeping muscles strong and the skills of co-ordination, including the ability to recover from a trip or stumble, as well developed as possible. Furthermore after someone has had a fragility fracture, for example a hip fracture or a Colles fracture of the radius, the forearm bone that interacts with the wrist, it is essential that they be assessed for osteoporosis and prescribed both appropriate medication and exercises to strengthen muscles and bones, and improve their co-ordination.

What can other people do?

It is essential that any health service knows what to do when someone has had a fragility fracture. What they need is an x-ray and what is called a DEXA scan (double exposure x-ray assessment). They then need treatment of any disorder that is found based on Vitamin D and calcium, but there are a number of other drugs now that can make a significant difference to people with osteoporosis. For women hormone replacement therapy may be indicated. For men, as we have emphasised above, we do not see testosterone as a useful intervention.

What can you do?

The most important steps are fitness training and a diet rich in calcium and protein.
We use the term 'fitness training' intentionally although it usually conjured up images of young people in leotards.
What is clear from research is that you need to put strain on the bones for the bones to stay strong and get stronger.  Walking, for example, even brisk waking, wonderful though it is, is not sufficient to prevent or reverse osteoporosis. You have to put a strain on the bones, for example by using or carrying weights. In addition, measures to improve muscle strength are also important but of course the same set of exercises to strengthen the bones will also strengthen the muscle. Improving co-ordination can be done in a number of different ways but the best is dancing or similar exercises, often done in a group to motivate you although they need to be done daily at home, such as Pilates, Tai Chi and Yoga, can improve co-ordination, but there is something about the co-ordination and speed that dancing requires that is particularly beneficial. So far as diet is concerned, it is important to have a good intake of calcium, for example a pint of skimmed or semi-skimmed milk a day. Vitamin D is also indicated; 25 micrograms of Vitamin D is available as a tablet and combined with the training is the benefit of increasing the amount of protein. Fortunately this is now very easy to do because the big supermarkets all have protein bars low in sugar but high in protein.
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