- Educate yourself about bone health. Understand that low bone density (osteopenia) or osteoporosis when diagnosed as bone density alone, is not sufficient reason to embark on a treatment regime. There are many other risk factors for osteoporosis such as previous fragility fracture, smoking, corticosteroid use and so on which need to be considered when a diagnosis is made. You can be tested for secondary causes of osteoporosis by your doctor.
- Make sure your diet covers the diverse nutritional needs of bone including calcium, magnesium, vitamin K, boron, manganese, zinc, copper, silicon and others nutrients is ideal. Fresh vegetables, fruits, nuts and seeds are good sources of these foods. Limit heavy protein and salt intake, reduce alcohol, don't smoke, and for essential vitamin D, get sunlight on your skin at safe times of the day. Note: too much supplemental calcium may be harmful and there is inadequate evidence that dairy foods protect against fracture.
- Exercise often! The force of muscles pulling against bone stimulates bone remodelling and formation. Higher impact activities like running, jumping and jogging are very effective, but regular aerobic exercise such as walking is also beneficial. Weight bearing exercises, resistance training, and flexibility and balancing exercises like Pilates, Tai Chi and yoga are also important. Research has demonstrated that we can benefit from exercise at any age - even centenarians will experience an increase in strength, stamina and muscle mass. Exercise programs have been found to reduce the frequency of falls in high risk older people.
- Don't rush into taking drugs that may influence bone density but at present have little known benefit in terms of reducing fractures.
Gill Sanson, updated July 2009
Further reading: The Myth of Osteoporosis by Gillian Sanson
(MCD Century Publications 2003)
[i] BMJ Vol 323 October 6 2001
[ii] Therapeutics Letter, issue 20, July - August 1997 http://www.interchg.ubc.ca/jauca/pages/letter20.htm#alendronate
[iii] Cummings SR, et al. Effect of Alendronate on risk of fracture in women with low bone density but without vertebral fractures. JAMA 1998;280 (24):1077-2082
[iv] Postmenopausal osteoporosis: optimum time to start therapy unclear. Drugs & Ther Perspect. 1997 10(7):8-12
- The Marketing of Osteoporosis - American Journal of Nursing 2009
- The burden of Osteoporsis? - WHU Nov 2007
- Cola weakens bone for women - WHW Dec 2006
- Calcium supplements & hip fractures - WHW June 2006
- More on Depo-Provera and Bone density - WHU November 2005
- Depo-provera, bone density & young women - WHU July 2005
- Fosamax - free for all? - WHU July 2005
- Depo Provera strips bone density - WHU Octobr 2004
- Exercise most effective at preventing falls - WHW Sept 2002
- Hip fractures lower than predicted - WHW Sept 2002
- Bone density screening raises questions - WHW Sept 2000
- RALOXIFENE (a.k.a. Evista) What we know - and don't know - WHW June 2000
- Osteoporosis - the good news - WHU Jan 2000
- Hormones and hip fracture: benefits only for current users - WHW June 1998
- How good are bone scans at predicting fractures - WHW Jan 1997
- Osteoporosis- from 'Feeling Fabulous at 40, 50 and Beyond' S.Coney 1996
- WHIS factsheet - Osteoporosis - are you at risk? - now online
November 2007 Women's Health Update
A staggering 84,354 New Zealanders are predicted to break bones this year as a result of osteoporosis; that's one osteoporosis related fracture every six minutes and a hip fracture every two hours. By 2020 the annual osteoporosis-related fracture rates are predicted to exceed 115,000. So cautions the Fonterra funded 'Burden of Osteoporosis in New Zealand Report' commissioned by Osteoporosis New Zealand. Gill Sanson takes a look at the assumptions behind the report and suggests that we ought not be intimidated by the spectre of crumbling bones and debilitating fractures. A mountain of osteoporotic fractures is not likely should we choose not to heed the exhortations to drink more milk, scoff calcium supplements, have our bones scanned or swallow powerful drugs....Read More (pdf)
December 2006 Women's Health Watch
This study builds on earlier studies on cola consumption and adolescent girls with similar findings. It is hypothesised that the phosphoric acid in cola has a deleterious effect. Other studies supposed that cola consumption displaced milk consumption but this Framingham study finds otherwise. The major difference between cola and other carbonated beverages is phosphoric acid, caffeine and cola extract. After controlling for overall caffeine consumption this study still showed a negative association between cola and BMD. It is not clear why women would be more sensitive to the effects of cola than men. Women have smaller bones and are at higher risk for osteoporosis so they may be more affected by nutritional imbalance.
Tucker, K.L et al (2006) Colas but not other carbonated beverages, are associated with low bone mineral density in older women. American Journal of Clinical Nutrition 84:936-42.
June 2006 Women's Health Watch
The Women's Health Initiative (WHI), who ran the large US study that uncovered the risks of HRT has recently found that calcium and vitamin D supplements do not prevent broken bones or colorectal cancer and increase the incidence of kidney stones in middle-age and elderly women... Read More
November 2005 Women's Health Update
A contribution from Dr Christine Roke, the National Medical Advisor from the Family Planning Association. The Family Planning Association has been aware of the link between Depo Provera and lowered bone density for more than a decade since some of our clients were involved in research on the issue at Auckland Medical School. Unfortunately not enough teenagers wished to participate in the observational study at the time so we were left with no clear answers for this age group. However the Auckland work and overseas studies indicated that bone loss plateaus after a few years on Depo Provera and that bone loss was reversible on stopping Depo Provera use. Read More (pdf)
July 2005 Women's Health Update
Back in November 2004 the FDA issued its strongest possible warning about the substantial loss of bone mineral density that research shows follows long term use (two or more years) of the drug. As a result of a new study published in September 2002 the drug manufacturer Pfizer wrote to health professionals advising that the contraceptive injection should be used for no longer than two years and only when other birth control methods are inadequate. Read More (pdf)
July 2005 Women's Health Update
New Zealand appears to be the only country in the world exercising restraint in the prescribing of the osteoporosis prevention drug Fosamax - the new 'gold standard' treatment for the condition and one of a class of drugs called bisphosphonates. Pharmac's restrictions have reflected careful consideration of the evidence for the drugs effectiveness and safety, but things may be about to change. Merck Pharmaceutical's Medical Director indicated on National Radio recently that the restrictions on their drug are about to be lifted. Gillian Sanson reports....Read More (pdf)
October 2004 Women's Health Update
September 2002 Women's Health Watch
A Melbourne study of more than 1,000 older people living at home has found that a weekly exercise programme was the most effective of three interventions at preventing falls.
The research, by the Accident Research Centre at Monash University, compared group-based exercise with home hazard management and vision improvement in a randomised controlled trial of over 70-year-olds in good health.
The reduction in falls among participants assigned to the exercise intervention seemed to be associated with improved balance. Neither home hazard management nor treatment of poor vision significantly effected falls.
However, exercise combined with home hazard management and improved vision produced the strongest effect, an estimated 14% reduction in falls. Seven people needed to be treated with the three interventions combined to prevent one fall a year.
Ref: BMJ 2002; 325:128
September 2002 Women's Health Watch
The number of hip fractures in New Zealand from 1988 to 1999 was fewer than predicted in a major 1990 study, but researchers do not understand the reasons.
In 1990 it was predicted that hip fractures would increase from 2,000 in 1987 to 4,000 in 2011. However, a Wellington School of Medicine team found that 1999 figures were 20% less than this prediction as the hip fracture rate between 1989 and 1998 dropped significantly for all women over 65.
The research group speculated that four factors could have contributed to this
- Osteoporosis prevention measures such as diets rich in calcium and vitamin D, and increased weight bearing exercise
- Strategies to prevent falls and fractures in older people, including risk assessments of their homes and installation of hand rails, lighting, arm rests and other measures
- A higher use of HRT, bisphosphonates or selective oestrogen receptor agonists
- Population changes, including a 2.4% increase in the 65+ age group and a 4.6% decrease in the 85+ age group on that predicted in 1990.
Ref: NZMJ 2001;114:154-56
September 2000 Women's Health Watch
Doctors and the public should understand the limitations of the newer peripheral densitometry devices, used to help diagnose osteoporosis. These devices measure bone density at sites like the heel, whereas the major problems caused by osteoporosis are the hip and spine. An editorial in the British Medical Journal says the limitations of measuring bone density at peripheral sites mean there is the potential for misdiagnosis.
One of the main problems is that bone mineral density is not the same throughout the skeleton, raising the risk of misdiagnosis, especially in women under the age of 65 years. More than one site should be measured in younger women to avoid this risk of misclassification.
The article raises concerns about increasing use of the World Health Organisation definition of osteoporosis, which it says was arrived at for research purposes only. Increasingly the WHO definition has been used for the diagnosis of osteoporosis. It says while optimal methods for defining osteoporosis and predicting fracture risks are debated, it is imperative users understand the limitations of the techniques. Portable peripheral densitometry devices should be used in conjunction with other risk factors such as previous fractures and falls.
Ref: BMJ 2000; 321: 396-98
June 2000 Women's Health Watch
New hormonal drugs called SERMs or Selective Estrogen Receptor Modulators are being hailed as the latest women's health wonder drugs for mid-life women. Unlike hormone replacement therapy, it's claimed they'll prevent osteoporosis without stimulating oestrogen dependent cancers. This article by Sari Tudiver, PHD, and Janine O'Leary Cobb, MSc, examines the evidence. It was first printed in the US journal A Friend Indeed ... Read More
January 2000 Women's Health Watch
Ian Reid, Professor of Medicine at the University of Auckland, gives an update on this common bone condition.
Osteoporosis is a major health issue for New Zealand's ageing population. The number of hip fractures in New Zealand women increased from 300 to about 2,500 per annum in the last 50 years. According to a large study recently carried out in Australia at least 56% of postmenopausal women and 29% of men now have a fracture of some sort... Read More
June 1998 Women's Health Watch
A recent Swedish case-control study showed that women currently using hormone replacement therapy reduced their risk of hip fracture, but that within five years of ceasing therapy, women had lost most of the benefit... Read More
January 1997 Women's Health Watch
Bone density measurements have been promoted as a way of identifying individuals at high risk of fracture and taking preventive measures.
Swedish researchers conducted a meta-analysis of cohort studies published between 1985 and 1994 which took a baseline measurement of bone density then followed up the women for subsequent fractures. Eleven studies covering 90,000 person years of observation with over 2000 fractures were covered.
The researchers found that bone density measurements can predict risk of fracture but cannot identify individual people who will have a fracture. They compared the use of BMD measurements to predict fractures with the use of blood pressure to predict stroke and serum cholesterol concentration to predict coronary heart disease.
The authors concluded that they could not recommend a bone screening programme. There was wide overlap in the bone densities of people who had a fracture and those who did not. They also noted that there is little information about whether people would comply would comply with a bone screening programme, or comply with a bone screening programme, or comply with treatment, and little information about the effectiveness of treatments, particularly any that show a reduction in fractures.
Ref: BMJ 1996; 312: 1254-59
Osteoporosis- from 'Feeling Fabulous at 40, 50 and Beyond' S.Coney 1996 Read Here
WHIS factsheet - Osteoporosis - are you at risk? - Read here