Osteoporosis Diet and Treatment

Breaking a hip or shrinking in height used to be simply accepted as a sign of ageing, buit now we know better. Osteoporosis is a condition in which bones lose calcium, become fragile and fracture more readily. It affects one in every 10 Australians, causing an osteoporosis fracture in one in two women and one in three men over the age of 60.

Food - Calcium Content

Your Health Check

Risk factors for osteoporosis include a family history, poor calcium intake, lack of vitamin D, low exercise levels, smoking, high alcohol and salt intake, and possibly high caffeine intakes, delayed menarche (onset of menstuation), early menopause (cessation of menstruation) and some medications.

Prevention of osteoporosis is a life-long commitment. Building strong bones especially before the age of 35, is one of the best defences against developing osteoporosis. It appears that childhood and adolescence is not only an important time for growing bones, but also an important time for determining bone density. By the age of 20, 90-95 per cent of peak bone mass is attained. Once we reach our mid 30s our peak bone mass starts to decline. Decreasing levels of oestrogen during menopause further accelerates bone loss. However, while it is best to build healthy bones early through the right diet and physical weight-bearing activity, it's never too late to start taking care of your bones.

The Importance of Calcium

The key to healthy bone habits is to ensure you're getting your daily requirements of bone-building nutrients like protein and calcium. Most Australians eat enough protein, but it's the calcium that some may be missing. Adults need 100mg calcium each day (roughly 3-4 servings), with an additional 300mg during pregnancy, breastfeeding, menopause and adolescence growth spurts. Dairy products are an excellent source of calcium as they are convenient, offer many other important nutrients such as protein, and the calcium is readily absorbable.

Calcium and Vitamin D: People over 60 may benefit from taking small daily amounts of vitamin D, along with 1500 mg of calcium. Stronger vitamin D preparations are sometimes used to treat osteoporosis in younger people.

Eat for Health

Too much salt (sodium), caffeine and alcohol are associated with decreased bone density and increased risk of bone fractures. Too much sodium is the diet can cause calcium to be excreted from the body, so it's important to choose low-salt foods to help protect your bones.

Foods containing phytates (wholegrain cereals, seeds, soy and legumes) or oxalates (tea, spinach and rhubarb) can also bind calcium, making it unavailable for absorption. While some of these foods also contain calcium, it is not absorbed as efficiently as other foods, such as dairy. For example, about 5 per cent of the calcium in spinach is absorbed compared to about 30 per cent of the calcium in milk.

Bisphosphonates This group of drugs works by slowing bone loss; in many people, an increase in bone density can be measured over 5 years of treatment. Both alendronate (Fosamax) and risedronate (Actonel) reduce the risk of hip and spine fractures in patients with osteoporosis. These drugs cannot be taken with food, and specific instructions on how to take the tablets are provided as they can cause irritation of the gullet. They are available either as daily-dose tablets or weekly-dose tablets. Etidronate (Didronel) is a slightly weaker drug of the same group, which is well tolerated and is taken in 3-month cycles.

Hormone replacement therapy (HRT) Women who have been through the menopause may consider using hormone replacement therapy to reduce their menopausal symptoms. HRT is only beneficial for bones while it is being used. A very large clinical trial reported in 2002 that using the commonest type of HRT tablet is associated with a reduction in fracture, but also with an increase in the risk of heart disease and breast cancer. It can also increase the risk of venous thrombosis. If you are considering long-term HRT use, discuss the potential risks and benefits with your doctor.

Selective estrogen receptor modulators (SERMs) The hormone oestrogen helps to keep the bones strong. Raloxifene (Evista) is a SERM which mimics this effect and reduces spine fractures. It also reduces the risk of breast cancer without increasing the risk of heart disease. It is taken by mouth once a day without the need to follow special instructions. It may cause side-effects like menopausal ‘flushing’ and, as with HRT, may increase the risk of venous thrombosis.

Calcitonin (Miacalcic) Calcitonin is a substance which the body produces naturally and which helps keep the bones healthy. When used as a treatment it has enabled the bones of people with osteoporosis to grow stronger. Calcitonin can only be given in the form of an injection or by nasal spray. Injections of calcitonin are normally given only as a short-term treatment for painful vertebral fractures, but the nasal spray may be used as a long-term treatment for osteoporosis. Possible side-effects include hot flushes, nausea, an unpleasant taste in the mouth, tingling in the hands and, rarely, an allergic reaction. The nasal spray may also cause a blocked or runny nose, sneezing and headaches.

Teriparatide (Forsteo) Teriparatide is a new drug which helps new bone to form and therefore reduces the risk of fractures. It is taken by daily injection into the thigh or tummy (patients are shown how to do this themselves). It is used for up to 18 months, during which time the bones are strengthened. At present it is used mainly for people who have had fractures despite using other treatments, or who have had side-effects from other treatments. Side-effects of teriparatide include nausea, limb pain, headaches and dizziness, but because it is a new drug the long-term side-effects are not known.