Getting Older

Menopause

American site information re menopause.

 

Osteoporosis means ‘porous bones’. When we talk about it we mean that the bones are more porous and more liable to break. The bones are made by cells called osteoblasts, and broken down by osteoclasts. The formation is a balance of these.

The strength of the bones is about having the right structure as well as the “ingredients” of the bone. From the age of 40 the osteoclasts are more active and the bones become weaker, and make one more predisposed to being broken.e.g. wrist, with relatively minor injuries or being squashed e.g. compression of the vertebral (back) bones which may end up being wedged causing curvature of the spine or loss of height.

 Questions you may be asked

  • Your age
  • Your gender
  • Whether you have reached menopause (women)
  • Your personal history of broken bones as an adult
  • Your family history of broken bones and osteoporosis
  • Whether you smoke or drink too much alcohol
  • Your dietary habits, including how much calcium and vitamin D you get
  • Your exercise and physical activity habits
  • Whether you have had an eating disorder such as anorexia nervosa
  • Whether you have had regular periods (premenopausal women)
  • Your testosterone levels (men)
  • Whether you take any medicines or have any medical conditions that may cause bone loss e.g. prednisolone,proton pump inhibitors e.g. lansoprazole. Please note this does not mean that these medicines should not be taken, just that the increased risk of osteoporosis needs to be conidered and the lowest dose used to control the underlying condition.

Medical conditions which may make you more prone include :

  • AIDS/HIV
  • Ankylosing spondylitis
  • Blood and bone marrow disorders
  • Breast cancer
  • Chronic obstructive pulmonary disease (COPD), including emphysema
  • Cushing’s syndrome
  • Depression
  • Diabetes
  • Eating disorders,  especially anorexia nervosa
  • Female athlete triad (includes loss of menstrual periods, an eating disorder and excessive exercise)
  • Gastrectomy
  • Gastrointestinal bypass procedures
  • Hyperparathyroidism
  • Hyperthyroidism
  • Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
  • Kidney disease that is chronic and long lasting
  • Liver disease that is severe, including biliary cirrhosis
  • Lupus
  • Lymphoma and leukemia
  • Malabsorption syndromes, including celiac disease
  • Multiple myeloma
  • Multiple sclerosis
  • Organ transplants
  • Parkinson’s disease
  • Polio and post-polio syndrome
  • Poor diet, including malnutrition
  • Premature menopause
  • Prostate cancer
  • Rheumatoid arthritis
  • Scoliosis
  • Spinal cord injuries
  • Stroke
  • Thalassemia
  • Thyrotoxicosis
  • Weight loss

The FRAX tool was developed by Sheffield University in conjunction with WHO and has a risk calculator. Please click on the link below :

https://www.shef.ac.uk/FRAX/tool.jsp

What can you do try and prevent this :

Do Exercise – weight bearing e.g. brisk walking,jogging,aerobics. ( You may need to be careful of high impact exercises if osteoporotic to prevent a fracture.)

Eat a good healthy balanced diet.

Eat / drink sufficient calcium.

We have about 1 kg of calcium in our bones. Most people do not need additional supplements.

According to NOF recommendations:

  • Adults under age 50 need a total of 1,000 milligrams (mg) of calcium from all sources* and 400 – 800 international units (IU) of vitamin D every day.
  • Adults age 50 and older need at total of 1,200 mg of calcium from all sources* and 800 – 1,000 IU of vitamin D every day.

mg calcium

1/3 pint milk (whole)                     224

1/3 pint semiskimmed                  231

150g low fat yoghurt                      225

28g cheddar cheese                         202

112g boiled spinach                         179

112g baked beand                             59

100g tofu                                             480

 

Get enough vitamin D.

15-20 minutes sunlight exposure 3-4x/week face/arms.

Supplements are now recommended during pregnancy.

 

Don’t drink excessive amounts of alcohol.

Stop smoking

 

Common Drug treatments

Calcium and Vitamin D tablets are prescribed epecially when one gets older and there has been a”fragility fracture”, or to prevent fractures in the elderly.

e.g.

  • Adcal D3 1 tablet bd
  • or Adcal D3 caplets 2 bd (gelatin free so useful if religious reasons not to have gelatin)
  • Calcichew D3 (forte) 1 bd

These are needed to be taken everyday before another group of drugs , Bisphosphonates, work which do so by reducing osteoclastic activity/breakdown of bones. This strengthen the bones further and are taken often if there is a fragility fracture or osteopenia/osteoporosis. These can be taken in a daily or often weekly peparation. Other types of preparation can be taken.

e.g.

Alendroic acid 70mg once weekly.

  • Should be taken whole on an empty stomach at least 30 minutes before eating or drinking anything other than water.
  • With plenty of water (at least 1 glass)
  • They should not be taken with other tablets.
  • These can cause heartburn and hence  at a time where you should not be lying down i.e. sitting or standing for a 30 minutes.
  • You should not have anything to eat for a couple hours after  and take it with lots of water.

Please stop them if you have any side effects e.g. signifiacnt heart burn or If you experience any pain or numbness in your jaw, or any problems with your mouth or teeth, stop taking the tablets and tell your doctor.

Strontium ranelate works on both osteoclasts and reduces breakdown of bone, and encourages osteoblastic activity (build up of bone) and is actually quite dense itself making scans* not useful in monitoring the weakness of the bones.

I DO NOT encourage you to have private scans done by some private companies as really they may not worth the paper they are written on and do not provide definitive results. Please discuss this with your GP.

 

 


Links

National Osteoporosis  Society

Leaflets From National Osteoporosis Society

https://www.nof.org/aboutosteoporosis/prevention/calciumcalculator

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