Osteoporosis - Prevention of Fractures

Many aspects of a patient’s lifestyle have an impact on their likelihood to develop osteoporosis and on how severely they are affected. Adopting a few simple changes to daily routines can make a big difference.

Regular Exercise

Regular exercise is important throughout life regardless of age. The specific benefits relevant to patients who are at risk of developing osteoporosis are listed below:

• Minimise bone loss and risk of fracture
• Increased muscle strength
• Improved balance
• Reduced risk of developing medical conditions such as cardiovascular disease and diabetes
• Improve cognitive function
• Improved posture
• Reduced risk of falling

Weight bearing exercise and resistance exercise are particularly important for patients who are at risk of developing osteoporosis. Weight bearing exercises are exercises where the weight of the body if being supported by the legs, these include walking, running, dancing and aerobics. Good footwear is vital if patients are considering taking up weight bearing exercises.

Resistance exercise involves contracting different muscle groups against resistance, the resistance can be in the form of the weight of the body, a weight in the gym or a specific machine designed to provide resistance. Resistance exercise is vital to maintaining muscle mass, which often decreases as patients get older, and is vital to maintaining safe independent mobility.

The National Osteoporosis Society has produced an information leaflet on the benefits of exercise in osteoporosis. For more information visit:
www.nos.org.uk/~/document.doc?id=770

Healthy Eating

The most important nutrients for the health of bones are Calcium and Vitamin D. Calcium is vital for maintaining strong bones, an average adult requires over 700mg per day, which should be easily available from a normal diet. Calcium rich foods include leafy green vegetables, dried fruit, tofu and dairy products.

Vitamin D is important to bone strength because it helps the body absorb calcium. It can be found in foods such as eggs, milk and oily fish, however Vitamin D requires exposure to sunlight to become active. If patients are housebound, pregnant / breastfeeding or required to cover up when outside then they are at high risk of not getting enough vitamin and should talk to the GP about supplementation.

Eating a healthy balanced diet is important for everyone, and can prevent many serious health problems such as cardiovascular disease diabetes and some forms of cancer. It also has an impact on osteoporosis.

The British Dietetic Society produced guidance on healthy eating techniques for patients with osteoporosis. For more information visit:
www.bda.uk.com/foodfacts/osteoporosis

The National Osteoporosis Society explain the links between diet and bone health. For more information visit:
www.nos.org.uk/about-osteoporosis/your-bones

For more information on Self-help in osteoporosis visit:
Arthritis Research UK www.arthritisresearchuk.org/arthritis-information/conditions/osteoporosis/self-help-and-daily-living.aspx

Preventing falls and the inevitable negative health consequences, which accompany them, is a priority for everyone involved in the care of older people. Falls are an increasing risk as patients get older, but should not be considered inevitable; there are several things that can be done to limit the risk of falls.

Falls risk can be minimised by maintaining a healthy lifestyle with a balanced diet and regular exercise, this will help maintaining muscle strength, co-ordination and will have a positive effect on mobility. If patients are showing signs of being unsteady on their feet, or have already suffered from falls, it is important to seek help from a GP as soon as possible. Many causes of falls such as poor eyesight, home environment, foot problems and certain medication can be identified and treated at very little cost.

Calcium and vitamin D can be given as supplements if not enough is being absorbed through a healthy balanced diet. Studies suggest that 1.2g of calcium and 20 micrograms of vitamin D are required daily to help prevent osteoporotic fractures.

For more information on vitamin D visit:
National Osteoporosis Society www.nos.org.uk/healthy-bones-and-risks/Vitamin-D

Bisphosphonates work by deactivating the cells that are responsible for the breakdown of bone. They are often prescribed in conjunction with Calcium and Vitamin D supplementation, and tend to take 6-12 months to start having an effect.

Side effects include irritation to the oesophagus, difficulty swallowing, stomach pain and very rarely osteonecrosis of the jaw.

For more information on Bisphosphonates visit:
National Osteoporosis Society Alendronate www.nos.org.uk/document.doc?id=1657

National Osteoporosis Society Risedronate www.nos.org.uk/document.doc?id=1662

National Osteoporosis Society Zoledronate www.nos.org.uk/document.doc?id=1664

Denosumab is a drug that inhibits the cells that breakdown bone. This helps reduce bone loss and therefore helps in reducing the rate of fractures. Denosumab is given by subcutaneous injection every six months. The first injection is typically given in hospital and subsequent injections can be given at the GP surgery.

For more information on denosumab visit:
National Osteoporosis Society www.nos.org.uk/document.doc?id=1658

Parathyroid hormone is naturally produced by the body. It acts to regulate the amount of calcium that is stored in the bone, which is available to the rest of the body for important processes in the heart and muscles. Parathyroid hormone acts to stimulate the cells which make new bone and can therefore reverse the effects of osteoporosis.

It is given as an injection and at present it is available to a small number of patients who have very severe osteoporosis and who don’t respond to other treatment. Parathyroid hormone can only be prescribed by a specialist. Side effects include nausea and vomiting.

For more information on Teriparitide visit:
National Osteoporosis Society www.nos.org.uk/document.doc?id=1665

Strontium ranelate is used as an alternative to bisphosphonates in patients who are intolerant. It works by both limiting the rate at which bone breakdown takes place and by stimulating the cells that produce new bone.

Strontium is taken as a powder dissolved in water. Side effects include nausea, diarrhoea and occasionally allergic reaction. It is not used very often now due to the increased risk of heart attacks and strokes in patients with other cardiovascular risk factors.

For more information on strontium visit:
National Osteoporosis Society www.nos.org.uk/document.doc?id=1663

Hormone replacement therapy or HRT is hormonal treatment containing oestrogen and often also progesterone. It is often prescribed to combat symptoms of menopause but is also known to provide a degree of protection against bone loss and therefore osteoporosis, particularly in women who have had an early menopause. There are certain risks associated with its use such as increased rates of breast cancer, heart attacks and strokes. Therefore long term treatment is not generally used as osteoporosis treatment but in certain situations it may be used for short periods.

For more information on HRT visit:
National Osteoporosis Society www.nos.org.uk/document.doc?id=1362

Raloxifene is a single daily tablet, which has a similar protective effect on bone as oestrogen. It slows the post-menopausal loss of bone density and limits the risk of osteoporotic fractures. Side effects of raloxifene include hot flushes, cramps and increased risk of blood clots.

For more information on Raloxifene visit:
National Osteoporosis Society www.nos.org.uk/document.doc?id=1661