Osteoporosis is the process of a relative weakening of the bones such that they are increasingly likely to fracture with age. Of itself, it is rarely painful yet should not be underestimated as a condition that affects both quality of life and, through complications subsequent to a fall, length of life as well. Women are more susceptible to osteoporosis as a result of hormonal changes due to menopause.
What are the Risk Factors for Osteoporosis?
Osteoporosis becomes increasingly likely with age, particularly in post menopausal women. However, it would appear that the most significant period of life for forming strong bones is during the teenage years. Hormonal imbalances in women including, in particular, total hysterectomies and early menopause increases the risk of Osteoporosis. Similiarly, low testosterone in men may also increase Osteoporosis risk. Factors such as poor diet (imbalanced Calcium intake), smoking, alcohol consumption and high caffeine intake may also mediate the risk of Osteoporosis. Vitamin D deficiency has been linked to Osteoporosis as has a lack of activation of Vitamin D through inadequate sun exposure. Some medications also increase the risk of Osteoporosis including long term use of corticosteroids, excess thyroxine and warfarin.
What Tests should I do to detect Osteoporosis?
A Bone Mineral Density test is used to detect age relative bone strength and hence diagnose Osteoporosis afterwhich a Urinary Telopeptidase test may help monitor treatment progress between BMDs.
When Should I Intervene Against the Risk of Osteoporosis?
Mainstream medical approaches intervene at the diagnosis of Osteoporosis with Calcium supplementation and the use of medications such as Bisphosphonates, often only after the first fracture has been experienced. However, an intermediate stage of relative weakening known as Osteopaenia is also measured and in the least this is when active treatment should begin. Of course the optimal time to prevent Osteoporosis is now, whatever your age and known bone strength through sensible long term dietary modification.
What is the Integrated Approach to Osteoporosis?
The integrated approach to Osteoporosis uses multiple modalities to address the condition as early as possible including exercise, dietary modification, nutritional supplementation, stress reduction and sensible sunlight exposure with the use of pharmaceutical agents only if such an approach fails or identification occurs only at a late stage of disease. For the elderly patient further interventions may be aimed specifically at reducing the risk of a fall.
What Exercise Should I Do?
Two approaches to exercise are encouraged simultaneously. First and foremost strengthening exercises in weight bearing positions are important to increase bone density. An Exercise Therapist or Physiotherapist can be helpful here, but a simple programme begins with exercise such as squats, lunges and sit to stand exercises and daily walking.
The upper body should also be strengthened with moderate resistance exercises to prevent the risk of wrist fractures, commonly experienced when the arm is thrown out during a fall. Elderly patients can gain from resistance exercise, no age is too late to start.
Balance exercises that improve coordination are also important in preventing a fall. Tai chi is commonly used in Falls Programmes and is encouraged.
Cardiovascular exercise is also encouraged here as the greater the fatigue during the day, the greater the likelihood of a fall leading to a fracture.
Will Diet Help?
A high Calcium diet including a high intake of dairy products has been encouraged in conventional Osteoporosis programmes. However, some question this approach based upon concerns for the acid alkali imbalance hypothesised to occur with a high dairy diet. The argument is that the acidity in dairy and grain foods needs to be buffered in the body and the mechanism for this is the release of calcium carbonate from bones. Hence it is suggested that high dairy diets actually lead to a secretion of more calcium from the bones, although it must be noted that recent evidence does not support this hypothesis. Another consideration is that many people are intolerant to high dairy diets due to lactose or casein in dairy. A balanced approach to dairy consumption is therefore suggested for Osteoporosis.
First, establish whether or not you are intolerant to dairy products ( see Food Elimination Regimes). If so, you may need to consume lower levels of dairy than often recommended. If you are not intolerant to dairy products consider the guidance provided in the Osteoporosis Diet. In the least, aim to balance your dairy intake through a high fruit and vegetable consumption, foods that naturally offset the acidity of dairy.
Foods that have a reasonable ratio of Calcium to Magnesium are also encouraged (for reasons we will outline in the Supplement approach). It is important to note that the argument that dairy is essential for human health is questionable at best, given that dairy consumption is a modern dietary habit. We can do without dairy and remain healthy, even if it may be beneficial to those that tolerate it. Here again is the necessity of an individualised approach to your health needs.
Should I Give Up Smoking?
However hard this may be, you must give up smoking. Smoking is a risk factor in the progression of Osteoporosis. See Quit Smoking.
What about Calcium Supplements?
Calcium supplements are an effective approach to Osteoporosis, but a view that Calcium alone will help is overly simplistic. Calcium requires balanced partnerships to work effectively in promoting bone formation. A Calcium to Magnesium ration of 2:1 is important (another reason for questioning high consumption of dairy where an 8:1 ratio exists) as Magnesium is critical in encouraging the healthy Parathyroid function required for bone formation.
Calcium supplements should not be taken alone as there recent evidence indicates the risk of cardiac complications. Note also that in a subgroup of Osteoporosis inadequare Calcium is not a problem and Calcium deposits may accumulate with overuse of supplementation.
Vitamin D ( as D3 not D2) is also important in encouraging bone formation.
There are many other micronutrients and minerals that play a part in Osteoporosis that in deficiency can be critical to address. These include Vitamin A , C and K, silica, zinc and manganese.
Furthermore, there is a subset of Osteoporotic patients in which Calcium supplementation may, in fact, be worthless or even detrimental. This subset may have an overactive Parathyroid and the added calcium risks soft tissue calcification elsewhere. Herein lies the risk of simplistic supplementation focusing on 1 or 2 nutrients alone ( i.e. only Calcium and Vitamin D).
Nutritional medicine can be complicated and consultation with an Integrative Practitioner is strongly encouraged to avoid inappropriate, excessive or even detrimental supplementation.
Can I Combine a Pharmaceutical Approach with Complementary Medicines?
Yes, if your doctor feels your Osteoporosis has progressed such that you need the assistance of pharmaceutical medicine. However, you need always check that any medication you are taking does not interact with a suggested supplement regime by discussing what you are taking with both your Doctor and Integrated Health Practitioner