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Women's Health
Osteoporosis
Osteoporosis is a silent disease and it means 'porous bones' – a condition where the bones become thin and fragile, and can easily break, even during everyday activities.1a,b,2a
Throughout life, the body loses bone and new bone grows to replace lost bone.3a
During childhood and adolescence, bone mass increases, reaching a peak during the second decade of life.3b Thereafter, more bone is lost than is made in both men and women.2b
In women, lack of estrogen after menopause accelerates the rate of bone loss.2b
As the person grows older, the body is less able to stay ahead of the bone loss and the result can mean weak and brittle bones i.e. osteoporosis.2b,3c
1 in 3 women > 50 years are affected by osteoporotic fractures.1c,2a
Although average life expectancy in South Africa is 51 years for males and 55 years for females4, life expectancy in other countries such as the UK is close on 80 years.5 Greater longevity, therefore, also confers a greater risk of osteoporosis in women than in men.6b
Risk Factors for Osteoporosis and Fractures
Non-modifiable3d,6a - Increasing age
- Female gender
- Maternal family history of hip fracture
- Diseases predisposing to osteoporosis e.g. rheumatoid arthritis
Potentially Modifiable3e,f,6a - Smoking
- Excessive alcohol consumption (= 3 units/day)
- Dietary calcium and vitamin D deficiency
- Early menopause
- Body mass index less than 19 kg/m²
- Amenorrhoea i.e. women who stop menstruating before menopause because of conditions such as anorexia or excessive exercise
- Lack of exercise
- History of falls
- Drug therapy e.g. use of high doses of cortisone
Signs and Symptoms of Osteoporosis - Osteoporosis often first presents as a fracture.6c
- A low trauma fracture, such as a fall from standing height or less in someone over the age of 45 years should trigger the suspicion of osteoporosis.6c
- In other cases, osteoporosis may present as backache, height loss and spinal deformity.6c
Complications of Osteoporosis - Spinal deformities may lead to activity limitations as well as restrictive lung and abdominal problems.3g
- Complications from osteoporotic hip fracture are often severe and can be devastating; they result in permanent disability in over 30% of patients.3h
Safety Options – PrecautionsVarious measures can reduce the risk of osteoporosis and fracture.3i - Regular weight-bearing exercise can increase bone density and also helps reduce the risk of falling because of improved muscular strength and coordination.3j
- A well-balanced diet adequate in calcium is recommended to reduce risk of osteoporosis.3k,6d
- Protect yourself from bone loss by not smoking and by limiting your intake of alcohol.6d
- Ensure safety in the home by not having any loose mats or wires that could cause a person to trip and fall.
Treatment OptionsTreatment options for osteoporosis either slow the breakdown of bone and/or promote bone formation.7a Since medicines for osteoporosis have generally been studied in patients taking calcium and vitamin D (400-800 IU per day), these supplements should be used in combination with most osteoporosis medicines.8a
Daily calcium needs:9
| | mg/day | | Adolescents 14-18 years | 1300 | | Men 19-50 years | 1000 | | Men > 50 years | 1200 | | Women 19-50 years | 1000 | | Women > 50 years | 1200 | | Postmenopausal women on estrogen | 1000 | | Postmenopausal women not on estrogen | 1500 |
Antiresorptive DrugsMedicines that work to slow the turnover of bone are called antiresorptives.7a
Bisphosphonates such as alendronate, risedronate and zoledronic acid are most commonly used for preventing and treating osteoporosis.8b They inhibit bone resorption (breakdown), increase bone density and reduce risk of fracture.8b They have been shown to be effective in both women and men, including the elderly.8b
A selective estrogen receptor modulator (SERM), raloxifene, may be used to prevent and treat osteoporosis in postmenopausal women.8c Raloxifene slows bone loss, increases bone density and reduces the incidence of vertebral (spinal) fractures.7b,8c
Hormone replacement therapy (HRT) with estrogen slows bone loss, increases bone density and reduces fracture risk in postmenopausal women.7c,8d HRT is mainly used in women with menopausal symptoms such as hot flushes who are unable to take other osteoporosis medicines.8e
Calcitonin is a naturally occurring hormone that slows bone loss and reduces risk of vertebral fracture. It may be given by injection or as a nasal spray. Calcitonin has an analgesic effect and is sometimes considered for patients with painful vertebral fractures.7d,8f
Drugs that Promote Bone FormationTeriparatide is similar to human parathyroid hormone. It increases bone formation and bone strength. It is usually reserved for the treatment of osteoporosis in patients once a fracture has occurred or in patients responding poorly to other agents.7e,8g,10a
Other OptionsStrontium ranelate reduces both bone loss and increases bone formation.2c It increases bone density and reduces risk of fracture (vertebral and non-vertebral) in postmenopausal women with osteoporosis.2d,6e It also reduces fracture risk in patients older than 80 years.2d
REFERENCES: | 1. | National Osteoporosis Foundation South Africa. The Silent Disease. Patient Information Brochure. | | 2. | de Villiers TJ. Preventing osteoporosis in postmenopausal women: Treatment approaches for family practitioners. SA Fam Pract 2008;50(1):41-47. | | 3. | Rizzoli R. Atlas of postmenopausal osteoporosis. 1st Ed. Science Press Ltd. 2004. | | 4. | South African Institute of Race Relations. Press Release. 19 Nov. 2009. www.sairr.org.za | | 5. | Office for National Statistics. www.statistics.gov.uk/cci. Accessed July 2010. | | 6. | Poole KES, Compston JE. Osteoporosis and its management. BMJ 2006;333:1251-1256. | | 7. | Tanna N. Osteoporosis and its treatment. Pharm J 2005;275:581-584. | | 8. | O'Connell MB. Prescription drug therapies for prevention and treatment of postmenopausal osteoporosis. J Man Care Phy 2006;12(6):S10-20. | | 9. | Ed. South African Medicines Formulary. 9th Ed. South African Medical Association. 2010. pp. 93. | | 10. | Hough S. New developments in osteoporosis. www.nofsa.org.za (accessed June 2010). |
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