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ARTHRITIS
FOUNDATION OF VICTORIA 
Everybody's Bones: A Handbook for the Prevention and Management of Osteoporosis - 3rd edition now available! Who needs to know about bone health? The answer
is everybody needs to know how to build and maintain healthy bones. A Book for Everybody!
These and many more questions are answered. Osteoporosis is a condition in which the bones lose calcium, become fragile and tend to break more easily. Osteoporosis afflicts one in two females and one in three males over the age of sixty in Australia. The hormonal changes that accompany menopause accelerate the loss of calcium. Your bones comprise a hard outer shell covering a less dense tissue resembling honeycomb. When osteoporosis develops, the outer bone 'shell' becomes thin and weak, and the 'honeycomb' develops larger holes, weakening the bones and increasing the risk of fracture. Serious complications may occur when bones are fractured, particularly in hip fractures.
Your "Bone Bank" An analogy is often drawn between your bones and a bank. Instead of depositing money, you deposit calcium, and your bones represent the 'account'. Calcium plays a major role in giving bones their strength. Each day you make deposits and withdrawals, but you should be saving for your future when you may need to withdraw quite large 'sums' of calcium. The sooner you start saving and the larger the amount deposited, the better off you'll be later, because you have taken steps to help prevent osteoporosis. Our bones possibly reach their peak strength by our early 20's with a great increase in strength during adolescence. The point at which they reach peak strength is called Peak Bone Mass. It's a very important turning point for your bones because there are two major factors which determine the potential for osteoporosis. Firstly, your Peak Bone Mass; and secondly, the rate at which you lose bone. At about 35 years, bones slowly start to lose calcium. Men may lose up to 1% every year over the age of 35, and so do women, except around the menopause when, for 5-10 years, women lose bone at a much faster rate than do men of a similar age. This is due to the sharp decline of the sex hormone oestrogen which plays a central part in maintaining bone balance in women. Bone loss after menopause appears to be the major reason that women in particular are at risk of osteoporosis. Many lose so much calcium that they reach a danger level when bones break more easily. This is sometimes called the fracture threshold. The more bone you have at peak bone mass, the more you can afford to lose before you are in danger of having a fracture. Bone is not just a 'static' structure; it is a living, growing structure which responds to various stimuli. Like muscle, for example, putting bones under stress, or 'making them work', stimulates their development. And the simplest way to make them work is weight-bearing physical exercise. Who is at risk of osteoporosis? The longer you live the more likely you are to develop osteoporosis. Osteoporosis affects both men and women, however it is more common in women. Doctors cannot be sure who will develop fracture but you are more at risk if you answer 'yes' to a significant number of the following questions: Risk factors you can change
Risk factors your doctor can help you with
Risk factors you cannot change
There are things you can do now to maintain or increase strength of bones and help protect yourself against osteoporosis. These habits should start in childhood and continue throughout life. Try to:
If you are a woman, information is available from the centres listed below and your family doctor about:
The importance of calcium Calcium is an essential ingredient in building and maintaining bone strength. The daily amount needed depends on age and sex. Because females are at greater risk of osteoporosis it is particularly important for teenage girls and young women to achieve and maintain adequate calcium supplies to ensure the highest possible peak bone mass in early adulthood. Surveys have shown that the daily calcium intake of many Australian women and girls is nowhere near adequate. The National Health and Medical Research Council of Australia recommends the following daily intake of calcium. Recommended daily calcium intake
Dairy foods are best because they are especially high in calcium. Calcium from dairy foods is more easily absorbed by the body than from other foods. It is easy to aim for three serves of dairy products daily in a balanced diet and if fat or cholesterol is a problem, there are many low fat dairy products to choose from. Canned fish with bones is another good calcium source. Choose products that are low in salt. Calcium occurs in a large number of foods but often only in small amounts. Where it does occur in larger amounts, such as in some nuts and vegetables, it is often not absorbed efficiently by the body. This is another reason why dairy products are such a valuable source of calcium. Use the calcium counter to ensure your recommended daily intake. If it is difficult for you to obtain adequate calcium from your diet you need to consider a calcium supplement. Discuss this first with your doctor or a dietitian. Weight-bearing exercise, which creates a positive stress on bones, helps to increase peak bone mass in younger people and to maintain or increase bone in older adults. Recommended activities include walking, jogging, tennis, golf, dancing and lawn bowls. Swimming is not a weight-bearing exercise but will be of some benefit because of the pull of muscle on bone. A regular weight-bearing exercise routine such as walking 3-4 times a week for 30-60 minutes (not necessarily all at once) is recommended. Even if you have osteoporosis the benefits of exercise are many. In addition to preventing further bone loss and stimulating bone growth, it will help improve balance, flexibility and co-ordination, which are important in avoiding falls. You should start your exercise programme slowly with modest, easily achieved goals, gradually building up to the desired level. People with arthritis should avoid undue stress on joints. If you are unsure about the safe, effective exercise program for you, talk to your doctor, a physiotherapist or the Arthritis Foundation. Strength training (or resistance training) is exercise in which resistance is applied to a muscle to develop and maintain muscular strength, muscular endurance and muscle mass. The resistance applied can take the form of free weights (dumbbells or leg cuffs), machine weights, resistance bands or even body weight. Improvements in muscle strength, function, pain and quality of life can be achieved through strength training. Importantly for osteoporosis prevention and management, strength training can maintain or even improve bone mineral density. Reducing the risk of a fracture is an important factor in osteoporosis management. Strength training can reduce the risk of fracture by: improving bone mineral density Improving muscle strength which can reduce the risk of falls and thus the risk of fracture. Strength training is also beneficial for the prevention and management of other chronic illnesses such as diabetes and heart disease and is useful in the management of arthritis. Click here for more information about strength training for osteoporosis. Statement on Hormone Replacement Therapy from Osteoporosis Australia Medical Advisory Committee It is still important to take plenty of calcium and have regular, gentle exercise. Consult your doctor or specialist about all aspects of medical treatment. Daily living with Osteoporosis.
Find out more
Osteoporosis Australia
Statement on Hormone Replacement Therapy from Osteoporosis Australia Medical
Advisory Committee Use of Hormone replacement Therapy (HRT) for Osteoporosis. Hormone replacement therapy (HRT)has been shown to prevent bone loss in a number of clinical trials but there has been evidence lacking about its effect to reduce osteoporotic fractures. The recent publication in the Journal of the American Medical Association (July 10th)of the results Women Health Initiative trial confirms long term use of combination oestrogen/progestagen HRT reduces the risk of hip fractures. However it also increases the risk of breast cancer, heart attacks and strokes. In terms of risk, from the study findings it can be calculated that if 10,000 women were treated for a year with combined oestrogen/progesterone HRT the absolute risks were 7 more coronary heart disease events, 8 more invasive breast cancers, 8 more strokes, 8 more pulmonary emboli, but 6 fewer colorectal cancers and 5 fewer hip fractures. Although the application of these results to other HRT regimens (patches, implants or other oral formulations) is currently unclear, based upon these findings Osteoporosis Australia does not recommend HRT use by patients for long term prevention or treatment of osteoporosis. Patients currently taking HRT should discuss the reasons for its ongoing use with their doctor in light of these risks and benefits. For women with osteoporosis, a number of other agents, such as the bisphosphonates (Actonel, Fosamax) and SERMS (Evista), have been proven in large clinical trials to prevent bone loss and reduce fracture risk and are appropriate alternatives to HRT. As the Australian expert committee established by the Federal Government has also recommended hormone replacement therapy should not be used for long-term osteoporosis preventive therapy, Osteoporosis Australia also calls for a review by the Federal Government into the availability in Australia of non HRT therapies for prevention of osteoporosis under the Pharmacetical Benefits Scheme. These non-HRT osteoporosis therapies are currently restricted under the PBS to patients who have already sustained at least one fracture, on the understanding that those women with osteoporosis who have not yet sustained a fracture could be treated with HRT. This latter approach is now no longer supported by the Government's own expert committee. For Further information please contact the offices of Osteoporosis Australia on 02 9518 8140 NEVDGP entry -
Check out "slow moving weight bearing exercise" Australian video
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