Osteoporosis is the medical term given to the thinning of the bones. This condition can be due to hormonal changes during the menopause, due to ageing or due to underlying disease processes.

Although osteoporosis is approximately 8 times more likely to affect women, it is important to be aware that men can suffer too.

Postmenopausal osteoporosis is caused by a drop during menopause in the levels of the female hormone oestrogen (estrogen) which protects against loss of bone density.

It is important to underrstand that the initial bone density at the start of the menopause is crucial to the development of this condition. To understand this we must first understand how bones form. It is during the two to three years of the growth spurt in puberty that 60% of the final bone mass is deposited and it is during these years that dietary inadequacy can severely alter final bone mass.

Whatever your bone mass is by the time the skeleton is fully formed is the maximum you will ever have. Any calcium supplementation, exercise, diet or medication will only help to top up what has already lost but not given you any extra!

Who is at risk?

There are various factors that may contribute to the growing number of osteoporosis sufferers.

• Now that the population is living longer there is greater number of women living past the menopause.
• The dietary trend of dairy intolerance is resulting in some of the population having low intake of dietary calcium and, especially in the young, this could start them off already at a disadvantage.
• The increase of eating disorders such as anorexia and bulimia. These eating disorders not only cause decreased consumption of calcium but can cause menstrual cycles to cease, therefore lowering oestrogen levels so that females lose their calcium protector earlier.
• Another factor that causes calcium loss is smoking.
• Menopause before the age of 45 years is a factor, again due to a longer period of time without the protective hormone oestrogen.
• Long term use of certain medication primarily corticosteroids.
• Heavy drinking (over 14 units of alcohol a week for females)
• Lack of sunshine. Exposure to the sun makes the body produce vitamin D which increases calcium absorption.

The frightening part of this condition is that it is sometimes not diagnosed until a bone is broken, whether it be a hip, an arm or even a vertebrae in the spine.

Read on to find out how to obtain information and what you can do to help yourself today.

What is my risk?

One of the easiest ways of finding out your risk of fracture is by having a bone density scan. This is at the moment the most accurate and reliable of measuring the strength of your bones.

This scan can be organised through your GP or private clinics.

Once your risk has been assured then the most appropriate advice and possible medication can be given.

Treatment

Oestrogen and progesterone are prescribed as part of HRT, but they don’t always have to be given together. ERT (estrogen replacement therapy) is given to women who no longer have their ovaries or wombs after a full hysterectomy. Women with their uterus intact should take progesterone as well to reduce the risk of uterine cancer. HRT treatments come in many forms, such as pills, patches, and creams. The oral oestrogen pill is taken every day of the month or 25 days in a row (usually the first 25 days of the calendar month). Oestrogen can be administered via a patch worn on the skin. It is impregnated with oestrogen in a gel form that is stuck to an area of the skin on the abdomen or buttocks. This close adhesion to the skin releases a small steady dose of oestrogen into the body over 3-7 day period before the patch has to be replaced. The most recent type of medication to help alleviate menopausal symptoms is SERM’s (selective estrogen receptor modulators), Relaxifene and Tamoxifen.

These drugs are designed to have some of the positive effects of oestrogen, without the potentially negative side effects such as increased risk of endometrial cancer. They can however make hot flushes worse.

There are many well-known side effects of HRT, ERT and SERM’s ranging from the relatively small risks, such as breast tenderness and swelling caused by oestrogen, water retention caused by oestrogen or progestin, and irregular bleeding, which usually stop after a few months.

The more dangerous side effects include increased risk of endometrial cancer if oestrogen is taken alone, and research has found that women taking combination HRT risk a 40% higher chance of breast cancer than those taking no therapy, women taking oestrogen alone had a 20% greater risk of developing it. In addition women are more likely to get gallbladder disease and an increase in the chances of blood clots with HRT. It has also been revealed that once females stop using HRT their bone mineral density declined so rapidly that by age 75 it was only 3.2% higher than in women who had never taken HRT.

Nutrition

There are many nutritional alternatives to taking HRT that can help to alleviate the symptoms that come hand in hand with menopause. These include things to eat, things to avoid and supplements that can be taken. Some plant foods, such as soy foods, lima beans, fruits, berries and grains contain a natural from of oestrogen known as phytoestrogens. Not only does Soya have valuable levels of phtoestrogens but it also contains good levels of essential fatty acids, has antioxidant properties, is virtually free of saturated fat and has a high level of vegetable protein and fibre. 

Almost all fruits vegetables and cereals contain phytoestrogens in varying strengths and compositions, but it is the isoflavones that are the most beneficial kind. To reap some benefit from phytoestrogens research recommends that a menopausal female’s diet should contain 45mg of isoflavones per day, equal to a typical serving 55g of tofu or 600ml of Soya milk. Although phytoestrogen are weaker than the oestrogens found in the body they do have a similar effect on some tissues in the body.   

Foods containing vitamin C, E and beta-carotene all have antioxidant properties as do the minerals selenium and zinc. Omega-3 oils in oily fish can also mop up free radicals.

Bioflavonoids are antioxidants that are closely associated with vitamin C and are found in many citrus fruits. These also help to preserve the collagen matrix which makes up about 90% of bone, and therefore help to ward off postmenopausal osteoporosis.

Supplements

Supplementation can also be taken to combat the progression of osteoporosis in women. Calcium, magnesium, boron and vitamin B6 and D supplements all help to slow bone resorption and help keep bone density from being lost too quickly.

As well as nutrition and supplementation, exercise is an important factor in helping to prevent osteoporotic symptoms. Because of the increase in bone breakdown after menopause, it is important to help the body replace and lay down new bone. Weight -bearing activities/exercise encourage the body to lay down bone at the points of stress which occurs naturally, for instance, at the femoral neck and the ankles, that are very prone to fracture in osteoporotic females. Specific exercises can be advised by your chiropractor or GP.

More information can be gained from the National Osteoporosis Foundation (NOF), Older Women’s League (OWL) and the National Dairy Council and also from your chiropractor or GP.