To prevent thinning bones
The medical problem that causes bones to break, with little or
no provocation, is usually osteoporosis, or “thin bones”. Once
commonly spoken of as a women’s problem, it is now increasingly seen in
men.
Observers of osteoporosis have shown great interest in a rapid
loss of bone strength in women when they go through menopause. Obvious for many
years was that women got shorter as they aged. And, it was also obvious that
women – partly because they generally live longer than men – were
breaking their hips as they aged. Thirty years ago, it was almost expected that
a women who broke her hip after a fall would die waiting for it to recover.
The invention of the artificial hip changed that. Almost all
broken hips are treated with an operation and replacement hip. Lying around in
bed recovering from a hip operation carries a much higher chance of death than
does an operation to replace a hip– regardless of one’s age.
Because broken hips in women were so common, it became
important to prevent the problem. Researchers focussed on the prevention of
falls, but also examined the rapid thinning of the bones of women going through
menopause.
A test called bone density looks at how strong the bones are
by correlating their density with the likelihood of breaking. We now speak of
the risk of fractures from minor injuries as the indication for treatment for
anyone with low bone density, or osteoporosis.
We have been able to stop bones from thinning but, until
recently, could not actually make them stronger. Therefore, prevention was most
important.
One of the main reasons for the establishment of hormone
replacement therapy (HRT) relates to osteoporosis. The theory was that, if we
stopped the rapid loss in bone density at the time of menopause, women would
not get the disease and therefore not die from a fractured hip.
These days, we have treatment that can increase bone density,
and change a thin, easily-broken bone into a stronger, less-likely-to-fracture
bone. The problem was so common in women that some treatments were only on the
Pharmaceutical Benefits Scheme (PBS) for women. The availability of the new
medications changed when a sexual discrimination case was brought by several
men.
Prevention is still important, and even today’s
treatments – which include calcium and vitamin D – are still better
used as preventative agents. The strongest agents are the biphosphonates
(alendronate, risedronate and etodronate), which actually push the calcium back
into the bones and increase their structure. This allows more calcium and
strength in the bones.
These drugs are expensive but, to both men and women, bring
hope of fixing osteoporosis of bones so weak that they break with very little
force. In the worst cases of osteoporosis, one can break one’s bones by
just sneezing. Bones with osteoporosis are commonly broken in the spine, hip or
wrist. For older people, who are short and stooped, broken hips and wrists will
hopefully fade into history.
Hormones are still sometimes used, and the introduction of
testosterone might be useful to treat osteoporosis. For women, testosterone, or
other male hormones, used to be the only way of treating advanced osteoporosis,
but the side effects were clearly bad. The new treatments provide safe
alternatives, and most trials now show that HRT is not the best way to treat
osteoporosis.
General preventative measures remain important for men and
women, so one should embrace discussion about them.
Bones develop strength in childhood and adolescence.
Weight-bearing exercise at these times will increase the bone density, such
that one will be older before osteoporosis sets in and therefore not struck too
early by the problem of thin bones.
In space, astronauts’ bones become thin very quickly,
which emphasizes that weight-bearing exercises are a natural stimulation for
bones to become stronger. Once we reach adulthood, we can hold our bone
strength with exercise but, without drug treatments, it is almost impossible to
make them any stronger.
Eating calcium is important at all ages because, without
calcium, bones cannot reach their maximum strength. And, without a minimum of
calcium, the bones will not be maintained.
A normal Australian diet is usually satisfactory but, if one
harbours doubts about one’s calcium intake, supplements of can be used.
But while food such cheese is good for calcium, it might be bad for cholesterol
levels.
Tobacco causes loss of bone strength, and the overuse of
alcohol makes things worse, too.
For those concerned that they are getting shorter, bone
density and other simple x-rays will reveal whether or not they have
osteoporosis. In light of available treatment for men and women, problems
should be treated as soon as possible.
