2017 HCHB_digital

Osteoporosis
Osteoporosis (meaning “porous bones”) is a common bone disease that
leads to an increased risk of fracture. One in three women and one in five
men over the age of 50 are affected by osteoporosis.
Bone is a living tissue made up of proteins and minerals, such as calcium and
phosphorus. Throughout life, bone is constantly being broken down and renewed.
Bone density – the amount of bone tissue in a certain volume of bone – reaches a
peak between 18 and 25 years of age. Higher peak bone masses are associated
with a lower risk of fracture or osteoporosis later in life. Women lose bone density
more quickly after menopause due to a decrease in oestrogen levels. Regular
weight-bearing exercise and an adequate dietary intake of calcium and other
minerals is also needed to maintain good bone density in addition to oestrogen
in women and testosterone in men.
Osteoporosis occurs when bone breaks down faster than it rebuilds. Although
bones remain the same size, they become thinner and more brittle. Osteoporosis
CALCIUM CONTENT OF SOME FOODS
CALCIUM CONTENT (MG)
1 cup cooked broccoli 59
½ cup cooked spinach 45
½ can baked beans 90
1 glass lite-blue top or trim milk, 250ml 310
1 cube Edam cheese, 8g 75
1 pottle yoghurt, 150g 195
1 cup ice cream, 157g 196
½ cup sour cream, 112g 124
tofu cubes, 100g 105
Soy drink, calcium fortified, 250ml 286
10 almonds 30
Sesame seeds, 1 tablespoon, 9g 88
6 mussels 136
½ cup salmon 110
1 sardine 66
Reference: Calcium Content of Foods. NZ Nutrition Foundation www.nutritionfoundation.org.nz
can cause significant disability and affect quality of life. Risk factors for
osteoporosis include:
• age (older than 50 years)
• being underweight
• coeliac disease, Crohn's disease or Rheumatoid arthritis
• early menopause or low testosterone levels
• excessive alcohol intake (more than 2 glasses wine/day)
• family history of osteoporosis and fractures
• female gender
• low dietary intakes of calcium
• physical inactivity (particularly lack of weight-bearing exercise)
• previous fracture as a result of a minor fall or bump
• smoking
• some medicines (eg, antiandrogens, aromatase inhibitors, corticosteroids)
• vitamin D deficiency.
Symptoms of osteoporosis
The condition is usually asymptomatic – it is not painful until there is a fracture.
Fractures usually occur in the spine, wrist or hip.
Hip fractures can have a dramatic effect on a person’s quality of life, with up to
50% of people unable to return to a fully independent lifestyle after a hip fracture
and requiring long-term ongoing care.
Bone mineral density (BMD)
BMD is a measure of the amount of bone in a particular part of the body and
can be calculated using a special type of x-ray, called DEXA. The World Health
Organization (WHO) defines osteoporosis in women as a BMD 2.5 standard
deviations below peak bone mass (20-year-old healthy female average) as
measured by DEXA.
Initial assessment
Customers who are more likely to have osteoporosis include those who look frail
or older adults with a current fracture. But all customers should be encouraged
to eat enough calcium in their diet while they are still young, with the aim of
TREATMENT OPTIONS
Category Examples Comments
Calcium +/- vitamin D
Vitamin D preparations
[GENERAL SALE]
eg, calcium (Caltrate, GO Calcium) calcium
+ vitamin D (Swisse Ultiboost) calcium +
other vitamins (Caltrate Plus)
[SUPPLEMENTS]
eg, vitamin D3 (Blackmores, Ethical
Nutrients Daily D, Swisse Ultiboost) eg,
vitamin D3 + other vitamins (Mvite,
Vitabdeck)
Milk and dairy products are the most readily available sources of dietary calcium and have the added
advantage of being high in protein and other micronutrients important for bone health. Dietary calcium is
preferred over supplements. Customers should talk with the pharmacist or their doctor before taking calcium
supplements.
The D3 form of vitamin D is most effective at maintaining body stores of vitamin D. This form is available as
supplements and also manufactured in specialised cells in the skin on exposure to sunlight. Vitamin D2 found
in foods and some supplements is not as well utilised. Certain groups of people (eg, elderly, dark skinned)
may require supplements (see also Vitamins and Dietary Supplements). There is no evidence that vitamin
D improves bone health in people who are not deficient. Usual supplemental dosage is 400–800IU/day.
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Page 116 HEALTHCARE HANDBOOK 2017-2018 Common Disorders