(9) Osteoporosis
Osteoporosis is a condition characterised by progressive
loss of bone tissue, which leads to fragile bones and increased risk of
fracture, particularly of the hip, wrist and vertebrae. Some degree of
osteoporosis is inevitable with ageing, but a number of risk factors influence
both the achievement of peak bone mass (which normally occurs by the age
of 30 years) and loss of bone in middle and later life. Women are at greater
risk than men because they have smaller, less dense bones than men and
because of the loss of oestrogen that occurs after the menopause. Other
risk factors include a lower than ideal body weight (particularly a reduced
amount of body fat), poor calcium intake, being Caucasian or Asian rather
than Afro-Caribbean, excessive alcohol intake, smoking, inactivity and
early menopause. Individuals who have a prolonged history of dieting or
anorexia nervosa or who have had prolonged steroid treatment are also
at risk.
- Dietary factors most likely to encourage excessive bone loss include
poor calcium intake (eg, low consumption of milk and dairy products),
lack of vitamin D (due to minimal exposure to sunlight or low intake
of foods containing vitamin D) or an unhealthy diet overall (eg, excessive
coffee, excessive alcohol, smoking, high sugar and high fat snacks).
- The most important time to reduce the risk of osteoporosis is early
in life, throughout childhood and adolescence. Bone mass declines after
the age of 30 years and, once calcium has been lost from the bone, it
cannot be replaced with dietary or supplemental calcium. However, encouraging
calcium intake may help to reduce further bone loss.
- The overall diet should be based on healthy eating guidelines (ie,
plenty of fruit and vegetables, bread, cereals, lean meat or fish, legumes
and dairy products). Although emphasis is often given to calcium, other
nutrients such as magnesium, potassium and antioxidants may help to
maintain bone health.
- Milk and dairy products are the richest and most bioavailable dietary
sources of calcium. Encourage two to three servings a day of foods such
as milk, yoghurt, cheese or fromage frais. Low fat or reduced fat varieties
contain just as much calcium as full fat products.
- Discourage excessive consumption of coffee, alcohol and salt. All
these substances in excess may contribute to calcium loss.
- Emphasise the importance of vitamin D. Encourage people to go outside
as much as possible. Most people will obtain sufficient vitamin D from
sunlight exposure. In addition, encourage consumption of foods fortified
with vitamin D (eg, margarines, fat spreads and breakfast cereals).
Oily fish is also a good source.
- People who are housebound or immobile, vegans, others who consume
no dairy produce and the elderly may benefit from a supplement containing
the recommended daily amount of calcium and vitamin D.
- Exercise is important. Weight bearing exercise (eg, walking, skipping,
running) helps to maintain bone mass, but all types of exercise help
to encourage mobility and reduce the risk of falls.
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This series of “dietary advice tips” is intended
to be a reminder of the main points to be made by pharmacists when giving
nutritional information to the public. The conditions included in the
series are those where diet is a well recognised risk factor, those in
which diet contributes to the management of the condition, and others
for which patients may welcome sound dietary advice.
Written by Dr Pamela Mason (a pharmacist with a postgraduate qualification
in nutrition)
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