Osteoporosis – Bone health following the menopause Osteoporosis – the bone-thinning disease – affects
score, and the World Health Organisation (WHO) has
some three million people in the UK. Post- menopausal women are by far the commonest sufferers, although osteoporosis can also affect
• T-score between –1.0 and –2.5 = low bone mass
younger women, men and children.
• T-score of –2.5 or less = osteoporosis. Introduction
X-rays are helpful for confirming fragility fractures e.g. of the
Typically strong and resilient in childhood, bones have a
ribs or vertebrae. However, they are relatively insensitive to
dense, ivory-like outer casing or cortex, enclosing an inner
the identification of early disease, requiring a bone mass loss
core or medulla of soft marrow filling up the gaps and spaces
of at least 30 percent before picking up diagnostic changes.
of the spongy interior. Like all living tissue, they are able toabsorb and utilise a range of proteins and mineral salts from
the bloodstream for renewal and repair. Bones generally stop
The gold standard drug for osteoporosis is the
growing in length after the age of 16 – 18 years, but their
bisphosphonates, which reduce the resorption of bone as it
density and strength increase until the late 20s.
normally occurs. The best-known, sodium alendronate(Fosamax), is poorly absorbed and tends to irritate the food
From the age of around 35 onwards, however, bones
pipe or oesophagus. It is given once a week on an empty
become weaker and more fragile due to a loss of mineral
stomach, and the patient advised to remain upright for an
salts. This loss intensifies in women as their oestrogen levels
hour after taking it. It often causes heartburn, however, and
fall, reaching a peak at the menopause when the production
many patients cease to take it for this reason.
of this hormone from the ovaries ceases altogether.
Calcium compounds such as carbonate and citrate, and
Thinned-down bones are weaker and more fragile, and the
calcium + vitamin D combinations are also widely prescribed
full-blown disease of osteoporosis is responsible for
to help re-mineralise osteoporotic bones, and on the whole
approximately 230,000 fractures yearly. The most serious of
are better tolerated by patients than alendronic acid
these is a fractured neck of femur (thigh bone) because the
long period of immobility during recovery increases the risksof life-threatening conditions such as bronchopneumonia,
Better bone health
and DVT (deep vein thrombosis) with subsequent blood clot
Exercise, sunshine and diet are all needed for healthy bone
on the lungs (pulmonary embolism), heart attacks and
strokes. Between 20 and 35 per cent of sufferers betweenthe ages of 75 and 90, die within 12 months of fracturing
Exercise – walking and gentle aerobics are excellent for bone
their hip joint, around 80 per cent of whom are women.
health because they promote the entry of calcium into thebone mass where it is used for improved strength and
The dual energy X-ray absorptiometry – DEXA – scanprovides the gold standard means of diagnosing
Nutrition – a healthy and balanced diet is fundamental to
osteoporosis. It expresses bone mineral density in terms of
bone (and general) health because it supplies the protein,
standard deviations (a statistical unit) below that of a young
carbohydrate and fat, vitamins, minerals and other nutrients
adult reference population. The unit used is presented as a T-
vital for tissue renewal and growth. This is important during
www.womens-health-concern.org Advice Line 0845 123 2319
Factsheet – Osteoporosis – Bone health following the menopause
childhood when new bone is being constantly laid down,
Vitamin K2 is new for many people. This vitamin is in the
and also throughout adult life when old bone is broken
spot light of scientists, because it possesses strong
down and destroyed, and new bone built up to replace it.
characteristics to prevent calcium depositing in the arteriesand helps to bind calcium in the bones.
Fresh fruit and vegetables supply a vast range of essentialminerals and other nutrients needed to maintain a sturdy
Vitamin K2 is found in fermented foods, while the more
skeleton. Dairy foods are rich in calcium, and eating them
common vitamin K1, the type usually found in supplements,
need not increase one's saturated fat intake because the
reduced fat versions supply just as much of this mineral, and often more – weight for weight.
Vitamin K2, however, it is the more effective of the two inencouraging the bones' calcium uptake and building up
Other sources of calcium include green leafy vegetables such
bone mass, i.e. bone mineralisation. It also stimulates the
as spring greens, spinach and broccoli, baked beans, dried
formation of bone matrix, the scaffold within which bone
fruit, bottled mineral water, soya beans, sardines, salmon,
minerals are deposited. (Without this scaffold, calcium is
nuts, dried beans and sunflower seeds.
unstructured, like a lot of loose sand).
Vitamin D is also essential because it enables calcium and
About the author
phosphorus to be used to form strong bones and teeth. It
Dr Caroline Shreeve is a qualified doctor working in hospital
can be obtained from sunshine and as a supplement.
medicine. Since qualifying in the seventies, she has pursued
Sunshine on the skin creates vitamin D and the advice is
several successful parallel careers in general medicine,
exposure of a reasonable body area for 20 minutes/day from
psychology, complementary therapies and health journalism
May to October. Vitamin D can also be obtained from food,
and is specially interested in herbal treatments, nutrition and
e.g. milk and dairy products, fish liver oils, sardines, herring,
Dr Shreeve has written regularly for the women's press,
Supplementary nutrients for healthy,
national and regional newspapers, medical journals and
trade magazine, appeared on Pebble Mill, the Gloria
Our Western diet is typically rich in proteins, the breakdown
Hunniford Show, TV-AM and most UK regional radio
products of which increase the body's acidity and adversely
stations. Her twelve books include titles on depression,
affect calcium metabolism. More calcium and magnesium
the premenstrual syndrome, the menopause, and the
are lost in acidic urine, and an acidic environment reduces
'Alternative Dictionary of Symptoms and Cures', which
the availability of calcium to bone tissue.
was a runner-up for the 1987 Booker Health prize.
The best dietary supplement for osteoporosis, therefore, is
one which increases the bone-strengthening effects of
National Osteoporosis Society
calcium by neutralising excess acid. A recently developed
one also provides vitamin D, which supports calcium uptake
Helpline: 0845 450 0230 (Monday-Friday 9am-5pm)
by the bones, and a substantial dose of natural vitamin K2.
Vitamin K2 activates a protein called osteocalcine. This
International Osteoporosis Foundation
protein helps to bind the calcium to the bone. The more
active this protein is, the better protection one will haveagainst osteoporoses. Medicine Guide website Medicines used to manage osteoporosis: www.medicines.org.uk/guides
www.vitabiotics.comThis factsheet has been produced with an educational grant from Vitabiotics Ltd.
This factsheet has been produced by Women’s Health Concern and reviewed by members of our Medical Advisory Panel. It is for your information and advice and should be used in consultation with your own medical practitioner. Updated: October 2010. www.womens-health-concern.org Advice Line 0845 123 2319
Prevalence of Antimicrobial Resistances in Streptococcus pneumoniae Isolates in Australia, 2005: Report from the Australian Group on Antimicrobial Resistance (AGAR) South Metropolitan Area Thomas Gottlieb1, Peter Collignon2, Jennifer Robson3, Julie Pearson4, Jan Bell5, and the Australian Group on Antimicrobial Resistance 1Department of Microbiology and Infectious Diseases, Conc
Hallam Stevens Date of birth: 30thJuly, 1979 Email: Cell phone: +65 9674-4600 Office Phone: +65 6790-5691 Citizenship: Australia, Great Britain. Publications: Books: Life out of sequence: bioinformatics from the ARPANET to post-genomics. [Under contract, University of Chicago Press] Biotechnology and society [Under contract, University of Chicago Press] Postgenomics (wor