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
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LayoutOsteoporosis – 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.
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 Treatment
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 Diagnosis
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
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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 strong bones
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 Useful contacts
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.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.
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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