I, together with over 60 other members of the Trust, were pleased to attend a presentation on Osteoporosis given by Dr Gulam Patel, Consultant Rheumatologist/Divisional Director, Specialist Medicine & Specialist Surgery; Liz Hedges, Head of Nutrition & Dietetics and Dr Vincent Prakash, Consultant Radiologist on Wednesday 4th July in the Lecture Theatre, Post Graduate Education Centre at St Peters Hospital.
Dr Patel opened the event by explaining what Osteoporosis was, the causes, those patients most at risk and the treatments available. He explained that peak bone mass occurred in both men and women in their thirties with women experiencing significant bone loss during the menopause and both men and women experiencing gradual bone loss with increasing age.
This bone loss increases the risk of fracture; the most common sites being hip, wrist and spine. The primary preventive measures that can be taken are to achieve a high peak bone mass and maintain it, have a good diet and engage in weight bearing exercise, avoid smoking and excess weight reduction and alcohol and minimize steroid intake.
For patients who are considered to be at risk, examples being: having sustained a fracture following a minor injury, bones which appear thin on a normal x-ray, early menopause etc should be given a DEXA (Dual Energy X-ray Absorptiometry) Scan. If the DEXA scan reveals a high risk then care should be taken with exercise and home environment to minimize the risk of falls. There are a number of additional therapies introduced to improve bone density and each patient’s need requires individual scrutiny.
Liz Hedges went on to discuss the role of diet in the prevention and treatment of Osteoporosis. Diet plays an important role in attaining peak bone mass, providing calcium, vitamin D, protein and other bone density enhancing elements.
Calcium is essential in attaining healthy bone mass and its absorption decreases as we get older. Absorption is helped by Vitamin D and improved by Lactose. I was surprised to learn that although skimmed milk contains more calcium than whole milk, the difference is negligible and that our calcium requirement peaks between the ages of 11 and 18.
90% of our vitamin D requirement is made in the skin by the action of UVB rays. The body can store vitamin D and 10 minutes of exposure to the sun twice a day from May to Sept is adequate for our needs. The 10% obtained by diet is primarily obtained from oily fish, margarine, butter, eggs, fortified cereals and cod liver oil. The latter caused me to have a flash back to the dreaded daily spoonful of cod liver oil forced upon me by my loving mother; there were no capsules in those days! I also learned that too much protein increases the excretion of calcium whilst deficiency adversely affects bone health and increases the risk of falling also reduces the recovery rate.
Fruit and vegetables contain potassium and magnesium which have been shown to have a positive affect on bone mass density. Dark green leafy vegetables are a good source of vitamin K but not if you take warfarin.
Things to avoid or moderate include: alcohol, fizzy drinks and caffeine.
Dr Prakash explained the benefits of DEXA scanning. Surprisingly 1 in 2 women and 1 in 5 men over the age of 50 will break a bone due to poor bone health. The early detection of bone loss is the best way to prevent fractures. The DEXA scan offers the best way to identify any problems, allowing your GP to prescribe treatments to curb bone loss.
The primary risk group is women after menopause. A woman may lose 15 to 20% of spinal bone in the first decade after menopause and without treatment she could lose about 40% of her bone density by the age of 80.
The best method of detecting early bone loss is with a DEXA scanner. It measures skeletal sites where early bone loss occurs; it is high precision and gives a very low radiation dose. There is no special preparation required by the patient other than to ensure that they wear clothing with no metal buckles or zips in the lower spine and hip regions. The whole process takes about 10 to 15 minutes. Follow up scans are usually taken at 2 year periods and to maintain accuracy it is essential that these are undertaken on the same scanner as the original scan.
There then followed a lively question and answer session.
These Member Health Events are held at regular intervals, details provided in the Members` Matters magazine. The Membership Office will be pleased to receive any suggestions of topics for future events.
Godfrey Freemantle, Public Governor of Hounslow