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Osteoporosis

IT is called the silent epidemic.

And it creeps upon thousands of women, and many men, slowly and by stealth, eating away their bones, robbing them of good health, whilst they are blissfully unaware of what is going on.

They may only realise the extent of its ravages, and that their bones have become lightweight and fragile, when they fall and break perhaps a wrist, or a hip - sometimes with fatal consequences.

Osteoporosis (brittle bone disease) weakens the bones, distorts the skeleton and brings pain and misery.

Britain has one of Europe's highest rates of the disease, and treating it costs the NHS around £1.6 billion a year. The good news is that it is largely preventable and there are steps you can take to keep it at bay.

A lack of calcium in modern diets and increasingly sedentary lifestyles are thought to be to blame so a balanced diet and exercise are the vital keys to warding it off.

Eating a bone-friendly diet which is high in calcium, includes vitamin D (the sunshine vitamin) and exercising regularly throughout life, to keep your skeleton strong and healthy, are helpful. And don't smoke - smoking 20 cigarettes a day can double the risk of fractures in later life.

The most common fractures caused by osteoporosis are in the bones of the hips, spine and wrists - it is said to account for around 60,000 hip, 50,000 wrist and 40,000 spinal fractures a year in the UK and it has been estimated that someone suffers a fracture every three minutes because of it.

Many die early because of the disease - there are said to be 40 deaths a day because of a broken hip or pelvis. Many more live in discomfort and pain.

Instead - being healthy and active their quality of life and ability to get around are greatly reduced, with many sufferers losing their independence.

But it doesn't have to be like that.

Prevention

Though the condition was once thought of as an inevitable part of ageing, we now realise this is not true.

Women are especially vulnerable after the menopause because their ovaries no longer produce the hormone oestrogen which helps maintain bone mass. But hormone replacement therapy can help.

Worryingly growing numbers of younger people in their late teens and twenties are also affected.

Over-dieting, low calcium diets, smoking, drinking, lack of exercise or too much exercise are a prescription for early fractures.

Constantly urged to eat less, stick to low-fat diets and exercise more in pursuit of the ''thin is beautiful'' pressures, the problems for many young people begins with excessive dieting (and anorexia) and overdoing exercise which leads to loss of calcium in the bones.

While exercise is essential to good bone health, you can have too much of a good thing.

Some women marathon runners stop menstruating because of the punishment their bodies receive, which leads to bone decline. And super supple ballet dancers have been found to be among those at high risk of developing the disease.

The skeleton is not a dead framework, but a living changing structure which constantly rebuilds and replaces itself for the whole of our lives.

It is also the storage system for calcium and if the body is not receiving enough for its other needs it withdraws calcium from this ''bone bank'', weakening the structure.

Strong healthy bone has a honeycomb of tiny holes, supported by a surrounding structure containing calcium, protein and collagen.

In thinning bones, which have lost much of the calcium, they need to remain strong and firm, the holes grow larger and the supporting structure weaker, more brittle and more likely to fracture.

The framework for good bones that should last a lifetime is laid down in childhood. From our early days we need to adopt a healthy eating pattern and lifestyle that will last us all our days.

For children

Make sure your child gets sufficient calcium, for example by: Eating fortified breakfast cereal with milk; having milky drinks; eating sardines or pilchards on white toast for tea; eating cheese or adding it as a topping to soups and hot dishes; eating plenty of green vegetables, such as broccoli, eating seeds or nuts; having yogurts as a dessert or snack food.

There is concern that children today drink too many fizzy drinks, and not enough calcium rich milk. If your child refuses to drink milk or eat cheese you can ensure they get their calcium quota by:

• Adding milk or yoghurt to soups and sauces Mixing yoghurt into fruit purees
• Sprinkling cheese onto vegetables and stews and grilling until crisp and golden
• Disguising milk as hot chocolate or a fruit milk shake

For Adults

• Most people do not take enough exercise which the bones need to lay down calcium. Take regular exercise throughout your life (such as vigorous walking, running, dancing, tennis) - a minimum of 20 minutes, three times a week is recommended.
• Eat a calcium-rich diet (eg milk, cheese, yoghurt). Skimmed milk has more calcium than full milk, and if you are watching your weight, low-fat cheeses contain as much calcium as full-fat ones.
• Include dark green vegetables like broccoli, spinach, watercress and spring greens in your diet. It is especially important for elderly people to maintain a good balanced diet with plenty of calcium.
• You need Vitamin D to absorb calcium. The major source is sunlight on skin, and 15-20 minutes a day on your face and arms in the summer (always wear a sunscreen) is adequate to allow the body to store enough to last the rest of the year.
• You can also get Vitamin D through your daily diet by eating oily fish, such as sardines and mackerel; cod liver oil; milk and butter; egg yolk; foods fortified with the vitamin, such as breakfast cereals and skimmed milk.
• Do not smoke. Smoking damages the bones and greatly increases the risk of fractures later in life.
• Hormone Replacement Therapy may help menopausal women. Talk to your GP about it.
• Change from cows milk to soya milk. Soya contains isoflavons and new research from Japan has shown that postmenopausal women who consumed high levels of soya had significantly thicker bones than those whose levels were low.

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