OSTEOPOROSIS. Information Leaflet. Your Health. Our Priority.

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1 OSTEOPOROSIS Information Leaflet Your Health. Our Priority.

2 Page 2 of 5 People are often unaware that they have fragile bones until the time of a first fracture. Broken wrists, hips and spinal bones are the most common fractures in people with osteoporosis and it is more widespread in older age although younger people can sometimes be affected. One in two women and one in five men over the age of 50 in the UK will fracture a bone, mainly as a result of osteoporosis. The cause of the disease is still not fully understood. What is osteoporosis? Bones contain collagen (protein), calcium salts and other minerals. Each bone is made up of a thick outer shell known as cortical bone and a strong inner mesh of trabecular bone, which looks like a honeycomb. Bone is alive and constantly changing throughout life. Old, worn out bone is broken down by cells called osteoclasts and replaced by bone building cells called osteoblasts, in a process of renewal called bone turnover. In childhood, osteoblasts work faster enabling the skeleton to increase in density and strength. This bone loss becomes more rapid in women for several years following the menopause and can lead to osteoporosis and an increased risk of broken bones, especially in later life. The older we get, the greater our risk of breaking a bone. Osteoporosis becomes more common as the density of bone decreases and bones become generally less strong and more fragile. Falling is also much more common because of poor balance and co-ordination leading to a higher risk of breaking a hip. Lifestyle changes and keeping active can help to prevent falling. Drug treatments, to strengthen bones, are available for those at highest risk of fracture. What are the other risk factors for osteoporosis? Genes - Our bone health is largely dependent on the genes we inherit from our parents. In fact, if one of your parents has broken a hip, you may be more susceptible to developing osteoporosis and fragile bones. Age - Bone loss increases in later life so by the age of 75 about half of the population will have osteoporosis. As we get older bones become more fragile and more likely to break. Gender The female hormone oestrogen has a protective effect on bones, at the menopause (normally around the age of 50) the ovaries almost stop producing this hormone reducing the protection it gives to bones. Low body weight If you have low BMI (body mass index) you are at greater risk of developing osteoporosis. Previous fractures - If you have already broken bones easily, including in the spine, then you are much more likely to have fractures in the future. Some medical conditions increase your risk: Rheumatoid arthritis Low levels oestrogen in women as a result of early menopause, having a hysterectomy with removal of ovaries (before the age of 45), Anorexia nervosa Low levels of the sex hormone, testosterone, in men following surgery for some cancers. Hyperthyroidism when levels of thyroid hormone are abnormally high Parathyroid disease when levels of parathyroid hormone are abnormally high Crohns or coeliac disease conditions that affect the absorption of food Immobility

3 Page 3 of 5 Some medicines increase your risks. Steroid tablets taken for over three months Anti-epileptic drugs Breast cancer treatments How can I prevent osteoporosis? Exercise The skeleton grows stronger if you do regular weight bearing exercise. This includes any kind of physical activity where you are supporting the weight of your own body, for example jogging, aerobics, tennis, dancing and brisk walking. Leading an active lifestyle will ensure you have good balance and co-ordination and will also help to develop muscle strength. The following exercises can help reduce the risk of falling and breaking a bone: swimming, gardening, walking, golf and Tai Chi. Diet The body contains 1kg of calcium, 99 percent of which is stored in our bones. While it is important to eat plenty of calcium to help build or maintain healthy bones, other vitamins and minerals are also important. It's also a good idea to avoid: Drinking lots of fizzy drinks - phosphate, in the form of phosphoric acid, is used to improve the flavour in a lot of fizzy drinks and too much can cause the body to use calcium to balance levels. Drinking too much caffeine - again, a high consumption of caffeine could affect the balance of calcium in the body. Letting your weight drop too low - being overweight is not good for general health but being underweight increases the risk of broken bones when you fall. Stop Smoking Smoking has a toxic effect on bone by stopping cells from doing their work. Reduce alcohol intake Enjoying the odd glass of wine could actually help bones. But drinking too much alcohol is damaging to our skeleton and increases your risk of fracture. Bear in mind that drinking alcohol can also make you unsteady and increase your risk of falling, and therefore breaking a bone. The current daily-recommended limit, as recommended by the Food Standards Agency, is 2 to 3 units for women and 3 to 4 units for men.

4 Page 4 of 5 What drug treatments are available? Bisphosphonates These are the most commonly prescribed drugs used to treat osteoporosis. These drugs have been shown to reduce the risk of broken bones. Most are available in tablet form daily, weekly or monthly - they are non-hormonal and act by slowing down the rate of bone loss. Side effects can include irritation of the gullet and these drugs may not be suitable for people with stomach/bowel trouble or kidney problems. If you are started on this medication it is important that you take it in the correct way: Must be taken first thing in the morning on an empty stomach Must be taken with a full glass of clear water You must be sat upright or standing when taking this medication and remain so for any hour after taking. Other medication, diet must be avoided for an hour after taking this medication. The weekly medication should be taken on the same day of the week. Ibandronate and zoledronic acid are also bisphosphonates, but do not have the same side effects on the gullet. This drug can be administered once a year in hospital via a drip or injection into a vein in the arm. Denosumab (Prolia) is used in the treatment of osteoporosis; it helps stop the development of the bone removing cells before they damage the bone, therefore increasing the strength of the bone. This is given via a subcutaneous injection every 6 months, and can be given by District nurse or in clinic. Calcium and vitamin D There are a number of calcium and vitamin D supplements, to help prevent broken bones. Side effects can include irritation of the gullet and these drugs may not be suitable for people with stomach/bowel trouble or kidney problem. For any further information please contact a member of staff. Nicky Makepeace Nurse Clinician Hip fracture care Information based on leaflets on NOS website Reference

5 Page 5 of 5 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number TO68 Publication date November 2013 Review date November 2015 Department Medicine Location Stepping Hill Hospital