Osteoporosis affects one in two women and one in five men over the age of 50 making World Osteoporosis Day on 20 October relevant to everyone.
What is Osteoporosis?
Osteoporosis is a disease characterised by low bone mass and deterioration in the micro-architecture of bone tissue, leading to an increased risk of fracture. Osteoporosis occurs when the bone mass decreases more quickly than the body can replace it, leading to a net loss of bone strength. As a result bones become fragile, so that even a slight bump or fall can lead to bone fractures. These are known as fragility fractures. Osteoporosis has no signs or symptoms until a fracture occurs – this is why it is often called a ‘silent disease’.
Osteoporosis affects all bones in the body however fractures occur most frequently in the vertebrae (spine), wrist and hip. Osteoporotic fractures of the pelvis, upper arm and lower leg are also common and are associated with significant disability. Fragile bones are not painful but the broken bones that result cause pain and increased morbidity and mortality.
Most wrist fractures happen in women, occurring earlier than hip and vertebral fractures, with the incidence increasing with age. Hip fractures are the most devastating fracture in terms of morbidity and mortality, as 20% of those who suffer a hip fracture die within 6 months after the fracture; most take place following a fall. Vertebral fractures are the most common osteoporotic fracture.
Vertebral fractures are frequently caused by routine activities such as bending forward, twisting and/ or lifting light objects. Even a single vertebral fracture can lead to a progressive loss of height, increased kyphosis (stoop), severe and chronic back pain, reduced mobility and reduced pulmonary function. The psychological impact of vertebral fractures is profound. The loss of mobility, pain and noticeable spinal deformity frequently lead to depression, loss of self-esteem, fear of falling and social isolation. Vertebral fractures are associated with difficulty in many activities of daily living, including forward bending, rising from a chair, dressing and climbing stairs. They lead to a slower walking pace, use of walking aids and decreased independence – all leading to a significant negative impact on quality of life. Vertebral fractures lead to significantly increased morbidity and mortality. In fact all osteoporotic fractures increase patient disability, with fractures of the hip and vertebrae associated with increased mortality, in both men and women.
Detection
Early detection is vital. Your doctor will make a clinical assessment and possibly refer you for bone mineral density testing which is a simple and non-invasive procedure.
What can you do?
Knowing the risk factors is the first step in successfully fighting osteoporosis. Some risk factors may be modifiable through changes to lifestyle, others are non-modifiable risk factors (such as age, genetics, previous fracture, affects of other health conditions) which can’t be changed.
Lifestyle changes include exercise which is vital for building bone mass in youth and slowing down bone loss in adults. Exercise also strengthens muscles, increases flexibility, and improves coordination and balance. These factors are significant in helping to reduce the risk of falls. Weight-bearing exercise such as walking, jogging, tennis and similar sports, aerobics and dancing is good for bone health. In terms of bone health, you will benefit more from “high-impact” activities like aerobics and jogging but they may not be suitable for you if you have any other medical conditions or problems with your joints, or if you have already had a fracture. Resistance training, also known as weight or strength training, is also good for muscles and helps maintain bone mass. Speak to your doctor or osteopath to find out which sort of exercise is best for you according to your age and health condition.
Both calcium and vitamin D are essential to maintain healthy bones. As we grow older we absorb calcium from food less efficiently. This means that over time we need higher amounts of calcium. Calcium rich foods include dairy foods such as milk, cheese and yogurt; certain greens (e.g. broccoli, curly kale, bok choy); whole canned fish with bones, such as sardines or pilchards; nuts (almonds and brazil nuts in particular) and tofu set with calcium. In addition, calcium-fortified foods – most commonly orange juices and breakfast cereals – are increasingly available.
Adequate intake of vitamin D, which helps calcium absorption, is also essential. For the majority of people around the world, the amount of vitamin D synthesized in the skin through regular daily exposure to sunlight is sufficient. Good dietary sources of vitamin D include oily fish such as salmon and mackerel, fortified dairy foods or margarine, fortified breakfast cereals and egg yolks.
In order to maintain muscle function and bone mass, sufficient protein should also form part of a healthy diet. Good sources of protein include white meat, fish, milk, beans and tofu.
A number of other factors will also make a difference to your bone health:
Stop smoking – smokers lose bone density more rapidly than non-smokers;
Drink alcohol in moderation – excess alcohol is a risk factor for osteoporosis;
Ensure healthy body weight – excessive weight loss should be avoided.
Take an additional measure to reduce the risk of fractures by fall-proofing your home. Reduce clutter at floor level, wear well-fitting shoes or slippers and make sure surfaces are slip-proof: rugs should have a skid-proof backing. Have grab rails installed in the bathroom and toilet and make sure that lighting is bright enough. It is also a good idea to have regular eye checkups – your vision is crucial in judging distances and detail.
Treating Osteoporosis
In addition to recommending lifestyle changes, doctors may prescribe drug therapy if osteoporosis is diagnosed. Common treatments that are currently available are: bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid), calcitonin, raloxifene, strontium ranelate, teriparatide and tibolone. Hormone replacement therapy (HRT), although not specifically for the treatment of osteoporosis, has also been shown to have a beneficial effect on bone.
Calcium and vitamin D supplements are also usually prescribed, to ensure adequate intake, and to ensure maximum effectiveness of the drug therapy. Sufficient calcium, vitamin D and protein intake not only helps to prevent osteoporosis, it is also important in helping to maintain bone density and muscle function in patients diagnosed with osteoporosis. Calcium and vitamin D supplements are especially important for individuals at high risk of fracture.
Nutrition and lifestyle factors as well as exercise play an important role in osteoporosis prevention and management. By improving balance, muscle strength and agility, individually tailored exercise programs can also help to prevent falls. Special exercise programs, under professional supervision, can help with rehabilitation and pain relief after a fracture.
Vertebral fracture quick screen
Ask yourself:
1) have you lost height (more than 3cm/just over an inch)?
2)have you recently had sudden, severe back pain?
3)have you noticed an increased stoop in your back?
4) do you have a family history of osteoporosis?
If you have answered yes to any of these questions, discuss the results with your doctor. Your doctor may send you for further testing and, if appropriate, may recommend possible treatment options.
The National Osteoporosis Society is the only UK wide charity dedicated to improving the diagnosis, prevention and treatment of osteoporosis. Its President is HRH Camilla, Duchess of Cornwall
Further information may be found below or speak to your doctor if you have concerns regarding osteoporosis
This week is National Falls Awareness week run by Age UK, and they have launched a new campaign – Get Up and Go! 2010 – to remind us all about the importance of keeping fit and active as we get older.
No matter what your age, weight, health problems or abilities, you should strive and do some form of regular physical activity. Here’s our guide to keeping healthy.
Why?
Physical activity is important as you get older because it helps maintain independence, is good for social activity and has positive health outcomes for long term health conditions. It also makes you look and feel better, gives you more energy, helps you sleep better and is a great confidence booster for getting you out there meeting people and making friends.
Alongside physical benefits, there are also mental benefits by helping you to reduce stress, anxiety and feelings of sadness and improve your concentration and self-confidence.
As we all know, physical activity also helps to control a number of important health factors such as weight, blood pressure, cholesterol, diabetes and bone and joint problems including arthritis. It also reduces the risk of heart disease, strokes and some cancers, and assists in managing pain, maintaining and improving joint movement and preventing falls and injury.
All these factors are important in maintaining a healthy, active and independent life.
How much activity should I do?
Older people should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all days. If you can’t do 30 minutes now, start with 10 minutes once or twice a day. After two weeks make it 15 minutes twice a day and you will have reached your daily goal. If you can do more than 30 minutes there will be additional health benefits
Try to be active every day in as many ways as possible, doing a range of activities that incorporates fitness, strength, flexibility and balance.
The excuses!
It’s easy to find excuses to avoid exercise: lack of time, fatigue, fear of re-injury or making a health problem worse, money, the weather, I’m not the sporty type, the list is endless. In reality these are simply excuses. Once you make some time and start exercising you will find that you will have MORE energy and feel less tired. It is also highly unlikely that you will injure yourself with gentle activity and most health problems can be helped by activity. Walking is the simplest activity, it’s free and you can always take an umbrella and gloves if it’s a bit chilly. Northamptonshire has some great walks (see www.walkinginnorthants.co.uk/Daventry for details).
What types of activity should I do?
There are four main types of activity that are needed to keep you healthy. Moderate fitness activities include brisk walking, yard and garden work, golf, cycling, swimming and dancing. A combination of these should be done for 30 minutes on most days. Strength activities help maintain your muscles and bones and make daily tasks easier to perform, and should be done 2-3 times a week and ideally be built into everyday activities. Weight, strength or resistance exercises, Lifting and carrying groceries and climbing stairs are all good strength activities.
Flexibility activities such as gentle reaching, bending and stretching help you to move more easily. Tai Chi, bowls, mopping floors, vacuuming, dancing, yoga and stretching exercises are all good examples. Stretching exercise can even be done whilst watching the TV.
Balancing activities improve balance and help to prevent falls. Make a specific time each day to do these exercises, or fit them in whenever you can, for example while waiting for the kettle to boil. These simple exercises may include Side Steps (standing tall holding the back of a chair, take a step from side to side and continue doing this for 30 seconds. When confident try holding the chair with one hand. Then try two steps to the side and back, continuing for 30 seconds), Heel Raises (standing tall holding a sturdy table, chair or sink, raise your heels taking the weight on the big and second toe, hold for a second and lower your heels to the floor with control. Repeat 10 times.)
Getting started
Make sure activities are safe. Wear comfortable clothes, preferably loose fitting and supportive footwear. Start slowly and allow your body time to warm up. The old saying ‘no pain no gain’ is not true. If you feel any pain, slow down or stop!
Increase activity gradually, start at a level that you can manage and build upon it. Be realistic and don’t make it too hard for yourself; remember every 10 minutes counts.
Set yourself a start date and a regular time to exercise. Choose some activities from the four groups listed above and set some goals. For example, “ I will walk the dog every day this week” or “I will walk every day for 10 minutes after meals”.
Staying active on a regular basis can be a challenge. Make it easier by using reminders, getting into a routine, try to make it social and vary activities. Using a diary to write down activity times and how you felt is a good way of motivating yourself on those dreary days, or choose a role model to encourage you to maintain active.
Overcoming setbacks
It’s quite common to have a setback when starting a new activity. Holidays, injuries and other life events all get in the way and break your routine. Don’t worry. Treat the setback as temporary and get back on track as soon as you can. Remember, when starting an activity again, do it in small amounts and stop if you feel pain.
National Falls Awareness week Get Up and Go! 2010 runs from 21-25 June see http://www.ageuk.org.uk for more information and activities in your area.
The London 2012 Olympic and Paralympic games will soon be here and for the first time in Olympic history, osteopathy is to form part of the host medical services provision. Osteopaths will work alongside sports medicine doctors, physiotherapists, chiropractors, podiatrists, and sports massage practitioners treating and providing support to elite athletes.
Jonathan Betser, who is Osteopath Lead on the Physical Therapies Working Group for 2012 says:“This is a fantastically exciting opportunity for osteopaths and it takes what we do in sport to another level. Being there combines all the things one aspires to: working at the highest level of sport at the highest profile sporting event in the world whilst working with the Country’s best sports medicine clinicians”
Osteopaths are being recruited on a volunteer basis as part of the 70, 000 volunteers supporting the London 2012 Games. They will be based at polyclinics located in the Olympic villages working with their sports medicine colleagues and using their skills, knowledge and experience to help athletes recover from injuries and return to peak condition.
For more information: The Osteopathic Sports Care Association http://www.osca.org.uk
How’s your health? The NHS has just made it a little bit easier to find out. Following on from the great success of BabyLife and TeenLife Check the NHS has recently launched MidLifeCheck. It’s a free confidential and easy to use online service for anyone over 40 that helps you get answers to important health questions. So whether you want to lose weight, feel less stressed, cut down on your drinking or be more active, NHS MidLifeCheck can help you get started. The website has 4 easy steps:
- Answer simple questions about you and your lifestyle.
- Get results and advice based on your answers.
- Plan some small changes and set yourself goals.
- Track your progress and sign up for free texts, emails or letters to support you.
If you would like to discuss any of the information with your GP it’s easy to print out the results to take along to your next appointment. And remember it’s free, so don’t delay in trying out this new service. www.nhs.uk/midlifecheck
With spring just around the corner, it’s time to get outside and begin sorting the garden out. But before you embark on over-enthusiastic pruning, digging or weeding, take time to consider how your muscles and joints might respond to such effort. Remember, gardening can often a source of injury but is easily preventable.
Start your gardening properly by wearing loose fitting, yet warm, clothing that covers the small of your back, and wear sturdy boots and gloves. Before getting on with the task at hand, ensure you take a brisk walk around the garden to get your blood flowing.
Once the circulation has been stimulated, try some simple stretches starting with your arms, shoulders, neck and chest before stretching your hips, thighs and calves. DON’T charge full steam ahead with back stretches; bending to the floor or sharply leaning backwards can easily result in injury. Start slowly. Try crouching down into a ball and if your knee’s complain bitterly, sitting on a seat and leaning forward to drop your chest onto the top of your thighs. Remember, ALWAYS listen to what your body tells you, more often than not it will let you know if you are over-doing something.
So now you’re ready! Make a mental note of all the jobs that you intend doing and instigate the 10 minute rule – spend ten minutes doing one job and then move onto the next. You don’t need to be a stickler for the 10 minutes, but you should aim to spend a short amount of time on jobs and vary them so that the body gets used to activity, but not aggravated by constant repetitive actions.
The problem with gardening is that we tend to spend long periods of time doing the same repetitive action. Trimming the hedge, for example, which may take over an hour, tends to throw the body weight all onto one side and bends forward at the waist. This can load the base of the back and pelvis joints, often to excess.
Where possible use long handled tools. Take care with loading wheel barrows, which should ideally have more than one wheel at the front for stability. Don’t be afraid to use small shovels and take modest loads rather than larger loads, and where possible drag, push or pull instead of carrying.
Happy gardening!!!
If you have suffered an injury the action you take in the first 24 hours can, in most cases, vastly reduce your recovery time. The principles of M.I.C.E are simple and easy to follow advice which anyone can do.
M – Movement
I – Ice
C – Compression
E – Elevation
Movement – Gentle movement (within your pain-free range) is advisable, but full weight bearing on a sprained ankle should be avoided. For back strain, alternating between lying down and gentle walking can be of benefit. If the strain is minor, keeping active is vital for your recovery. If playing sport, there is often a temptation to ‘run it off’ but this will only lead to further injury and increased recovery times.
How does it work?
Gentle movement will help to improve the circulation to the affected area; reducing the build up of inflammation.
Ice* – apply an ice pack or cold compression to the area. Do this for 10 minutes at a time – anymore and you could cause further damage. NEVER apply ice or cold packs directly onto the skin, rather always ensure that they are covered with a layer of thin material ie. a tea towel. Cheap and easy alternatives to cold packs include bags of frozen peas or crushed ice in a plastic bag. Remember always to cover in a thin material to protect your skin.
How does it work?
Applying ice to an injury reduces excessive muscle spasm, reduces the pain, decreases the rate of cell death by slowing metabolic activity, and reduces bleeding by causing blood vessels to shrink (vasoconstrict), thereby reducing swelling.
Compression – this can be utilised for 24 – 48 hours following an injury. A supportive compression strapping can be applied using crepe bandage or tubi grip. It must not be so tight as to cut off circulation and you should allow for some swelling to take place.
How does it work?
Excessive swelling of a joint can significantly affect the function of that joint, applying the compression physically restricts the amount of swelling that can occur.
Elevation - Elevating the injured limb so that fluid drains toward the centre of the body will improve the drainage, reducing the swelling and subsequent pain associated with swollen tissues (oedema). For lower limb injuries raise the leg above the height of the hip, and for upper limb injuries raise the arm above the level of the shoulder. Elevation should be employed as often as possible in the first 48 hours following injury.
* Should I apply heat? This can be very comforting and when used at the appropriate stage of injury rehabilitation is beneficial. However, in the acute stages of an injury where there is torn tissue and internal bleeding (ie. bruising developing), then heat will exacerbate the problem. We use ice at this stage to reduce the swelling and pain occurring at that joint.
A note on pain relief – Paracetamol is the painkiller of choice as aspirin and neurofen can aggravate asthma, digestive problems. Do make sure that you only take the recommended dose and do not mix with other medicine (including cold remedies). If you have liver or kidney problems, or alcohol dependence, consult your GP first.
For a non-pharmacological alternative try arnica (either as a cream or tablet).
If there is a lot of swelling or bruising, the pain is unbearable or you suspect a fracture, you should consult your GP.
Visit your osteopath as soon as you are mobile for full evaluation and advice.
May 2010: Osteopath Direct is pleased to announce that we are now registered with a number of private medical insurance companies for the provision of osteopathy.
The medical insurance schemes are: Simply Health (formerly trading as HSA, BCWA, LHF, HealthSure and Totally Active), Pru Health, WPA, Groupama, Aviva, Cigna, Standard Life Health Care, Allianz World Wide Care and AXA/PPP.
We recommend that patients consult with their insurance provider to ensure their plan covers osteopathy and to determine the correct way to claim for osteopathic treatment as some insurance providers require a GP referral.
If your private medical insurance covers complementary healthcare but your provider is not listed above, please let us know as we are often able to arrange this.
February 2010: A new Osteopathic clinic has opened in Daventry to provide care to patients in the town and surrounding areas.
Osteopath Direct has opened at the One to One Health Centre and gym on High March in Daventry led by registered Osteopath Luke Dillon.
Osteopathy is an NHS-recognised therapy that relieves pain, improves mobility and significantly enhances the quality of life for many patients – all without the use of medication or surgery.
Luke Dillon is an experienced practitioner who trained at the British School of Osteopathy in London and uses a combination of techniques to treat patients of all ages. In addition to effective treatment, Luke places a great emphasis on helping and advising patients regarding their work-life, sleeping postures, diet and exercise.
Luke Dillon said: “Osteopathy is an increasingly important form of healthcare, so we are delighted to be bringing a professional and comfortable new practice to residents and workers within Daventry and the surrounding areas.”
Osteopathy can help people of all ages with a range of conditions from back and neck problems including ‘trapped’ nerves, muscle and joint stiffness and sports injuries, to postural problems, repetitive strain, pain associated with arthritis and the effects of trauma such as whiplash.
Luke Dillon is registered with the General Osteopathic Council and a member of the British Osteopathic Association and London Osteopathic Society.
New Osteopath Clinic Opens in South London
Osteopath Direct launches in Elephant & Castle
September 2009, London: A new Osteopathic clinic has opened in South East London to provide care to patients in Elephant & Castle, Kennington and the surrounding areas.
The new clinic, which is based in Elephant & Castle, offers effective treatments for a range of muscular pain and dysfunction and is led by Luke Dillon, an experienced practitioner who trained at the British School of Osteopathy.
Luke uses a combination of techniques at the new practice and has experience in treating patients of all ages. In addition to effective treatment, he places a great emphasis on helping and advising patients regarding their work-life, sleeping postures, diet and exercise.
Luke Dillon said: “Osteopathy is an increasingly important form of healthcare, so we are delighted to be bringing good quality Osteopathic care to both residents and workers within Elephant & Castle, Kennington and South East London.”
Care provided at the clinic includes the treatment of neck and back pain, joint pain, sports injuries, repetitive strain injuries and work place injuries, postural problems, effects of trauma such as whiplash, plus headaches and symptoms of chronic conditions such as asthma and osteoarthritis.
Luke Dillon is registered with the General Osteopathic Council and a member of the British Osteopathic Association and London Osteopathic Society.
Web: www.osteopathdirect.co.uk
Email: info@osteopathdirect.co.uk
Telephone: 0843 28 98 848 / 07956 453 993
-ends-
Notes for editors:
What is Osteopathy?
Osteopathy is a primary care profession, focusing on the diagnosis, treatment, prevention and rehabilitation of musculoskeletal disorders, and the effects of these conditions on a patient’s general health.
Osteopathy is based on the principle that the body has the ability to heal, and osteopathic care focuses on strengthening the musculoskeletal systems to treat existing conditions and to prevent illness. Osteopathy is very effective at resolving aches, pains and injuries because it looks at the causes of a problem. It is an Osteopath’s aim to prevent a problem or injury from recurring by identifying and removing the original cause of the problem.
What do Osteopath’s treat?
Osteopaths are capable of treating a wide range of musculoskeletal conditions and the effects these conditions have on the body. These include common aches and pains due to strains, falls and overuse, as well as the more long-term back and neck problems. It can often alleviate the problems associated with stress and tension including chronic headaches. Osteopathy can help with the following conditions (this list is not exhaustive): Low back pain, which may or may not include sciatica; Neck and upper back pain; Peripheral joint pain (shoulder, elbow, wrist, hand, hip, knee and foot problems); Sports injuries; Repetitive strain injuries/work place injuries; Postural problems; Stiffness associated with ‘wear & tear’; Effects of trauma. E.g. whiplash; Jaw pain; Headaches; Musculo-skeletal symptoms associated with chronic conditions. E.g. Asthma, osteoarthritis
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NICE – the National Institute for Health and Clinical Excellence (NICE) – has published guidelines to improve the early management of persistent non-specific low back pain and one option is a course of manual therapy, including spinal manipulation of up to 9 sessions over up to 12 weeks.
This covers people who have been in pain longer than six weeks, but less than one year, where the pain may be linked to structures in the back such as joints, muscles and ligaments
British Osteopathic Association welcomes the new NICE guidelines . We are pleased to gain recognition of the part osteopathy has to play in the relief and management of lower back pain and we also appreciate the additional guidance given to GPs and other health professionals. We hope these new guidelines will lead to increased access to osteopathy for the general public through the National Health Service and avoid the current postcode lottery that can affect some people when seeking help for lower back pain.
