What causes brittle bones disease?

As women age, one of the hazards they face may be the development of the bone disorder called osteoporosis. In this condition, there is a loss of the substance of bone, both the calcium and the protein matrix on which the calcium is laid down. This makes the bone brittle and more likely to break.

We all, men and women, lose bone as we grow older, but modern researchers now believe that osteoporosis is a disease in its own right rather than just a consequence of age.

lt seems to appear in post-menopausal women from about the age of 55 and also in men about 10 years later, but rarely causes symptoms before 65 in women and nearly 85 in men.

Bone is not static tissue but is continually being built up and broken down. The problem with osteoporosis is that the removal of bone is faster than the build-up.

There are many theories and reasons why this happens. The loss of circulating estrogen, the main female sex hormone, that occurs after the change of life is one factor, and the total bone mass is believed to be important as the condition is more common in small women.

Other factors are calcium deficiency, poor absorption of calcium from the gut, the reduced activity that goes with increased age, vitamin D deficiency, and the high intake of phosphorus that goes with the Western diet of meat, bread, and potatoes. The level of calcium and phosphorus is in balance in the body.

Osteoporosis doesn’t cause any symptoms and is not noticeable on an X-ray until about 30 percent of the bone is lost. It may be detected when X-rays are taken for some other reason or when a fracture of a bone leads to its recognition.

Because the bones are more brittle they break more easily, sometimes with little stress. A slight fall may cause the upper part of the femur or thighbone to break.

Falls on the hand in elderly women are likely to cause a broken wrist, the Colles fracture. And thinning of the bones in the spine may lead to a fracture of the vertebra. This type of break may follow the minor stress of picking up a grandchild or of a heavy parcel when shopping.

This vertebral fracture causes sudden pain in the back and may not be recognized as such, the woman may think she has just strained her back and not seek medical treatment.

The disorder doesn’t affect the healing of bone and the fracture should heal in between four and eight weeks.

Prevention is better than attempting to reverse an already established process. There is evidence that if women take estrogen supplements from the time of menopause, osteoporosis can be prevented. However, there are many other considerations when thinking of using hormones in the long term.

Keeping active is one means of keeping bone strength and it has many other health benefits as well.

Taking a diet high in calcium and avoiding unnecessary stresses, particularly to the back, are commonsense rules.

Treatment of already established osteoporosis may depend on whether the condition is noticed on X-rays taken for other reasons, or if the diagnosis follows a fracture. In the latter case, further fractures may follow, so treatment is more necessary.

Many doctors and most patients aren’t too happy at treating conditions that produce no symptoms and where treatment is to prevent some happening in the remote future.

Oestrogen can prevent the development of osteoporosis if it is taken early enough. If it is given for already established disease then it appears to prevent further bone loss but does not make good the loss already there.

Androgens or male hormones lead to an increase in the protein tissue of the body.

Unfortunately, the main male hormone, testosterone, may make grandmother grow a beard, so the anabolic steroids have been used. These are related chemicals without the masculinizing effect. They have been widely used to build up muscle tissue in athletes. All these hormones seem to have a better effect in combination with calcium.

Calcium alone has been recommended both for the prevention and treatment of this condition, and there is strong evidence that it may be the most effective of all the treatments tried.

Calcitonin is produced by tissue near the thyroid gland in the neck. Its action appears to be to slow down the removal of bone. Results of treatment for osteoporosis are not good but it is of use in the bone condition known as Paget’s disease.

Fluoride has been used, but alone it eventually increases bone loss. A combination of calcium, fluoride, and vitamin D is regarded as effective but requires close control.

Increasing the intake of calcium in the diet may not be enough to prevent the development of osteoporosis in the average woman after menopause and it may be necessary to take calcium tablets.

But all forms of treatment have their side-effects, and too much calcium can lead to kidney problems. Stones form, especially in those women who have poor kidney function or some other disorder.

Self-medication with any drug and include vitamins and minerals in this, can lead to unexpected problems.

We can’t stop the process of growing old but we could change our attitudes. Ill health is certainly more common in the elderly but it should not be regarded as normal. Growing old gracefully doesn’t mean being passive. You might have to work harder at being healthy than do the young, but then you might enjoy it more.

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