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Beating Osteoporosis
Beating Osteoporosis The facts, the treatments, the exercises
Diana Moran in association with The Royal Osteoporosis Society
GREEN TREE Bloomsbury Publishing Plc 50 Bedford Square, London, WC1B 3DP, UK BLOOMSBURY, GREEN TREE and the Green Tree logo are trademarks of Bloomsbury Publishing Plc First published in Great Britain, 2019 Copyright Š Diana Moran, 2019 Illustrations Š David Mostyn, 2019 and Jasmine Parker, 2019 Diana Moran has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as Author of this work For legal purposes the Acknowledgements on page 151 constitute an extension of this copyright page All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers The information contained in this book is provided by way of general guidance in relation to the specific subject matters addressed herein, but it is not a substitute for specialist advice. It should not be relied on for medical, health-care, pharmaceutical or other professional advice on specific health needs. This book is sold with the understanding that the author and publisher are not engaged in rendering medical, health or any kind of personal or professional services. The reader should consult a competent medical or health professional before adopting any of the suggestions in this book or drawing inferences from it. The author and publisher specifically disclaim, as far as the law allows, any responsibility from any liability, loss or risk (personal or otherwise) which is incurred as a consequence, directly or indirectly, of the use and applications of any of the contents of this book. If you are on medication of any description, please consult your doctor or health professional before embarking on any exercise plan or diet. A catalogue record for this book is available from the British Library Library of Congress Cataloguing-in-Publication data has been applied for ISBN: PB: 978-1-4729-6190-7; ePub: 978-1-4729-6189-1; ePDF: 978-1-4729-6192-1 Text design by seagulls.net Typeset in Archer by Deanta Global Publishing Services, Chennai, India To find out more about our authors and books visit www.bloomsbury.com and sign up for our newsletters
Contents Introduction
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Royal Osteoporosis Society Top Tips
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PART ONE 1 What is Osteoporosis?
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2 Know Your Bones
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3 Who is at Risk of Osteoporosis?
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4 Bone Screening and Who is Eligible
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5 Menopause and its Consequences
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6 Drug Treatments for Osteoporosis
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7 Diet, Supplements and Natural Alternatives
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PART TWO 8 Why Do We Need to Exercise?
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9 Exercise Plan Warm-Up
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Contents
10 Upper Body Workout
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11 Lower Body Exercises
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12 Osteo Relief Exercises
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13 Preventing Falls
134
Afterword
149
Further Information
150
Acknowledgements
151
Index
152
Introduction My interest in the bone disease osteoporosis was fuelled by a painful accident. My career in the world of fitness and well-being spans more than four decades, but back in 1993 I slipped and fell heavily while skating with friends at an ice rink in Poole, Dorset. I was immediately taken to Poole Hospital A&E, where I was diagnosed and treated for a Colles fracture, a fracture of the wrist that is typical of osteoporosis. At the time I was aged 53 and osteoporosis was not diagnosed. However, I soon found out that such fractures are painful, and can cause both disability and a loss of self-esteem, significantly affecting quality of life and physical activity. As somebody with a knowledge of exercise, I appreciated that the general public needed information about how to build strong bones through exercise and which exercises are safe. So, a few months later, I was particularly interested to be approached by the co-founders of a new charity, based at Poole and Bournemouth hospitals. Knowing of my interest in health and fitness through my work as the Green Goddess on BBC’s Breakfast Time, they invited me to become President of
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Osteoporosis Dorset. I was honoured and accepted, and have continued in my role for 30 years. I am also proud to have been an Ambassador for the past 10 years for The Royal Osteoporosis Society (ROS), which carries out research into the disease, and gives advice and support to osteoporotic patients throughout the UK. As the only UK-wide charity dedicated to ending the pain and suffering caused by osteoporosis, they are there for anyone affected by the condition, providing help and support. An increasing number of people, both men and women, are affected by osteoporosis, and I know just how beneficial the charities are, with the advice and support they offer. Knowledge empowers those of us with bone issues to manage our bone health more effectively. Understanding the condition and knowing more about the treatments available can transform our quality of life, and this is particularly true for frail and vulnerable older people. The ROS telephone helpline service (see p. 6) provides information and support, and a network of support groups, information leaflets and books are available to reduce the impact of fractures. Now aged 80, and like many women of a similar age, I have been diagnosed with osteopenia. Osteopenia is best described as bone density that is between the lower end of the normal range and the osteoporosis range. Most people who are diagnosed with osteopenia are recommended to consider some lifestyle changes – to keep their bones strong and to help reduce the chances of their bone density dropping to within the osteoporosis range in the future. Sometimes a person who is within the osteopenic range and who has easily broken a bone
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Introduction
may be advised to follow a drug treatment because they will be at higher risk of breaking a bone. Having presented with osteopenia myself, I decided it was important to find out all I could in order to help myself maintain bone strength, and to discover what drugs, treatments and exercises help delay the onset of osteoporosis. I have decided to share my findings with you in this book. And I shall heed my own advice and look to the two organisations I am involved with for further help and information, as and when I need it (see Further Information, p. 150). Diana Moran, 2019
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Royal Osteoporosis Society Top Tips We all know that regular physical activity is very important for general health and good bone strength, and Beating Osteoporosis is packed with useful information and suggestions for how to exercise. However, on the days when time is short, we recommend you consider the following: ▶▶ Take the stairs and not the lift or escalator. As you get stronger, increase your speed to a little jog. ▶▶ Park your car at the far end of the supermarket car park to make you walk that bit further. ▶▶ Buy a really good backpack, properly supportive and well positioned, for carrying shopping, or add a small load when you are walking. This will increase the ‘pull’ on your muscles and bones to make them stronger. ▶▶ Use bags of coins in a jacket or top with lots of pockets to create your own weighted vest to exercise in.
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Royal Os teoporosis Societ y T op Tips
▶▶ Learn some balance exercises, such as standing on one leg until you wobble and then shift to the other. The wobble is good – it challenges your balance and improves it! Do them when you are waiting for the kettle to boil or the toast to pop up. ▶▶ If you are standing and waiting at the bus stop or watching a football match on the sidelines, and you have good balance, do some low-level jumps – just a few inches off the ground. ▶▶ As you start to sit down, stop for a moment, before your bottom reaches the chair. Hold that position for a moment and feel your muscles working. ▶▶ If you are less able to exercise, try to make sure you don’t sit for too long. Stand up whenever the adverts come on the TV at the end of a programme, you reach the end of a chapter of your book, or you hear a text come through on your phone. If you can, stamp your feet 10 times too! ▶▶ If you enjoy swimming, invest in small water paddles which can be strapped to your hands when swimming to provide greater pull on the muscles and help maintain bone strength. ▶▶ If you can, use your wrists to lift yourself up out of the pool instead of using the steps – take your paddles off first! ▶▶ Try a jog/walk – walk for two minutes, do 10 (or 20) jogging steps, walk for two minutes and so on. Aim for at least 50 jogging steps during your walk. If you have had spinal fractures or are breaking other bones easily, do lower-impact activities like brisk walking, especially if you still have pain.
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There are lots of things you can do in your everyday routine to strengthen muscles and build bone strength. If you need help, you can ask your GP for a referral to a physiotherapist to get you started and advise which exercises are best for you. We suggest exercising with a friend or family member to keep you motivated and make it enjoyable. Set aside a time at least once a week when you work through the exercises together. Have some music on, eat together afterwards – look forward to it! For further information or guidance on exercise and osteoporosis, please contact the specialist nurses at the Royal Osteoporosis Society (ROS) on 0808 800 0035 (free from all UK landlines, mobiles and call boxes), email nurses@theros.org.uk or look up www.theros.org.uk
If you are concerned about your health, or if you suffer from heart disease; have high blood pressure; joint problems or back problems; are very overweight or have any other illness, please consult your doctor before following the exercise plans in this book.
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PART ONE
1 What is Osteoporosis? Osteoporosis is a condition by which bones lose their strength and break more easily. Osteoporosis literally means ‘porous bone’. Nowadays we hear a great deal about osteoporosis, but it is by no means new. The Romans were referring to non-healing hip fractures and other similar-sounding conditions in the 6th century. By the early 19th century, physicians were concerned about the ‘spongy’ texture of bones in old age, even before they were able to see them on X-ray. According to the Royal Osteoporosis Society (ROS), osteoporosis is ‘a condition in which bones lose their strength and are more likely to break, usually following a minor bump or fall. Broken bones are also referred to as fractures but that means the same thing. Fractures that occur because of reduced bone strength are described as fragility fractures, and many of these will be caused by osteoporosis.’ Today we regard osteoporosis as a largely preventable condition, and although there is still a great deal we don’t know, there are many things we can do to prevent fractures and to maintain healthy bones, preventing further bone loss. Osteoporosis describes the low bone density that can be measured on a bone density scan, known as a DXA (or, formerly, DEXA). 8
What is Os teoporosis?
A DXA scan is Dual-energy X-ray Absorptiometry and is a means of measuring bone mineral density (BMD). Two X-ray beams with different energy levels are aimed at the patient’s bones. Despite its association with ageing and the menopause, osteoporosis can also affect younger women and men. Genetic inheritance and other factors can contribute to bone loss in both men and women, and for every five women with osteoporosis there will also be two men. More cases are being diagnosed today through the new services that can find out if osteoporosis is the cause of a broken bone, but it doesn’t necessarily follow that osteoporosis is on the increase. The increase is more likely due to the fact that more of us are living longer. The chance of osteoporosis presenting itself increases with longevity, and more doctors are now fully aware of the effects of loss of bone density. Other reasons explaining why so many people present with osteoporosis include excessive dieting, poor nutrition, sedentary lifestyles, obesity, smoking and alcohol. The Royal Osteoporosis Society reports: ‘we know from a recent study conducted at Southampton and building on a study from Svenborn that numbers of reported osteoporosis cases have remained the same over the last 10 years. However, with the ageing population it is predicted that the numbers of falls and fractures will rise.’ Three-quarters of 75-year-old women will have osteoporosis, but in many cases the fragility fractures many of us suffer from in our 70s could have been prevented. It’s important to understand that osteoporosis is not just a consequence of growing older. A lifestyle that includes a well-balanced diet containing plenty of calcium and vitamin D to build strong bones and regular exercise (particularly weight-bearing exercises such as brisk walking, running and 9
BEATING OS TEOPOROSIS
balance exercises) will help to prevent the condition. People living with osteoporosis risk disabling hip and wrist fractures in the event of a fall, and others suffer the painful, debilitating crumbling of the spine due to fractures of the vertebrae, often causing a severe loss of height. Fractures follow falls, and even a minor impact can lead to a fracture when bones reach a certain stage of weakness. So, why do people fall down more as they get older? Some may suffer from muscular weakness through illness or lack of exercise, or are on a course of drug treatment that makes them drowsy (tranquillisers, for instance), or they simply lose their balance. Others may suffer from blackouts or fainting. And, of course, as we age our vision isn’t as keen as it was, increasing the danger of tripping over where lighting is poor. Excessive alcohol (more than the daily recommended amounts) seems also to be a significant risk factor for osteoporosis and fractures. Alcohol appears to affect the cells that build and break down bone, and small amounts can cause unsteadiness and increase the chance of falling. Not everyone has the opportunity, or the stubborn determination, to regain full mobility after an accident, as I did. But people with weaker or less strong bones have a lot to lose if they fall, putting both their physical independence and quality of life at risk. Many accidents leading to nasty falls occur around the house, so be aware of potential hazards such as loose rugs, slippery floors, spilt liquids and snake-like flexes. Small grandchildren and pets are often the cause of ‘accidents just waiting to happen’! Objects get moved from their familiar spots and toys are left in unexpected places, as their bored little owners abandon treasured possessions in the most inconvenient places! 10
What is Os teoporosis?
Accidents in the kitchen are best avoided by keeping things in more accessible places; it’s all too easy to lose one’s balance and tumble off the kitchen steps. For people suffering from osteoporosis, handrails and non-slip mats in bathrooms can stop nasty falls on slippery surfaces, which could have such devastating consequences. Cold weather too can take its toll in other ways. One study of elderly women admitted to hospital with fractures showed that there was a midwinter peak. But these women weren’t slipping on icy pavements; most of the accidents took place indoors. The researchers noted that a large proportion of the women were thin, possibly suffering from poor nutrition, which can trigger low body temperature, hypothermia and subsequent lack of coordination.
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2 Know Your Bones Bone is not dry, nor is it dead: it’s alive and kicking! From the outside your bones appear to be simple, solid structures, but their clever design allows your skeleton to be strong without being heavy. Your bones work with your muscles to allow your body to move and give your body its overall structure. Your bones also provide support and protection for your internal organs. Bones are made of protein hardened by calcium salts and other minerals essential to make them strong. They are alive and constantly changing to stay healthy. Bone changes constantly, with new bone repairing and replacing old bone. Throughout our lifetime, old and worn-out bone is broken down by cells called osteoclasts, and then rebuilt by cells called osteoblasts. This process is called bone remodelling. I liken the process of osteoclast cells at a worn-out bone surface to my council workmen, who make holes in the road for maintenance reasons. When they’ve fixed the problem, their mates come along and fill in the hole – not dissimilar to the osteoblast cells rebuilding new bone to make it good! When we are children, the osteoblasts have to work fast as our skeleton grows. It takes just two years for the skeleton to 12
Know Your Bones
completely renew itself, unlike the 7–10 years it takes to completely renew as an adult. Between the ages of 16 and 18, bones stop growing in length, but the amount of bone tissue continues to increase slowly until the late 20s, then stays steady for some 15–20 years when bone begins to decrease. In younger adults up until about the age of 35, there is usually a balance between the amount of bone that is removed and the amount laid down, and so the bone tissue stays the same. However, as we continue to age, this gets out of balance, resulting in a decrease of bone tissue. The cortical shell (thick outer layer of bone) thins and the honeycomb struts also thin and begin to break down, resulting in the holes becoming larger and the bones more porous and less strong.
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There is evidence to suggest that your weight at the age of 1 year could predict bone strength in adult life. A study by the Norwegian University of Science and Technology indicates that small babies and those born prematurely are at greater risk of developing osteoporosis in adult life. The reason is that they had less time to absorb calcium in the womb. This suggests that much of the transfer of calcium to the growing foetus happens during the last few weeks of pregnancy. The study also found that small full-term babies had lower bone mass and could also be at risk. Genes may decide the potential size and strength of your skeleton, but how you live life during your youth can play an important part in how much gets invested into your ‘bone bank’. A positive, healthy lifestyle including a well-balanced calcium-rich diet, plus plenty of exercise, helps to build strong bones during your youth. Two types of exercise are particularly important; weight bearing with impact – on your feet with some impact or force behind it (e.g. running, jumping and jogging) and muscle strengthening exercise that works all the muscles quite hard. Bone mass will decrease gradually and naturally in both women and men after the age of 35, but in some people genetic inheritance and other factors can also contribute to bone loss. In adulthood, smoking or drinking excessive amounts of alcohol are detrimental to bone health. Bone loss continues naturally throughout life. Bone loss is more marked in mature women, due to dramatic changes in their hormonal levels as a consequence of menopause. Some women may lose bone faster than others
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Know Your Bones
and will have lost as much as 30 per cent of bone within 10 years of the menopause (which begins, on average, at age 51). A woman who has an early menopause (before the age of 45) can experience bone loss even earlier, because she will have been without bone-protective oestrogen for a longer period of her life. For the same reason, fast bone loss can also be expected after a premature menopause, possibly brought about by hysterectomy. The likelihood of fast bone loss is even greater if one or both of the ovaries were removed at the time (oophorectomy). Bone consists of the compound calcium phosphate embedded in collagen fibres. The calcium gives strength and hardness, while the fibres provide flexibility. Bone is a living tissue full of little cavities looking not unlike a honeycomb – think of the inside of a Crunchie chocolate bar. There are two types of bone: trabecular and cortical. All of our bones consist of these two types of bone tissue; the outer thick shell is cortical bone; and the inside of the shell is a strong mesh or scaffolding, called trabecular bone. Bone also contains bone marrow, in which your blood cells are produced. Both the cortical and trabecular bone tissue are fed by a nerve and blood supply, while fat and bone marrow fill the spaces. Your spinal bones and the ends of the long bones in your arms and legs have a high proportion of trabecular bone, and fractures in these areas can be a sign of post-menopausal osteoporosis. A woman will lose about 50 per cent of trabecular bone and 35 per cent of cortical bone in her lifetime. Trabecular bone is most likely to be lost in the 10 years or so around the menopause.
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Cortical bone is associated with slower, gradual bone loss later in life. Hip and shoulder bones are both cortical and trabecular, and fractures here are associated with later ageing. With advancing age there will be increased bone loss, resulting in poor bone health and the possibility of the fragile bone disease osteoporosis. Bone is liable to fracture and one in two women and one in five men over the age of 50 will experience fragility fractures associated with osteoporosis, mostly as a result of low bone strength. Missing and irregular periods in younger women can lead to bone loss. One common cause is anorexia. A study of young women suffering from anorexia and missing periods for a year showed that 77 per cent had spinal bone loss. The other common causes are poor nutrition, weight loss, loss of ovarian function – and excessive exercise. Though exercise in normal amounts is protective, too much of it is definitely a bad thing. When young female athletes train to excess, they become underweight, their periods stop, and they can lose 5 per cent of bone density a year. 16
Know Your Bones
Bone tissue is continually replacing itself, most rapidly in the young and more moderately in adulthood. Peak bone mass is reached during the early 20s, and after that things begin to go downhill (to put it pessimistically). This gradual loss of bone density is common to both men and women and is part of the ageing process. But in some women, the loss accelerates to between 2 and 3 per cent a year at the onset of the menopause, and by the age of 70, a third of bone mineral mass can have disappeared. You see the results in the skinny ankles and stoop of some elderly women, which is caused by a loss of height and curvature of the spine (itself caused by spinal fractures known as crush fractures). Heavier women gain extra protection in two ways. Greater body weight puts more stress on the bones ( just as weight-bearing exercise can do), and after the menopause fat cells store more oestrogen.
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Diana Moran is here to help spread the word about treatments and preventative measures we can all take to tackle osteoporosis.
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