Prevention*

Good nutrition: Essential for building healthy bones
Although calcium has been shown to have a beneficial effect on bone health in all age groups, individual dietary calcium intakes fall below recommended levels in many EU member states. The optimal way to achieve adequate calcium intake is through a balanced diet which should include dairy products. Vitamin D deficiency is common in many elderly populations in western Europe and increases fracture risk. Regular exposure to sunlight, eating foods rich in vitamin D and vitamin D supplements where appropriate should maintain adequate levels of vitamin D.

Moderate alcohol intake may have beneficial effects on bone mass. However, excessive alcohol intake reduces bone mass. Smoking is known to be detrimental to bone health and smokers have a higher lifetime risk of hip fracture than non-smokers.

Exercise: Start young for best results

Physical activity during childhood and adolescence is positively related to bone density but effects in postmenopausal women are modest. Elderly people who have experienced some bone loss may benefit from a programme of weight-bearing and endurance exercises. These include walking, stair-climbing, swimming and dancing. The principal benefit from an exercise programme is increased muscle strength and endurance which should help prevent falls.

Prevent falls:

Falls are common in the elderly and the consequences of falls can be death, injuries, fractures, hospitalisation, permanent disability, social isolation and psychological problems. Most falls occur among elderly single women. The three most predictive factors for falling are muscle weakness around the hip joint, increased unsteadiness and intake of more than three medications.

Vision is particularly important for balance and steadiness in the elderly and should be cared for. Exercise programmes improve muscle tone and enhance confidence. Regular adjustment and reduction of medicines helps to prevent falls.


Protect against falls:

Any bone will break if the force is strong enough, but reducing the impact of the force may prevent fracture. Hip protectors have been developed to reduce the impact of trauma and protect the bone when a fall occurs from a standing position. Studies have demonstrated the protective value of hip protectors worn by vulnerable older women and men who have already sustained a fracture, particularly those in nursing homes.

Medication: Effective and available:

Various medications are currently available for the management of osteoporosis and include bisphosphonates, calcitonin, calcium, fluorides, hormone replacement therapy (HRT), ipriflavone, oestrogen derivatives, steroids (anabolic), vitamin D and vitamin D metabolites. However evidence for the effectiveness of these medications in reducing fracture risk varies considerably.

Additionally new medications are in development such as selective oestrogen receptor modulators, strontium ranelate and parathyroid hormone.

Rehabilitation: Regain mobility, reduce pain:

Many patients suffer from chronic or acute pain, muscle fatigue, limited mobility, loss of height, humpback, and loss of independence. These symptoms have a devastating effect on a patient's health, both physically and psychologically. Therefore treatment with medications needs to be accompanied by non-medical therapy. A tailored exercise programme helps to regain mobility and muscle strength and reduce pain. Patients should be taught how to cope with the disease to improve their quality of life. However, many osteoporosis sufferers remain ill-informed about their disease and isolated from the health care community.

Contact with national osteoporosis patient societies and use of the services they provide, such as helplines, nutritional advice and contact with local support groups, can help patients prevent future fractures and manage their disease effectively. A recent German study found that members of a support group had a reduction in anxiety level and a rise in bone density due to better compliance.

Increase awareness and understanding:

An effective communications framework is required to combat the dramatic increase in fractures due to osteoporosis and limited financial health care resources. Awareness of risk factors must be raised and education on prevention should be prioritised. European, nationally and locally planned and implemented awareness campaigns will increase knowledge about osteoporosis and encourage individuals to adopt a healthier lifestyle.
* Source: Summary Report on Osteoporosis in the European Community - Action for Prevention, © European Communities/European Foundation for Osteoporosis (EFFO - now IOF), 1998.