OSTEOPOROSIS &
ARTHRITIS
Some questions answered
What is osteoporosis?
Bone is a "living tissue", which is laid down and removed
throughout life. If more bone is removed than is laid down, then the bone
becomes thin and brittle. This is osteoporosis; it can result in fractures and
pain in the hip, spine, and sometimes other bones.
It does not affect men and women at the same rate. After the menopause one
in four women is likely to develop osteoporosis, compared to only one in forty
men of the same age. The likelihood of being affected increases with age. Over
the age of 75 one in two women will develop osteoporosis.
What is the chance of developing osteoporosis?
White-skinned people are more likely to develop osteoporosis than other
ethnic groups; lightly-built people are also more susceptible. The likelihood
also increases if a close relative has it, or if the menopause occurs early.
Prolonged use of some drugs, such as steroids, anti-convulsants and antacids
can lead to osteoporosis. It can also accompany some endocrine or metabolic
disorders, for example over-production of hormones by the adrenal gland or the
thyroid gland (hyperthyroidism). Osteoporosis can also result from a
hysterectomy, and from having had insufficient calcium (i.e. a poor diet) in
childhood and adolescence.
Calcium is obtained from foods like milk and cheese, but Vitamin D (which
comes from the effect of sunshine as well as from food) is also needed,
otherwise the calcium will not be absorbed.
A more immediate risk factor is lack of exercise. If bones are not regularly
subjected to mechanical loading, through exercise, disuse osteoporosis may set
in.
Why is the menopause important?
Oestrogen in women protects bone mass in various ways. First, it reduces the
body's ability to dissolve bone. Secondly, it stimulates Vitamin D (from the
liver and kidneys) and calcitonin (from the thyroid), both of which help to
maintain bone mass. At the menopause the oestrogen production ceases and
accelerated bone loss can take place.
What are the main forms of arthritis?
Osteoarthritis affects the cartilage in the joints. Bony
"outgrowths" form at the outer edges of the joints. The joint becomes
more stiff and painful to move. The joints most often affected are in the
knees, hips, spine, hands and feet.
Rheumatoid arthritis is a disease in which the joint lining (synovial
membrane) becomes inflamed. Joints become stiff and inflamed and the patient
also feels unwell. Eventually the cartilage and bone in the joint can become
damaged and lose bone mass. During a "flare-up", when the disease is
active, mobility may be severely restricted, but there should also be periods
of remission.
Does arthritis affect men and women differently?
No, although different types are more common in one sex than another.
Arthritis affects people of all ages, including children. Osteoarthritis is
more common in older people, whereas rheumatoid arthritis is commonest among
women in the 20-50 age group.
Does the menopause matter in arthritis?
Osteoarthritis of the hand can develop for the first time in the years
shortly after the menopause. The symptoms can be troublesome in the end joints
of the fingers for some years. Later the pain usually settles, leaving some
bone swelling but normal hand function.
There is no evidence that rheumatoid arthritis is affected by the menopause,
but Hormone Replacement Therapy (HRT) seems to have some effect on its
development.
When are osteoporosis and osteoarthritis found in the same person?
It seems from studies in Belgium that people with osteoarthritis in many
joints are less likely to get osteoporosis. In osteoarthritis bone mass
increases, sometimes producing knobbly joints in the fingers and knees. This
type of arthritis, which often runs in families, may lessen the risk of
osteoporosis. But, as general health plays a big part in bone health, some
diseases of the liver, kidney, thyroid or lung may increase the risk of
osteoporosis.
Osteoarthritis and advanced osteoporosis of the spine can both cause back
pain. A clue to the presence of osteoporosis may be a loss of height after the
menopause. This is when it is important to consult a doctor.
When are osteoporosis and rheumatoid arthritis found in the same person?
Having rheumatoid arthritis increases the risk of osteoporosis in different
ways. It may be that the patient is unable to take adequate daily exercise. If
he/she has severe rheumatoid arthritis, then oral corticosteroids
("steroids") may be needed. These, in high doses, and taken over a
period of months or years, may deplete the calcium in the bones.
Local injections of corticosteroids into a joint to reduce inflammation do
not appear to cause osteoporosis, unless repeated at frequent intervals.
What can doctors do about osteoporosis?
Someone in a high risk category (as outlined above) should consult their
doctor about minimising the risk. Reducing the effects of the menopause by
taking HRT may be one protective measure. This may be taken by mouth (either
with or without progesterone), by transdermal patch, or by subcutaneous
implant. It is worth starting treatment even up to 10 to 15 years after final
menstruation.
What are the different views about HRT?
Some people are very enthusiastic about HRT. They have more energy, sleep
better and feel well. Other people find it "unnatural" and hate the
thought of starting their periods again.
Others are worried about the extra risks of cancer of the uterus and breast
with HRT. The risk of cancer of the uterus is not increased if both oestrogen
and progesterone are taken, but it is increased if oestrogen is taken alone.
The risk of cancer of the breast is not increased until HRT has been taken for
more than ten years, although the risk remains small. Controlled high blood
pressure need not rule out having HRT.
What are the other treatment options?
Calcitonin and diphosphonate treatments are looking promising, and are now
being used to treat men with osteoporsis and those women who for any reason
cannot use HRT.
What can be done to manage osteoporosis/arthritis?
Exercise in the middle years and upwards reduces the amount of bone loss
from the skeleton. Specific exercises for those areas of the body most at risk
have shown by research to produce an increase in bone mass. But these need to
be done regularly and in a particular way (see listed books for fuller
details).
This may mean doing 20-30 minutes of general exercises several times a week,
or, for those with osteoporosis, two short sessions of exercise per day.
Reduction of tobacco and alcohol consumption is advisable, as both may have
adverse effects on bone mass.
What books can be consulted?
Avoiding Osteoporosis by Dixon and Woolf. Published by Optima at £5.99
Osteoporosis: Prevention, Management and Treatment Mcilwain, Bruce,
Silverfield and Burnette. Published by John Wiley & Sons at £8.95
Understanding Osteoporosis: Every woman's guide to preventing brittle bones
by Wendy Cooper. Published by Arrow (1 990) at £3.99
Boneloading - The New Way to Prevent and Combat the Thinning Bones of
Osteoporosis. A tried and tested programme of Easy Exercises to Stimulate Bone
Growth by Ariel Simkin and Judith Ayalon Published by Prion at £7.50
What organisations offer support?
The National Osteoporosis
Society, the Arthritis & Rheumatism Council for Research, and
Arthritis Care, all publish useful
information for people with (or interested in) all aspects of arthritis and
osteoporosis.
For a detailed booklet about osteoporosis and HRT, send £1 and SAE
(9" x 5") stamped with 29p to:
The National Osteoporosis Society
PO Box 10
Radstock
Bath
BA3 3YB
For further information about the work of the Arthritis & Rheumatism
Council for Research and their publications, including Arthritis Research
Today, send a SAE (9" x 5") stamped with 38p to:
Arthritis & Rheumatism Council for Research
Copeman House
St Mary's Court
St Mary's Gate
Chesterfield
Derbyshire
S41 7TD
For further information on arthritis and the work of
Arthritis Care, including the
quarterly newspaper Arthritis News, send a SAE (9" x 5")
stamped with 38p to:
Arthritis Care
18 Stephenson Way
London
NW1 2HD
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