Osteoporosis is an increasingly topical subject and with the increase in research on diseases of women, there have been a number of new developments in treatment and ideas about prevention.

Does your doctor ever talk to you about osteoporosis? If not, you are not alone. Most women never talk about osteoporosis with their doctors. There are so many things one can do to prevent this disease. Start today...

How can you prevent osteoporosis?

Before even thinking about drugs, let's look at how your lifestyle can help. Regular exercise, particularly weight bearing such as walking, and weight training will definitely help. You don't need to go out and run a marathon, or pump iron until you look like Ms Universe, but a brisk walk at least three times a week and training with weights which are heavy enough to make you strain a bit will do the trick.

  • Stop smoking! The eternal cry of all health care professionals, but it really does have an effect on osteoporosis, particularly if you are naturally thin.

  • Eat the correct diet, rich in calcium and vitamin D. Most authorities recommend that you eat a diet with between 1500 and 2500 milligrams of calcium daily, plus 400 IU of vitamin D.

    Treatment: When should you start?

    The experts are divided on this, as they are on how long treatment should continue. Hormone replacement therapy (HRT) is still regarded as the mainstay for osteoporosis treatment and prevention.

    Most women reach their menopause in their 50's, but the peak incidence of fractures resulting from osteoporosis is in the 70's. It may be that starting HRT as soon as you reach menopause and continuing it for five to ten years will result in sufficient increase in bone mass to prevent fractures later. However, as many as 30 percent of women stop taking HRT when they feel that the worst of their menopausal symptoms have passed, so would not get the full benefit. Some experts think that short-term treatment later may be sufficient if all that is needed is treatment of thinning bones. The short and long term risks of HRT must be also be considered.

    Some people are now recommending that between five and ten years of HRT followed by treatment with the new bisphosphonates such as Fosamax® is the right approach.

    Different kinds of treatment

    Hormone replacement therapy is still the first line treatment for osteoporosis as mentioned before. But for those who cannot take HRT or do not want to there are alternatives.

    An easily available drug is Fosamax® (aledronate). This can boost bone mass by as much as three percent per year, and has reduced the incidence of new fractures in the spine by as much as 50 percent in women who use it. The only real problem with the drug is that it is poorly absorbed from the stomach so must be taken on an empty stomach with a full glass of water. Fosamax must be taken exactly as directed or it can irritate the gastrointestinal tract.

    Another option is calcitonin, marketed as a nasal spray called Miacalcin. This is a synthetic hormone which slows down the rate of bone thinning. It only builds about half as much bone as Fosamax does, but it is easier to use, since it can be used at any time and has few side effects.

    Tibolone, not widely available, is thought to be a possible alternative to HRT. It has properties of both oestrogens and androgens. It is effective at controlling menopausal symptoms and bone loss, but nothing is known of its potential for preventing heart disease.

    Raloxifene acts on oestrogen receptors and increase bone mass without causing vaginal bleeding and without any apparent effect on the breast or endometrium (lining of the womb), so removing the risks of breast or endometrial cancer which may be present with HRT. The downside of this new drug is that it doesn't prevent hot flushes, but many women may prefer to put up with hot flushes for a while rather than the other side effects or potential risks of conventional HRT.

    The message is: talk to your doctor about osteoporosis. Prevention is always better than cure.

    For more information contact the National Osteoporosis Foundation by telephoning (021) 931 7894.