What you need to know to maintain healthy bones

Why are healthy bones important?
Healthy bones are important in order to keep us mobile without pain and problems. Like a lot of things in life, healthy bones are something you do not miss until they are gone.

What is Osteoporosis?
Osteoporosis is a condition where your bone density is such that it falls significantly below that of the average for your age and gender.

Osteoporotic bone is normal bone, there is simply not as much of it as there should be.

These bones are much easier to break, and when they do break they tend to collapse as the bone has increased space between tissue and thus they often heal in a different shape.

They do heal, however, just as well as bones that do not suffer osteoporosis. It is simply that the small holes between the bone tissue are larger than they should be.

We all lose bone mass as we get older. Men and pre-menopausal women lose 1% per year after the age of 25.

Post-menopausal women lose 3% on average per year after menopause. It is when this loss reaches a critical level that we deem someone to have osteoporosis.

It affects some bones more than others, with bones of the spine, pelvis and hip and wrist being most at risk. These are bones that consequently have a high rate of fracture.

Are there any symptoms of Osteoporosis?
Disturbingly osteoporosis carries no symptoms until the condition is complicated by a fracture. Often by the time we fracture it is too late to slow the progress of Osteoporosis and it must be remembered that this is a condition that is almost impossible to reverse in most people.

Why would you need a Hip Replacement? What options are available?
The hip is one of our joints that is prone to wear out with age and injury. This commonly produces pain, the main reason we replace hips.

Hip replacement is a replacement of joint surfaces returning the ball and socket to a round shape with very low friction.

This is one of the most successful operations in all of medicine, with a hip replacement lasting more than 25 years over 90% of the time and more than 90% of people being happy with the result.

The options available relate to how the replacement is seated in the bone, what materials the lining surfaces are made of, which is the part that wears out if it does wear out, and the method by which the replacements are put in.

The surface bonding the bone can be press fit, which means the components are hammered into the bone as a nail is into timber, or they can be cemented, or grouted, in.

Neither of these in most cases has any real advantage.

The lining surfaces can be ceramic, metal or plastic.

Metal on metal hip replacement had very poor results in the last decade and have mostly been removed from the market due to high failure.

The most common combinations now are metal on plastic, ceramic on plastic or ceramic on ceramic. No one combination at the moment is definitely superior to any other, and all should be considered where appropriate.

There are three methods of putting the hip replacement in, with a cut at the back, on the side or at the front.

There is a trend to put in them in from the front at this time, which is a much smaller incision that does not cut any muscle, it just moves them aside, and tends to have people mobilising much faster.

Most studies show that for the first three months this is the least painful way of performing hip replacement, but all replacement methods after that three month period fall into line and there is no long-term advantage of any method.

More than 45,000 hip replacements were inserted in Australia last year.

Why would you need a Shoulder Replacement? What options are available?
Pain.

The need for a shoulder replacement is very similar to hip replacement. Once again, this is a pain relieving procedure used in people whose shoulders don’t function and have significant pain and problems.

The options available are principally an anatomic shoulder or conventional, where the ball and socket are replaced with a ball and socket of the same size and configuration, or a reverse shoulder replacement.

Some people have very damaged tendons around the shoulder, which makes the shoulder unstable, and there is a method where the ball is replaced with a socket and the socket is replaced with a ball, which very reliably takes the place of the tendons, and muscles that are lost. In Australia last year, more reverse shoulder replacements were used than anatomic shoulder replacements for the first time.

Current options for shoulder replacement have only been available for 15 years and the number that have survived to 15 years is the same for both the anatomic shoulder and the reverse shoulder at around 92%, very similar to knee replacement results.

Last year 5,756 shoulder replacements were performed in Australia.

How can I build and maintain healthy bones?
We start with a set amount of bone and then lose bone at a predictable rate, with osteoporosis not becoming obvious until there is a broken bone.

In the early year's good nutrition and weight bearing exercises are the best way to build healthy bones, and the more weight bearing exercise we do, the more bone we start with in our adult years. This exercise is up to the age of 25.

An important thing to do as an adult is to identify those people most at risk of developing osteoporosis in order to try and predict who we need to worry about most.

We identify these people through risk factors such as family history of osteoporosis, early menopause, (as we lose more bone after menopause and early menopause means we start losing more bone earlier), excessive use of steroid hormones such as Cortisone, heavy alcohol use, those with malnutrition or imbalances particularly involving calcium and simply being female.

In people with risk factors, bone density testing is usually government subsidised, helping us to identify those at most risk.

Once we identify those at most risk they can be treated specifically with bone strengthening drugs, which have limited success at reversing osteoporosis but will help limit the bone density loss.

Simple calcium supplements can also be of benefit and in milder cases, this is what we usually use.

In all of us, just maintaining a healthy diet, particularly rich in calcium to those of concern, is a very good way to help limit unnecessary bone density loss.

If you have any concerns or doubts please consult your health care professional.

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