Wednesday 28 September 2016

When bones and eyes start to degenerate

Ask the GP...

Nina Byrnes

Published 12/07/2016 | 02:30

In Ireland, there are 300,000 people with osteoporosis but only 20,000 are diagnosed.
In Ireland, there are 300,000 people with osteoporosis but only 20,000 are diagnosed.

Q: I went to my doctor for an asthma check lately. She started talking about osteoporosis and said she was worried about my bones. I have been referred for some tests. I thought this only happened to women. Do I really need to worry about this?

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Dr Nina replies: Bones may seem inert but they are, in fact, living, changing tissue. It is estimated that our entire skeleton is remodelled every 10 years between the ages of two and 30. Peak bone strength is reached in our 20s and stabilises until our mid 30s.

From the age of 35 onwards, bone tissue breakdown increases and leads to an overall loss in bone density and strength. Maintaining good bone health starts in childhood and continues for the rest of your life.

Calcium and vitamin D are the two main minerals involved in bone health. Unfortunately, a large percentage of people don't meet their adequate daily intake. Nearly 40pc of children and 75pc of adolescents don't have enough calcium in their diet. Vitamin D deficiency is also very common, with about eight in 10 adults and primary school children having less than 50pc of recommended vitamin D levels.

Recommended daily doses of calcium vary according to age and sex, but it is roughly three servings daily (800mg) for children and adults, rising to five servings daily (1,200mg) for adolescents and women who are pregnant, breastfeeding or menopausal. The best source of calcium is from dairy products - other sources include green vegetables, pulses and breads.

Poorly nourished bones become brittle and weak leading firstly to osteopenia, then to osteoporosis (brittle bone disease). Osteoporosis affects one in two women and one in five men. It can also affect children. If bones are weak they can break easily, often with little or no trauma. Osteoporotic fractures are serious, especially in those over 60. Only 30pc of those over 60 who break a hip will regain full independence, 20pc will die within six to12 months due to secondary complications and 50pc will no longer be able to dress, wash or walk unassisted.

Women over 50 lose bone density rapidly at menopause but the rate in men also eventually catches up. The risk of earlier or more serious mineral loss is higher in those who are hormone deficient (menopause and testosterone), those with thyroid disease, a history of bone fractures, and a family history of osteoporosis.

Taking steroids over a prolonged period is an important and serious risk. Those who have needed steroids on and off for conditions such as asthma and arthritis are particularly at risk.

Lifestyle also plays a role. Smoking, excessive use of alcohol and having a low Body Mass Index or frequent dieting all increase the risk. Both men and women who have increased risks should be checked for osteoporosis.

A DEXA scan is a simple, painless X-ray that can diagnose osteoporosis. If your doctor feels other factors play a role, specific blood or urine tests may also be arranged.

There are things you can do to strengthen your bones. Take part in regular weight-bearing exercise. Ensure you get five portions of dairy daily. Vitamin D is important and hard to maintain if you don't get enough sun. Look for fortified cereals, yoghurt and milk, or consider taking a supplement. Maintain a healthy weight, stop smoking and keep alcohol within healthy limits.

If you are diagnosed with osteoporosis, you will also need other prescribed medication. Treatment may include tablets taken weekly or monthly. Other treatment includes an injection given twice a year or an annual intravenous infusion. Your doctor can decide which treatment is best for you. Adequate calcium and vitamin D is essential in combination with any treatment. Follow up DEXA scans will assess how the treatment is working.

Q. My mother was recently advised to start taking a vitamin supplement to protect her eyes. She has been diagnosed with macular degeneration and was told this can run in families. Should I do anything to prevent it?

Dr Nina replies: Macular degeneration (MD) occurs when the cells of the macula (the most light sensitive part of the retina) become damaged and stop working.

This most commonly occurs as part of ageing and the exact cause is unknown. It results in central visual loss. This deficit won’t cause complete blindness but central vision is necessary for reading, driving and recognising faces, so MD can be very debilitating.

Macular degeneration can run in families and is most common in those over 60. It affects Caucasians more than other races and is also more common in women. Lifestyle factors such as obesity, smoking, high blood pressure, high cholesterol and a diet low in fruits and vegetables also increase the risk.

There are two main types of MD. The most common one progresses slowly and initially symptoms may not be obvious. As the condition progresses, a person may notice difficulty adapting to or reading and working in low light conditions.

Printed words may appear blurred. Faces may become more difficult to recognise and colours may appear less intense or bright. Ultimately, vision becomes hazy and  blurred, or a blind spot occurs in the centre of vision. There is no cure for macular degeneration but treatment may prevent it from advancing. Research has shown that a combination of vitamins and antioxidants can slow progression.

A specific vitamin combination is recommended by the National Eye Institute of America. This includes 500mg vitamin C, 400 IU vitamin E, 10mg lutein, 2mg zeaxanthin, 25 milligrams zinc oxide and 2mg copper (cupric oxide). A diet high in veg (especially leafy greens) is recommended but it may be hard to obtain the high vitamin levels recommended with diet alone. In advanced cases, injections or laser surgery may help but prevention is better than cure.

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