Colin Beevor Matron & Clinical Nurse Specialist

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1 Colin Beevor Matron & Clinical Nurse Specialist Love your Bones years

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3 How our bones work Pelvis Periosteum Cartilage Spongy bone Structural support for body and protection of organs Store for calcium and other minerals Movement Blood cell production Medullary cavity Femur (thigh bone) Compact bone 3

4 Osteoclasts and Osteoblasts

5 What is osteoporosis? Normal Bone Bones are fragile and more likely to break (or fracture) easily Fractures = broken bones Fragility fractures occur with minimal trauma Osteoporosis Fractures can lead to pain, changes in body shape and disability

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7 With life long bone health Life style choices With Treatment Without Treatment Benefits of life style choices

8 Your risk of a Osteoporotic fragility fracture Falls Alcohol > 3 units daily Other diseases & conditions Rheumatoid arthritis Parent broke their hip Smoking Glucocorticoids Bone density Age Previous fragility Body mass index fracture 8

9 Colin Beevor Matron & Clinical Nurse Specialist

10 A Woman is the axle around whom the family, society nay! The whole universe is revolving.so her health is of utmost importance at all stages of life more Dr.maninder Ahuja chairperson Geriatric gynaecology committee FOGSI

11 Life

12 Bone Mass

13 Life and

14 Life and

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16 Oestrogen and Bone Formation

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18 Oestrogen levels Causes of Early Menopause Amenorrhea

19 Causes of Early Menopause Amenorrhea Autoimmune Disorders Chromosomal Irregularity- Turners Syndrome Oophorectomy and Total Hysterectomy Ovarian Damage Due to Other Surgical Procedures uterine adhesions- post surgery Radiation Therapy and/or Chemotherapy Tamoxifen Polycystic Ovarian Syndrome Family History (5% risk if mother/ grandmother Viral Infections- effecting unborn daughters ovary development Thyroid Disease: Hyperprolactinemia Pituitary and/or Hypothamic Disorders Cushing's Disease:-overactive adrenal glands Excessive weight gain or weight loss Medication-psychiatric and certain narcotics Excessive exercise; Birth control pills -it's not uncommon to stop getting periods for up to six months after discontinuing the pill. Smoking

20 Menopause The average age for a woman to go through the menopause naturally in the UK is 51, although symptoms such as periods stopping may often start between 45 and 55. Estimates say:- 1% of women go through the menopause under 40 and 0.1% go through it before they are 30.

21 Risk of Fracture

22 Breast Cancer Incidence of breast Cancer and mortality rate Breast Cancer Mortality Rates

23 Breast cancer treatment and bone health Both women who haven t yet gone through the menopause (premenopausal) and women who have gone through the menopause (post-menopausal) may have an increased risk of osteoporosis related to breast cancer treatment. Chemotherapy- can affect the function of the ovaries, causing an early menopause in some women. - Women aged 45 or under whose periods have stopped for at least a year as a result of treatment may also be at risk of osteoporosis, even if their periods restart. Some research has shown that post-menopausal women who have chemotherapy may notice greater loss of bone density than they would have had without chemotherapy.

24 Ovarian suppression- is when the ovaries are removed, or temporarily or permanently stopped from working. This means there s less oestrogen in the body to stimulate the cancer to grow, which can also reduce bone density. Ovarian suppression can be done using a type of hormone therapy, surgery or radiotherapy. Tamoxifen- be given to both pre-menopausal and post-menopausal women. It blocks the effect of oestrogen, which helps stop breast cancer cells from growing. In pre-menopausal women, taking tamoxifen may cause a slight reduction in bone density.- this is unlikely to lead to osteoporosis unless ovarian suppression is given as well. However, your risk may be higher if you re 45 or under and your periods have stopped for at least a year. In post-menopausal women, taking tamoxifen slows down bone loss and can reduce the risk of osteoporosis.

25 Aromatase inhibitors (including anastrozole, letrozole and exemestane) are mainly used to treat breast cancer in postmenopausal women. These drugs reduce the amount of oestrogen circulating in the body, which can reduce bone density. Some pre-menopausal women have an aromatase inhibitor at the same time as ovarian suppression. Having these two treatments can reduce bone density. The likelihood of developing osteoporosis while taking aromatase inhibitors also depends on how healthy your bones were before your breast cancer treatment.

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27 Ask our Breast Care Surgical Team,Oncology & Radiotherapy Team or our GP about Osteoporosis Prevention after breast cancer

28 Life and

29 Smoking Cigarette smoking was first identified as a risk factor for osteoporosis decades ago. Studies have shown a direct relationship between tobacco use and decreased bone density.

30 Smoking Analyzing the impact of cigarette smoking on bone health is complicated. It is hard to determine whether a decrease in bone density is due to smoking itself or to other risk factors common among smokers. For example, in many cases smokers are thinner than non-smokers tend to drink more alcohol may be less physically active have poor diets. Women who smoke often produce less oestrogen and tend to experience menopause earlier than nons mokers These factors place many smokers at an increased risk for osteoporosis apart from their tobacco use.

31 Passive Smoking At least one study suggests that exposure to second-hand smoke during youth and early adulthood may increase the risk of developing low bone mass.

32 Smoking and fracture healing Smokers who fracture may take longer to heal than non smokers and may experience more complications during the healing process.

33 E Cigarette I smoke and want to stop and have wondered about swapping to e-cigarettes. Can you tell me whether these have the same adverse effect on bone health as conventional tobacco cigarettes? Answer- There is a consensus view that e-cigarettes might in general be less harmful especially in terms of conditions that affect the lungs and the heart than smoking tobacco (which contains many other toxic additives). This does not mean, however, that smoking e-cigarettes is safe. E-cigarettes have not been studied for long enough to determine whether they increase a person s risk of osteoporosis and fractures in the long run. However, as they contain nicotine, which has adverse effects on bone, it is likely that they will have some adverse effects also.

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35 Quitting smoking appears to reduce the risk of low bone mass and fractures. However, it may take several years to lower a former smokers risk. Stop smoking service Wellbeing Service wellbeing@portsmouthcc.gcsx.gov.uk NHS national helpline

36 Alcohol and Osteoporosis Drinking can deplete your calcium reserves. Alcohol can raise your Parathyroid Hormone (PTH)- which is an important regulator of your body's calcium and phosophoros levels. Increased alcohol causes a rise their PTH levels can remain elevated. That puts a strain on the body's calcium reserves. Since your bones are a major calcium reserve-loosing calcium from our bones. Drinking can prevent your body from absorbing calcium from food. Alcohol interferes with liver enzymes that are necessary for converting the inactive form of Vitamin D into the active form. Without sufficient active Vitamin D, your body can not absorb calcium from your gastrointestinal tract.

37 Alcohol and Osteoporosis Excessive drinking often damages the pancreas, a source of some of the enzymes that help you digest food and absorb Vitamin D, calcium and other nutrients. Alcohol's ability to increase your levels of Cortisol. Cortisol, the stress hormone, reduces the work of osteoblasts and so less bone is formed. It also increases the work of osteoclasts and so more bone is resorbed (removed).

38 Alcohol and Osteoporosis It appears that alcohol poisons osteoblasts while at the same time it stimulates osteoclasts.. This is a serious Osteoporosis alcohol connection since it means means that less new bone is formed by your Osteoblasts & at the same time that additional bone is being removed/resorbed by your Osteoclasts. Drinking often has a negative effect on your hormones. In women, excessive drinking can interfere with their menstrual cycle. Irregular periods lead to bone loss.

39 Alcohol and Osteoporosis Other Associations Those who drink significant amount of alcohol tend to have lower body mass index Replace calcium rich drinks with alcoholic drinks Tend to smoke/ passive smoke more Fall more frequently

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43 Review your alcohol intake Telephone: Civic Offices Guildhall Square Portsmouth, Hampshire, PO1 2AY Website:

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45 Guidelines for adults aged To stay healthy, adults aged should try to be active daily and should do: at least 150 minutes of moderate aerobic activity such as cycling or fast walking every week, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms) Or 75 minutes of vigorous aerobic activity, such as running or a game of singles tennis every week, and strength exercises on two or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).

46 Mixture of moderate and vigorous aerobic activity A rule of thumb is that one minute of vigorous activity provides the same health benefits as two minutes of moderate activity

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49 Lets get active Independence &Wellbeing Team Scheme co-ordinator

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