Osteoporosis is a major public health problem. It costs the NHS £1.7 billion a year in diagnosis and treatment, that's £5 million each day. Osteoporosis affects many more women than men - striking 1 in 3 women over the age of 50 in the UK and 1 in 12 men. And osteoporosis isn't just a matter of brittle bones. It can kill. In fact it is a bigger female killer than ovarian, cervical and uterine cancers combined.

But the biggest problem is that osteoporosis is so often a 'silent disease', bone loss happens gradually over time, without any symptoms. Osteoporosis, at the moment, remains woefully unrecognised and yet it is preventable and treatable.

What is Osteoporosis?

Bone is living tissue, which is constantly being broken down and replaced. Old bone tends to be weak so this renewal (termed "remodeling") is vital for bone strength. Remodeling involves two different kinds of cells and several hormones. It is characterised by a process called 'coupling' where old or damaged bone is slowly dissolved by cells called "osteoclasts" and the cavity this creates is filled by new bone created by other cells called "osteoblasts".

Risk Factors

There are a number of risk factors for osteoporosis and these include:

• Family history of osteoporosis
• Yo-yo dieting, or an eating disorder such as anorexia or bulimia
• Irregular menstrual cycles or long gaps between periods when younger
• Postmenopausal
• Premature menopause
• Total hysterectomy
• Certain medications - steroids, heparin, anticonvulsants, diuretics, long-term laxatives or antacids
• Thyroid illness
• Smoking
• Physically inactive
• European or Asian descent
• Digestive problem, Crohn's, ulcerative colitis or Coeliac's disease
• Exercising too much
• Being a woman!

Testing for Osteoporosis

These are the tests most commonly used to assess bone health.

1. DEXA Scan
A DEXA scan (Dual Energy X-ray Absorptiometry) is a machine that uses two X-ray energy beams simultaneously to measure hone density. A DEXA scan does have some drawbacks in that it exposes the person to X-rays and the other is the machine has to be operated by a radiologist and so is only available in too few specialised units.

 2. Quantitative Ultrasound Scan (QUS)
In a QUS, sound waves are passed through the heel (calcaneus) bone which, like the hip and spine, is rich in trabecular bone. Recent research has shown that the QUS scan can predict those patients who subsequently go on to have a fracture as well as DEXA scans.

 3. Bone Turnover blood and urine tests
Another way of assessing bone health is to measure biochemical markers in urine that show the rate of bone resorption. Higher levels of these bone resorption markers, indicating higher bone turnover and higher bone loss, have been found to he associated with a two fold increased risk of osteoporotic fracture.

Nutrition and Osteoporosis

Scientists have looked at women and the incidence of hip fractures in different countries. The highest rate of hip fractures is found in Western countries that consume between 60 to 80g of animal protein per day. The lowest incidence occurs in Asian and African populations in which animal protein intakes are much lower.

One of calcium's roles in the body is to act as a neutralises The body uses calcium in the form of bicarbonate, an alkaline substance, to counteract the acidity and it does this by taking calcium from bones.

The ability to excrete acid declines with age, so this is especially important for women around the menopause, who are at greater risk of developing osteoporosis.

Vegetable foods are rich in organic salts like citrates that are metabolised into bicarbonates and reduce acid production. Recent research has concluded that the critical determinant of hip fracture risk is the amount of acid in the diet and that reducing the intake of animal food can help to protect against osteoporosis.

Supplements and Osteoporosis

The first nutrient that twines to mind is calcium. But many other nutrients are equally crucial for healthy bones, and these include magnesium, vitamin C, vitamin D, zinc and boron.

Magnesium helps to metabolise calcium and vitamin C and converts vitamin D to the active form necessary to ensure that calcium is efficiently absorbed. It is also essential for the normal function of the parathyroid gland which releases parathyroid hormone - one of the important 'bone hormones'. Vitamin C is vitally important in the manufacture of collagen, which is a son of "cement that holds the bone matrix together. In the digestive system, vitamin D is responsible for calcium absorption - it transports calcium across the wall of the intestines and helps to move both calcium and phosphorus into bones. Boron is an important mineral in relation to osteoporosis as it plays a crucial part in the conversion of vitamin 13 into its active form, which, in turn, is necessary for calcium absorption, and zinc is needed for the proper formation of osteoclasts and osteoblasts.

Osteoporosis is a preventable illness that requires a multi-disciplinary approach looking at lifestyle issues such as exercise (which is crucial), diet and supplements.

Dr Marilyn Glenville PhD is the UK's leading nutritional therapist specialising in female hormone problems. She is a Fellow of the Royal Society of Medicine and a registered nutritionist She has published six internationally best selling books on women's health. Her new book 'Osteoporosis - The Silent Epidemic' has recently been released and if you are a practitioner you can order copies of the book at trade price from the Nutri Centre by calling 0207 637 8436.

For more in depth information on many areas of women's health go to www.marilynglenville.com.

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