The poster presentations caused much discussion at the conference and not just amongst the clinicians present. Nurses had reason to voice their opinions too. According to one poster, many nurses who deal with broken bones need, and want, more education about osteoporosis. Nurses from A&E and other services were found to have knowledge gaps around osteoporosis risk factors, recognition, consequences, treatment and prevention. This could lead to those at high risk of fracture slipping through the healthcare net and going on to break bones. While the nurses in the study all had positive attitudes about their role in osteoporosis care and prevention, many lacked the confidence to act due to their knowledge shortfalls.  Nurses recognised the need for training and all requested further education on osteoporosis.

"Osteoporosis affects a great number of women and men and leads to painful and often unnecessary fractures," explains Trauma Specialist Nurse Alison Lorch, study author. "Despite increased advances in the prevention, diagnosis and treatment of osteoporosis, we are still failing to recognise many of those at risk. Nurses caring for these patients require adequate knowledge to help prevent needless fractures from occurring."

Diet During Pregnancy

Zoe Cole’s study showed that Mothers with a healthy, well balanced diet during pregnancy have children with stronger bones. In contrast, mothers with poorer quality diets had children with smaller and less strong bones when measured 9 years after they were born.

“This is the first study to show that mothers can improve their child’s bone development early on by consuming a good diet in the late stages of their pregnancy,” said Dr Zoe Cole, study author from the University of Southampton. “We reach our peak bone mass around our mid twenties so it’s vital that young people accrue strong bone before then.”

The nutritional status of the mothers was recorded in early and late pregnancy using a validated food frequency questionnaire. A statistical technique called “principal component analysis” was used to reveal the most common patterns of diet. Two main patterns emerged- Firstly, a healthier pattern, characterised by high intakes of foods such as fruit and vegetables, yoghurt, wholemeal bread and breakfast cereals (corresponding closely to recommendations from Department of Health). Secondly, a less healthy pattern comprisinghigh intakes of foods like chips and roast potatoes, sugar, white bread, processed meat, crisps, tinned vegetables, and soft drinks was apparent. The children were followed up at age 9 years for an assessment of their bones.

Mothers who followed the more healthy pattern in late pregnancy had children with significantly increased bone size and density, thus with stronger bones. Children born to mothers with the healthiest diets had 11% greater bone calcium content and 8% great whole body bone area than those born to mothers who had the poorest patterns of dietary intake.

 “Bone mass determines bone strength and studies suggest that a lower bone mass when we are young will affect bone fragility in later life,” explained Dr Cole. “An unhealthy diet during pregnancy may have huge ramifications for the unborn child’s future bone health.”

Low Income

Having a lower than average income may have long-term effects on bone health, according to Vassant Hirani’s research. The study shows that people in Britain with a low income, or who are materially deprived (which was defined according to their personal possessions), have lower average levels of vitamin D than the general population. The study authors recommend national prevention strategies addressing poor vitamin D status in the wider adult population, but particularly in deprived populations.

“Our study has highlighted a worrying link between lower incomes and vitamin D status,” said study author Vasant Hirani of UCLMedicalSchool, London. “Sufficient vitamin D is crucial for good bone health and a deficiency can lead to osteoporosis and an increased risk of fractures. Evidence suggests that vitamin D may also play an important role in the prevention of diabetes, cancers, heart disease and other non-communicable diseases. The future impact of low vitamin D levels is likely to be phenomenal, leading to a poor quality of life and accelerating cost implications for the NHS.”

Vitamin D is a fat-soluble vitamin which acts like a hormone, regulating the formation of bone and the absorption of calcium. It helps to control the movement of calcium between bone and blood, and vice versa. To keep bones strong we need to get enough vitamin D. While you can get some of your vitamin D from food, the majority comes from the action of sunlight on the skin.

“Low-income adults can be subject to a range of health inequalities and more needs to be done to address these problems, particularly in the current economic climate,” said Nick Rijke, Director of Public and External Affairs for the National Osteoporosis Society. “Further research will help us determine the causes of vitamin D deficiency in this group, but the good news is that we can get most of our vitamin D for free by getting 10 minutes of sun exposure twice per day in the summer months, taking care not to burn.”

With over 1,000 attendees, Monday was a busy day at the Osteoporosis Conference 2009 in Manchester. Falls and Vitamin D took the spotlight with lively presentations on both topics.

Falls

Marion McMurdo shocked the crowds with her mission to ban the ‘F-word’ from the conference. Delegates were confused until she explained that she was referring to ‘falls’. She felt that the word ‘falls’ should be replaced with something more positive. Her view is linked to the negative connotations which can be portrayed when doctors use of the term ‘falls patients’. This puts the emphasis on the person who has fallen, as if it were their fault for not taking care. Falling is often seen as an accident through lack of concentration. However, many falls can be prevented. Falls often occur in the context of medical issues and risk factors, the causes of which can be minimised or managed. So should doctors be doing more?

Marion McMurdo believes that effectively preventing falls and fractures relies on one team of experts addressing and recognising the reasons why someone may fall in the future. This same team can then actively manage the risk and make changes to prevent a fall, rather than referring someone to other medical teams.

She believes we need to focus on bone health and fall reduction in a combined effort. Her presentation promoted exercises which are specifically designed for this. For example, she believes exercises which challenge balance would be beneficial, such as the heel rise, rather than recommending just any exercise as a general measure.  

Vitamin D

Reinhold Vieth gave us a brief history of bones, explaining how they evolved from a simple calcium storage device into magnificent supporting structures. He was adamant that more needs to be done to address bone health in teenagers, a vital age when we are still building bone strength. Once we have reached our peak bone mass, in our twenties, the emphasis shifts to maintaining the bone strength we have accrued in our youth, so reaching teenagers really is key. He also had some interesting advice on getting enough vitamin D, the sunshine vitamin. He felt that it was vital to get out in the sun while it was directly above us, as this is the best time to soak up the much needed rays. He said that shadow length could help us identify the right time of day. If your shadow is longer than your height, the sun is too low and vitamin D will not be produced, he advised. But take care not to burn!

Cortical Bone

Other interesting facts came from Serge Faerrari who believes that cortical bone strength (the outer shell) is important in hip fractures and that trabecular bone (the inner mesh) may only account for 7% of the bone’s resistance to fracture.

Case Studies

Mike Stone presented various case studies showing us a wide range of people affected by osteoporosis. He used the story of a 53-year-old company director to illustrate difficulties in taking medications tied to food intake. With a busy schedule and late business dinners, she found medications difficult to fit around her erratic routine. An 82-year-old case study highlighted the fact that those over 80 are often excluded from important clinical trials which are used to help doctors determine the best medicines. This can leave treatment choices more difficult without the guidance of study data.

A Warm Welcome

After an exciting day of presentations and learning, welcome drinks offered a chance to relax and catch up, but osteoporosis was still top of the agenda. Discussions continued well into the evening with delegates expressing their views and debating what had been presented. While some issues have agreement from all, there are plenty of areas where more research is needed. Osteoporosis is an evolving field and we have much to do to educate people about prevention, diagnosis and treatment.