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Animated Edition - Issues 1996 - 2001
Bare bones - the facts about the silent epidemic: osteoporosis
Animated, Summer 2000. Whilst the issue of dancers' health is not new, our (and indeed the public's) expectations in terms of heightened athleticism and physicality coupled with our aspirations as artists, choreographers, practitioners and teachers for a longer and healthier career (and the dance manager's concern to exercise their duty of care and to take action to minimise the risk of injury and illness) are all gathering momentum. One of the most prominent issues facing us all is bone health. Dr Nicola Keay highlights the findings of two research studies, The Retired Dancer and Dancer's Entering Full-time Training which showed that optimum levels of training, a balanced diet, and for women, regular periods, are essential for good bone health. So, if you think it does not affect you ... read on, "One person every three minutes in the UK fractures a bone due to osteoporosis ..."(1)
Healthy bones are essential, especially for those of you involved in dance, as your skeleton is the scaffolding supporting your body. Bone is brilliantly engineered, as strong as steel and yet light enough to dance with. But, it is living tissues that you need to take care of for life. Bone is not static, but constantly changing, responding to exercise, nutrition and hormones. By your mid 20s it reaches its maximum strength and density.

The silent epidemic: osteoporosis
Osteoporosis is a condition where bones become thin and brittle - the internal architecture of the skeleton or inner mesh - becomes porous and holey. Such bones are prone to stress fracture, osteoporotic (or fragility) fractures and deformity. In fact, osteoporosis is often silent until the first fracture. How many of you have, or know someone who has, had a broken wrist or compression fracture of the spine? Osteoporotic fractures can occur with very little force, perhaps as you land from a movement or even just bending down to pick something up, resulting in debilitating injuries.

Osteoporosis is on the increase. One in three women and one in 12 men suffer with osteoporosis in their lifetime. But if you thought this is a condition confined to old age, think again. Dancers and young people involved in dance can also be at risk of developing this debilitating condition, primarily because of your lifestyle and the prevalent body image of paper thin, malnourished physiques. Prevention is far more effective than cure. In order to avoid fragile bones, it is never too early to treat your bones well.

During childhood and adolescence, bone increases in size and density. This is an ideal time to start boning up. Although there are pressures for young dancers to be thin (perpetuated by the dictates of fashion and the media) and to smoke and drink alcohol these are exactly the factors which will have a harmful effect on bones. This early damage can be permanent.

As an artist, practitioner or teacher involved in dance, you might think that your bones are healthy from regular exercise. However, a hectic lifestyle can mean erratic eating patterns and being under-weight. In this situation, male dancers risk low levels of the male hormone, testosterone, and there is some evidence to show that this can lead to weakening of bones. In women, low body weight leads in a drop in oestrogen levels (the female hormone) causing periods to stop (a condition known as amenorrhoea). This means bones become thinner (especially if periods have stopped for more than six months). So although it might be convenient not to have periods, in fact this puts you at risk of fracture and the early onset of osteoporosis. Any damage to the internal architecture of bone is irreversible so bone fragility persists even after stopping dancing. Without periods the bones of a young dancer in her 20s can be as weak as those of a 70-year-old.

Unfortunately, treatment with the combined contraceptive pill is not very effective. The best way for healthy bones is to find a balance between training, diet and body weight. Periods are then more likely to be regular and bones to be stronger. Strong, healthy bones are vital for a successful career and enjoyable life.

A special note for mothers! Breast feeding puts a big nutritional demand on your body - bone density is lower during pregnancy and whilst breast feeding. New babies are hard work (I speak from experience!) and it can seem difficult to find time to consider your own health. But you need to, for you and your baby. Breast feeding is an excellent start for babies, but remember you need to be in good health too to be able to produce good quality milk!

Menopause is the time when periods stop, around 50 years of age. This change is associated with a rapid loss of bone density (about four per cent) and increased risk of heart disease. In order to offset these changes, you need to continue regular exercise. There are also a number of treatments available for those at risk of osteoporosis including Hormone Replacement Therapy (HRT) as it maintains oestrogen levels strengthening bone and helping to prevent bone loss and fractures.

In older age, regular weight bearing exercise continues to be of benefit to bone strength. Exercise also helps maintain muscle tone and balance to protect against falls, which is when many fractures occur. Maintaining healthy eating is also important, in particular your intake of calcium and vitamin D.

Healthy bones are essential to all those involved in the dance world. Bones need feeding, exercising and balanced hormones. Do not take your skeleton for granted, or it may suffer. Wise up, bone up?

Dr Nicola Keay MRCP, Research Endocrinologist, Kingston Hospital

Reference
1 Healthy, The Holland & Barrett Magazine, May/June 2000

National Osteoporosis Society +44 (01761) 471 771 or Email info@nos.org.uk Website www.nos.org.uk

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Animated: Issues 1996 - 2001