Osteoporosis: is a condition in which the bones become brittle. It can be very serious disease with the potential to cause many problems throughout life. Bones can break easily or spontaneously. Complications can lead to being confined to a wheelchair or worse.

Bone is active, living tissue. Every day, until about the age of 35 years, bones go through a remodeling process; being built up and torn down. After this age, we begin to slowly lose the minerals in our bones. Differences in bone content can be determined by several factors, namely: how much exercise done, how balanced ones diet is, and the amount of hormones we produce. There are several reasons why PWS children can develop this condition: (1) lack of hormones (2) lack of weight-bearing exercise and (3) lack of diets high in bone-building nutrients, calcium and other bone minerals.

If the proper actions are taken, the progression of this disease can be stopped or even reversed. The recommendations are also the best ways to prevent osteoporosis.

It is strongly suggested that all persons diagnosed with PWS have a bone density study done at the age 10 years and continue with regular follow-up testing.

Common drugs used include: hormone replacements (estrogen and progesterone for females), Fosamax (binds calcium into the bones). These should be combined with nutrient supplements and exercise.

You will probably not find a supplement with all of the needed components mentioned in the table below in it, but try to make up the difference. Use the table below to help you to make a suitable choice in supplement.

The easiest way of getting the nutrients needed, is by eating a balanced diet that is high in calcium, vitamin D, minerals and trace elements which promote growth of bone tissue. Eating foods high in specific vitamins / minerals and taking supplements will help to provide the essential nutrients.

Eating and drinking some types of food can "leach" the calcium and other minerals out of the bones. Avoid the following - refined flours and grains, sugar, caffeine and excess protein and phosphorus.

• Refined flours and grains are highly processed. The bran and kernel have been removed by milling, making the product ‘white’. Use whole or sprouted wheat and grains.
• Sugars come in many forms in many products. Avoid white sugar products like baking goods, soda, and ‘fun’ breakfast cereals.
• Caffeine is found in coffee, tea, cocoa, chocolate and even some medication. Use decaffeinated varieties.
• Phosphorus is found in red meat and cola-type beverages. Avoid the intake of excess protein, due to its phosphorus content, rather drink clear-colored soda beverages. Buy decaffeinated, diet Sprite and 7-UP.

The amount and type of exercise is important. Weight-bearing exercise is what is needed.

Weight-bearing exercise involves an action of supporting the weight of the body. Resistance training is also a form of weight bearing exercise. The easiest weight-bearing exercise for the lower body is walking, on flat even surfaces. It is also necessary to exercise the upper body. Free weights can be lifted, pushed or pulled to work all areas of the arms, back and shoulders.

Each exercise should be done as a ‘repetition’. A repetition is a series of the same movement performed over and over. Repetitions done with minimal weights will firm and tone muscles. Any form of exercise needs to be done at least 3 times a week for a minimum of 30 minutes. To begin, do 10 minutes 3 times a week, gradually increase the time for each session until the work-out is 30 minutes in total.

Good training results from exercise is the time spent doing it, the frequency of times and the intensity of the workout. Using exercise as a method to build stronger bones must be a lifetime commitment.

The daily recommendation for calcium is a combination of all calcium you take in, both from the diet and from supplements.

The latest recommendations are simplified as follows:

• Eat 3 low-fat dairy products a day + 200 mg from other sources = 1000-1200 mg
• For each calcium-rich food you don’t eat, get 300 mg from a supplement or a healthy calcium-fortified food like orange juice.
• Choose either calcium carbonate or calcium citrate malate as a supplement. Calcium citrate malate is the most easily absorbed and calcium carbonate is the most concentrated, making it the best value for money.
• Take calcium supplements with meals for best absorption, ideally in quantities of 500 mg or less.
• Effervescent tablets are sometimes absorbed better but are much more expensive, and one must remember that supplementation will be lifelong !
• Get enough vitamin D from milk, the sun or a supplement to boost calcium absorption.
• Reading supplement labels can be confusing because they are often not standardized. To locate the amount of usable calcium in a specific product, look for a quantity in milligrams (mg) labeled either "elemental calcium" or plain "calcium".
• Also important to pay attention to dose amounts or serving sizes.
• Avoid the so-called "natural" calcium supplements that are derived from oyster-shell shells, dolomite or bone meal, they may contain dangerous levels of lead.

(Reference: Osteoporosis, Calcium and PWS by Gail M. Thune, The Gathered View, July/August 1998)

• Water is very important to drink, any water-based drink is considered to be water, e.g. LOWCAL cool drinks, Rooibos tea, Soda water, flavored low cal mineral water. This excludes any caffeine containing drinks (coffee/tea/coke). If your children are not used to drinking water, help them to gradually get into it, it is a habit that you have to learn to do.
• It is the same as with the water, eating fruit, vegetables and salad is something they also need to learn to do. The best is to teach your children to eat these foods from a young age, especially when it comes to salads.

• Use LOW-Cal imitation cool drink to make ice-lollies.
• Make a chocolate milkshake with fat-free ice-cream and skim milk, cocoa and sweetener.
• Make a strawberry milkshake (420kJ/100kcal): Use the following ingredients:

The strawberries must be frozen to make the milkshake thick.

• Fat-free whipped ‘cream’ : can be served with fruit salad. In a bowl mix together one sachet fat-free milk powder, half a cup of ice-cold water and one teaspoon castor sugar. With a hand whisk or electric beater, beat until frothy and thickened. Serve immediately.