Osteoporosis

What is meant by osteoporosis?

Our bones are made up of a strong outer shell and a honeycomb-like centre in which blood vessels and bone marrow lie. When these tiny holes inside the bone become bigger it becomes weaker, more fragile and so more likely to break. The process of the bone becoming fragile in this way is osteoporosis.

Who is at risk of osteoporosis?

For most people, bone loss as a natural part of ageing does not begin until after the age of 35. This loss is often accelerated in women around the time of the menopause, although both men and women can develop osteoporosis. Since people are generally living to an older age, old age remains the key reason for the rise in osteoporosis, but other risk factors in women include early hysterectomy (surgery removing a woman’s womb) menopause, or missed periods for more than six months due to anorexia or over-exercising. The long-term use of steroid tablets (for conditions such as asthma or inflammatory bowel disease) increases the risk, as does smoking, heavy drinking, immobility or a family history of hip fractures. Having osteoporosis does not automatically mean that your bones will break, it just means that you have a ‘greater risk of fracture’. Thin, fragile bones in themselves are not painful but the broken bones that can result can cause pain and other problems. What are the symptoms?

Because bone thinning cannot be felt or seen, most people with osteoporosis are not aware of any problem until they suffer a fracture, and as such it can genuinely be called a ‘silent’ disease. Although X-rays will readily show up broken bones, osteoporosis will only become apparent when at least 30% of the bone density has been lost. This means more accurate assessment is needed and so a bone density scan called a Dual Energy X-ray Absorptiometry (DXA) scan is often used, to show whether or not bone thinning is present. This scan is recommended for people who are at high risk of osteoporosis and results of these scans show how your bone density compares to the average for your age and sex. Osteoporosis does not generally slow or stop the healing process, so bones that break because of osteoporosis will still heal in the same way as they do in people who do not have osteoporosis, which is usually in about six to eight weeks.

What are the risk factors for osteoporosis?

Genes; our bone health is largely dependent on the genes we inherit from our parents. In fact, if one of your parents has broken a hip, you may be more susceptible to developing osteoporosis and fragile bones.

Age; bone loss increases in later life so by the age of 75 about half of the population will have osteoporosis. As we get older bones become more fragile and more likely to break.

Gender; women have smaller bones than men and they also experience the menopause which accelerates the process of bone turnover. The female hormone oestrogen has a protective effect on bones. At the menopause (normally around the age of 50) the ovaries almost stop producing this hormone reducing the protection it gives to bones.

Race; studies show that people who are Black Afro Caribbean are at a lower risk than other groups because they tend to have bigger and stronger bones.

Low body weight; if you have low BMI (body mass index) below 19g/m2 you are at greater risk of developing osteoporosis.

Previous fractures; if you have already broken bones easily, including in the spine, then you are much more likely to have fractures in the future.

How can I strengthen my bones?

The first way to begin strengthening your skeleton is with a ‘bone friendly diet’, rich in calcium, using sources such as cheese, milk and yoghurt. Low-fat varieties contain just as much calcium as the fuller fat varieties, and do not forget that bread, green leafy vegetables, bony fish and tofu are also rich in calcium. Take care not to eat too much salt or drink lots of caffeine-containing drinks as these can reduce calcium absorption. Vitamin D is needed to help calcium uptake in the body, and sunshine is the best source of this – enjoying 20 minutes of sunlight daily during summer can enable the body to store enough vitamin D to last the rest of the year – just remember to wear sun protection to prevent skin damage. If diet is a problem for any reason then calcium supplements are an acceptable alternative.

Exercise also plays a key role in keeping bones strong and healthy. This can range from brisk walking to swimming or cycling, but whatever activity you choose, it is important to excercise for at least 20 minutes 3 to 4 times a week. Even jumping on the spot 50to 60 times a day can increase bone density in pre-menopausal women.

What is the treatment for Osteoporosis?

Unfortunately for all of us, once bone has been lost it cannot be replaced completely and treatment is therefore always aimed at helping to prevent further bone loss. There is currently a range of treatments available including hormone replacement therapy, calcium and vitamin D supplements and for men with osteoporosis, testosterone treatment. . Biphosphonates are non-hormonal treatments that work by switching off the cells that break down bone, and selective estrogen receptor modulators (‘SERMs’) are new synthetic hormones that work to reduce bone thinning but which do not increase the risk of breast or womb cancer.

There are few conditions where the term ‘prevention is better than cure’ applies more accurately than for osteoporosis. Fortunately, a healthy lifestyle is the best medicine for most people and a prescription for sunshine, exercise and a sensible diet is the best one.