Health & Well-being 
Healthy People Osteoporosis
QUICK FACT
Around 3 million people in the UK have osteoporosis.
QUICK FACT
One in two women and one in five men in the UK will suffer a fracture after the age of 50 - mainly because of osteoporosis.
QUICK FACT
The lifetime risk of fracture in women at the age of 50 years is greater than the risk of breast cancer or cardiovascular disease.
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Guide to Osteoporosis
What is osteoporosis?
Osteoporosis, literally meaning 'porous bones', is a condition in which the bones lose substance, gradually becoming weak and fragile and more likely to break. Whilst some loss of bone substance occurs naturally with ageing in all individuals, this loss reaches significant proportions with osteoporosis - and if not treated can progress painlessly until a bone breaks.
Although most commonly a condition of older age, anybody can be affected by osteoporosis. Fractures of the spine, hip and wrist are most typical and the cause of most concern.
In terms of symptoms, the thinning of the bones in itself does not have a great deal of effect. However, it does lead to an increased risk of easily broken bones and in fact the bones of the spine can collapse without any obvious cause. In general terms, all bones are more at risk in people with osteoporosis and falls as well as coughs and sneezes can lead to fractures.
What causes osteoporosis?
There are two types of cells that are constantly at work in our bones, ones that build up new bone and others which break down old bone. Old bone is reabsorbed and new bone laid down all the time, resulting in about 10% of the bone in our bodies being replaced every year. However, when more bone is reabsorbed than is laid down thinning of the bones (loss of bone mass) occurs.
The substance of the bones (bone mass) builds up to a peak at about 30 years of age as the construction cells work harder building strength into our skeleton. After that the demolition cells take over and we gradually lose bone mass by about 1% each year. Whilst this is a natural part of aging, in some cases this loss reaches such significant proportions that osteoporosis develops. The first sign is commonly when a minor bump or fall causes a bone fracture.
Who is at risk?
As previously mentioned, osteoporosis occurs mostly in women over the age of 50. This is because bone loss speeds up after the menopause. In women the risk is increased if they have early menopause, have their ovaries removed before menopause, have abnormal menstrual periods, or if over-exercising or dieting. For men, low levels of testosterone increase the risk.
Other factors which are associated with osteoporosis include:
- hormonal problems
- digestive or gastrointestinal problems
- arthritis and joint disease
- cancer and malignant diseases
- certain medications
- smoking
- alcoholism
- family history.
There are also times when osteoporosis occurs in both older and younger people where no specific cause is identified.
The consequences of osteoporosis
Osteoporosis can affect people in a number of ways:
- Pain - the broken bones, which can happen without any obvious cause, can lead to severe pain and can last for several weeks and even months.
- Dependency – people, in particular the elderly, who develop a fracture become more dependent on others to look after them. This may result in an independent person needing long term support at home, or even having to go into a nursing home.
- Mortality - with a 20% increase in mortality in the first year after a broken hip, the mortality is greater than that of cervical cancer.
- Knock-on effects - the gradual collapse of vertebrae leads to increased curvature of the spine and loss of height. If the spine becomes deformed, other body parts may then also be affected. For example, the ribs can be pushed against the pelvis or the stomach can be pushed into the pelvis.
How do I know if I have osteoporosis?
Due to the nature of the condition it is difficult to diagnose as you can't see or feel your bones getting thinner. As such, people are often unaware of any problems until they break a bone or start to lose height.
If you think that you are at risk then you should talk to your GP. You may then be sent for a specialist assessment.
As well as an examination and blood checks there are tests which can give you a more definite bone density assessment.
The most common test used to measure bone density is called a DEXA (dual energy x-ray absorptiometry) scan. It is a painless procedure, involving a low dose of x-rays which measures how dense bones are. The specialist will then be able to tell you whether you have, or are at risk from, osteoporosis. There is a variety of treatment options if osteoporosis is diagnosed.
It is worth noting that even if the condition is diagnosed on a bone scan this does not always mean that you are at a high risk of breaking a bone at that time.
Treatment
Once the diagnosis of osteoporosis has been made, there are various forms of treatment that can help with the condition. Treatment will depend on the extent of bone loss, the individual's age, and whether or not fractures have occurred. Generally treatment is aimed at preventing further bone loss and replacing lost bone, if possible.
In order to lower the risk of further bone loss and fractures the following treatments may be recommended:
- In women who are at the menopause, or experience it early, the use of hormone replacement therapy (HRT) can help protect against bone loss.
- For men testosterone therapy can help strengthen bones.
- Biphosphonates – a class of drugs used to arrest the progress of osteoporosis and even reverse it. They encourage the laying down of calcium in the bones and can be very effective in the treatment of osteoporosis.
- Calcitonin – a hormone available as a nasal spray used as a long term, ongoing therapy.
- Calcium and vitamin D supplements.
- Selective oestrogen receptor modulator (raloxifene). This is prescribed for spinal fractures if bisphosphonates are not suitable.
- Pain relief. Strong pain killers (analgesics) may be required for quite some time in the event of an osteoporotic fracture.
Other, drug-free, ways to manage pain include physiotherapy and hydrotherapy (exercise in water) or using a TENS (transcutaneous electrical nerve stimulation) machine. Alternative therapies, like acupuncture, homeopathy, the Alexander Technique and aromatherapy, can also be of some benefit.
Whilst on treatment it is likely that you will require follow-up tests of bone density to monitor progress.
Prevention
As with many medical conditions prevention, where possible, is far better than management. Two of the most important preventive measures that should be taken are regular exercise and adequate intake of calcium.
Regular exercise
Like muscles, bones stay stronger the more they are used, so exercise is very important. The best form of exercise is regular, moderate, weight-bearing exercise such as walking as this helps to both maintain and increase bone mass.
Increase calcium in your diet
The bones in our body act as a storehouse for calcium. This calcium is essential for a number of bodily functions, including the process that maintains the hardness of bone. The bones use calcium and they also store reserves for when the body does not receive an adequate amount of dietary calcium or when the body needs additional calcium, as with pregnancy and breastfeeding.
Some other measures that you can take to help prevent osteoporosis:
- maintain a healthy alcohol intake
- stop smoking
- if you are a woman around the time of menopause, discuss HRT with your doctor
- if you are on long term steroids, check that your doctor has considered taking action to prevent osteoporosis.
If you have any concerns please do not hesitate in contacting your GP. There are also various other sources that you can refer to or contact for further help and information.