The fragile bone condition osteoporosis can affect anyone, but women are four times more likely than men to develope the condition,which can lead to painful fractures and breaks from minor falls.
Most of us take our bone health for granted, giving it little thought until we have a fracture. After the age of 35 we all lose bone density and whilst this is a natural part of ageing, for some people this can result in osteoporosis. This is where the bone loss results in damage to the honeycomb structure within bones, making them weak and prone to breaks. By the age of 75 half of the population will have osteoporosis.
Three million people are estimated to have osteoporosis in the UK and between them they suffer around 250,000 fractures a year. These fractures mainly occur in the spine, wrist and hips but also in the arms and pelvic area. Osteoporosis is more common in women, but men get it too – which is sometimes overlooked.
What are the symptoms?
‘Osteoporosis is known as the silent epidemic because people who have it don’t realise they do until a bone breaks,’ says Dr Nicola Peel, consultant and clinical lead at the Northern General Hospital’s Metabolic Bone Centre, Sheffield.
‘We don’t screen for osteoporosis routinely in the UK but we now have a screening tool called FRAX which can assess your risk of having a fracture in the next 10 years.
‘If your risk is assessed as high you can discuss with your GP whether you need treatment or further investigation with a specific type of scan called a DXA scan which measures your bone density.
‘If you break a bone after the age of 50 from a low impact fall – it should be investigated – ideally by a fracture liaison nurse. You shouldn’t have to wait until you’ve had several breaks before your bone density is investigated.’
Know your risk factors
Risk factors for osteoporosis include age, but also the following:
• History of previous fractures: Especially from a low impact fall – from standing height or less after the age of 40.
• Premature menopause in women: If you’ve had a premature menopause before age 45 or had a hysterectomy where your ovaries were removed before age 45 you may be at risk of osteoporosis because of low levels of the female hormone oestrogen which protects you against bone loss.
• Family history: A first degree relative (mother, father or sibling) with a history of hip fracture before the age of 75. ‘It’s important to remember that men are affected by family history too,’ says Dr Peel.
• Corticosteroid treatment: Long term treatment with high dose steroids for conditions such as asthma and arthritis can also put you at higher risk.
• History of rheumatoid arthritis (RA) or other inflammatory diseases: These include not only RA but other types of inflammatory arthritis and inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.
• A history of eating disorders which interrupted your menstrual cycle: The lower levels of oestrogen may have affected your bone density.
• Being underweight: If you have a body mass index of less than 19kg/m2 you’ll be at greater risk of developing osteoporosis.
There are a number of drugs available to slow down bone loss and one treatment which can build bone mass.
Drugs which slow down bone loss include bisphosphonates, which maintain bone density and reduce fracture risk. These include alendronate, ibandronate , risedronate and zoledronic acid.
‘Alenodronate is usually the first line treatment and is taken once a week usually with a calcium and vitamin D supplement,’ says Dr Peel.
‘If patients suffer side effects though or don’t respond well, the second line treatments include weekly risedronate or ibandronate which is taken once a month. Another option would be an injection of denosumab once every six months. This works by blocking a chemical which breaks down bone.
'Other drugs including strontium ranelate and raloxifene can also maintain bone density but are not suitable in some patients.
‘Injections of parathyroid hormone (Teriparatide) can build bone density. This treatment is considered in patients with severe osteoporosis, particularly when this has led to multiple spinal fractures.'
There are a number of ways to help protect your bones against osteoporosis. These include:
• Eating a healthy diet: ‘It is increasingly recognised that eating a diet rich in fruit and vegetables is important for bone health,’ says Dr Spiller. ‘This is because they alter the way acid is handled in the body.
Your diet should also include calcium-rich foods such as milk and dairy products, dried fruits, fish such as pilchards and sardines and leafy green vegetables.
• Getting enough vitamin D: If you are at risk of deficiency or a blood test reveals your levels of the “sunshine” vitamin D are low (most of your vitamin D is made in your body after contact with sunlight), your GP may recommend a supplement.
• Taking weight-bearing exercise: Weight-bearing exercise includes brisk walking, jogging and aerobics. ‘This is less effective in building bone in post menopausal women who already have osteoporosis but more effective in preventing osteoporosis in younger women,’ says Dr Peel.
• Repetitive weight training: Lifting weights in the gym helps strengthen your muscle and bones.
• Not smoking: Smoking increases your risk of having a fracture.
Coping with osteoporosis
Osteoporosis can result in painful fractures: hip fractures involve a lengthy recovery period and where vertebrae in the spine fracture, this can cause height loss and increased curvature of the spine.
Bones usually heal within 6 to 8 weeks but pain, especially after spine fractures, can persist for much longer. The National Osteoporosis Society says painkillers, physiotherapy, hydrotherapy (where you exercise in water) and TENS machines may help you cope with the pain.
Severe pain after spine fractures can sometimes be helped by techniques to augment vertebrae in the spine: percutaneous verteblasty is where a needle is used to inject surgical cement into the vertebrae if you have compression spinal fractures, kyphoplasty involves inserting a small balloon into the fractured vertebrae, which is then partially inflated to correct the vertebral height before the cement is injected.