Osteoporosis is a condition where the bones become thin and weak, and break easily. It frequently goes undiagnosed until a fracture occurs, as there are no warning signs. The spine, wrist and hips are particularly vulnerable to fracture.
Occasionally a person develops a dowager hump or kyphosis at the top of their spine due to collapse of the vertebrae, and notices they have lost height. But mostly the thinning bones remain hidden away inside the body, with no symptoms or signs to alert someone to the fact that they have osteoporosis, until a minor bump or fall causes a bone fracture such as a broken hip or a crushed vertebrae.
The break that results can cause pain, disability and loss of independence, or even prove fatal, especially when it leaves an older person immobilised. Only one in three people return to their level of function after breaking a hip and one in five will require long term nursing care.
It’s important to consider whether you’re at higher than average risk for osteoporosis, and seek help if you are. Ask yourself the following questions:
- If female, have you had the menopause?
- Was it premature, before the age of 45?
- Did you have an eating disorder severe enough to stop your periods?
- Have you had low trauma or spontaneous fractures in the past?
- Have you been told that previous x-rays suggest thinning of the bones?
- Have you lost height in the past ten years?
- Have you been on steroids for more than six months?
- Is there a family history of osteoporosis, easy fractures or ‘dowager’s hump’?
- Do you have chronic illness, such as thyroid disease, arthritis or bone disease, renal disease or hormonal problems?
- Have you been immobile for any reason?
- Do you smoke or drink a lot?
If you answer ‘yes’ to two or more of these questions, you may have osteoporosis or be at risk of it. See your GP who’ll send you for specialist assessment.
The bones are a living tissue, just like the rest of the body. They consist of cells which both build and break down bone, within a surrounding substance known as the extracellular matrix which is composed of proteins and mineralised components (it’s rather like a scaffolding made of millions of tiny struts). The composition of the extracellular matrix determines how strong the bone is, and the higher the concentration of calcium, the greater the strength. Bone is constantly being broken down and rebuilt (this is known as remodelling, a process which maintains bone strength).
Bone reaches a peak of being most dense and strong by around the third decade of life. From this point, bone mass slowly decreases. The greater the peak bone strength the longer it takes for bone mass to fall to dangerous levels. So it’s vital that by early adult life a person has done everything possible to build their bones up with good nutrition and regular physical activity. Genetics also play a large part in determining an individual’s peak bone strength.
After the menopause, as oestrogen levels fall, the rate at which bone is broken down increasingly outstrips new bone production. Bone mass falls even further, the bones thin and osteoporosis has developed.
For this reason osteoporosis mainly affects women after the age of the menopause, although men can develop it too. The risk is increased for a woman if she has an early menopause, has her ovaries removed before the menopause, or has gone for six months or more without periods for as a result of excessive exercising or dieting. For men low levels of testosterone increase the risk.
Osteoporosis may occur in younger people if they have other predisposing factors.
Common risk factors which may affect men or women include:
- Long-term use of corticosteroid medication
- Maternal osteoporosis
- Heavy drinking
- Sedentary lifestyle
- Low body weight
- Medical conditions that affect absorption (such as coeliac disease)
It’s important for those at particular risk of osteoporosis, especially post-menopausal women, to be aware of the condition and what they can do to reduce the risk. Talk to your doctor if you are worried.
As well as an examination and blood checks, there are a variety of tests that can give you a more definite assessment of the density of your bones. The most common is called a DXA (‘DEXA’) scan. This painless test involves a low dose of x-rays (less than a normal x-ray) usually across your spine and hip.
Once your doctor has the scan results they can then tell you whether you have osteoporosis, or are at risk, and will suggest treatments. Sometimes the risk of osteoporosis is so high (for example in women aged over 75) that a scan isn’t necessary and treatment is offered right away.
There a number of treatment options if you’re diagnosed with osteoporosis. Medication may include:
- Calcium and vitamin D supplements
- A variety of hormone treatments, including HRT and SERMS or Selective estrogen receptor modulators (oestrogen, either naturally before the menopause or as HRT, is known to protect against bone loss).
- Bisphosphonates, a group of drugs that prevent bone breakdown and can be very effective in osteoporosis.
It’s better to prevent any condition than simply to manage it when it happens. Assessing the health of your bone structure and managing your risk for osteoporosis should be an important step you take as you enter middle age. Increase the calcium in your diet, increase the amount of weight-bearing exercise you do – this helps maintain bone density – reduce your alcohol intake and quit smoking.