Osteoporosis

Osteoporosis is a common medical condition where the bones become brittle and fragile and increases the risk of broken bones or fractures.

Osteoporosis is a commonly occurring bone disease, which increases the risk of fracture.

Osteoporotic bones become more porous and fragile (brittle) and therefore vulnerable to fracture. People with osteoporosis will experience more bone fractures than those without. Osteoporosis can develop without any symptoms being noticed until a bone is fractured.

Symptoms & causes

Osteoporosis is often called a ‘silent disease’, because bone loss occurs out of view and in a progressive manner. Usually there are no symptoms in the early stages of bone loss. It is only when a fracture occurs, that the condition is discovered.

As bones become increasingly brittle, everyday activities such as bending over or coughing, or even a minor bump or a fall can lead to a fracture. A fracture can be either a complete or partial break in a bone. While any bone in the body can potentially be affected by osteoporosis, most osteoporosis-related fractures occur in the hip, wrist or spine. Spinal fractures due to osteoporosis can also lead to height loss or changes in posture. 

Symptoms 

Despite the common experience of no symptoms in the early stages of bone loss, once the bones have been weakened by osteoporosis people may experience signs and symptoms that suggest underlying osteoporosis.

These include:

• back pain, caused by  fractured or collapsed vertebra
• loss of height over time
• a stooped posture
• bones that break much more easily than would be expected.

Causes & Risk Factors 

Osteoporosis usually arises as a result of hormonal changes, or deficiency of calcium or vitamin D. A number of risk factors have been identified for osteoporosis. Some of these risk factors are beyond our control (e.g. age), while others are modifiable (e.g. smoking, alcohol use). 

Risk factors for osteoporosis that are beyond our control include:

• Sex – Women are more likely than men to develop osteoporosis. Men do lose bone as they age, but because their testosterone levels decline more gradually than women’s, their bone mass remains adequate till later in life.
• Age – The risk of osteoporosis increases with age.
• Race – Those who are white or of Asian descent have a higher risk of osteoporosis. 
• Family history – Bone health can be inherited. Having a parent or sibling with osteoporosis increases your risk for the condition (especially if your mother or father fractured a hip).
• Size – People with small body frames tend to have a higher risk of osteoporosis, because as they age they have less bone mass to begin with.

Other risk factors, some of which may be modifiable, include:

• Calcium & vitamin D levels – Low calcium intake (adults require 1,000 mg per day, while women over 50 and men over 70 require 1,300 mg per day) and low vitamin D levels (required to absorb calcium) increase your risk for osteoporosis.
• Medical history – a number of medical conditions impact on bone health. These include: low hormone levels (e.g. early menopause in women; low testosterone levels  in men); thyroid conditions, such as overactive thyroid; gut malabsorption conditions  (e.g. coeliac disease; inflammatory bowel disease); certain chronic diseases (e.g. rheumatoid arthritis; chronic liver or kidney disease). 
• Some medications can increase osteoporosis risk, such as: corticosteroids ( for asthma and rheumatoid arthritis); breast and prostate cancer treatment drugs; epilepsy drugs; certain antidepressants. 

A number of lifestyle factors have been associated with osteoporosis. These include:

• sedentary lifestyle (low levels of physical activity)
• smoking
• excessive alcohol intake
• body weight: both thinness and obesity (recent studies suggest hormones associated with obesity may impact on bone health).

If you are concerned about your risks for osteoporosis, you  should discuss your concerns with your doctor. If you are over 50 years of age and you have risk factors for osteoporosis  your doctor  may refer you for a bone density scan.

Prevention

Osteoporosis can be prevented by leading a bone-healthy lifestyle throughout your life. In fact, osteoporosis prevention begins in childhood. A healthy diet and adequate exercise helps ensure that children reach their highest possible ‘peak bone mass’. Having good bone mass when you reach adulthood means you are less likely to have weak bones when you’re older.

Early prevention is especially important for women, whose bone loss is increased following menopause (around 50 years of age). Bone loss occurs at a faster rate after menopause, because women lose the protective effects of the hormone oestrogen.

Everyone can take steps to maintain and improve their bone health regardless of their age. The three most important protections for healthy bones include an adequate daily calcium intake; maintaining sufficient vitamin D levels to  help with calcium absorption; and taking part in regular exercise. These three factors are also very important for people with low bone density or established osteoporosis. 

Diagnosis

Osteoporosis is diagnosed with a bone density scan (commonly known as a bone density test). The bone scan usually  measures bone density at the site of the hip and spine. Sometimes  other body sites (e.g. the wrist) may also be checked.

Bone scans are simple procedures. People remain clothed and the procedure typically takes  10-15 minutes . The scan involves lying flat on a padded table while the arm of the bone density scanning machine passes overhead. 

At AIMSS, we offer bone density tests.

Treatment

Treatment of osteoporosis involves lifestyle changes as well as the use of medications. Factors such as a person’s age, sex, their risk of breaking a bone and whether they have a history of previous fractures will influence any treatment decisions recommended for them.

Treatment involves review of a person’s lifestyle including physical activity and diet, and the use of medications. 

Review of a person’s diet is important to ensure that they are regularly consuming adequate amounts of vitamin D and calcium. Dietary supplements and exercise may be recommended to improve bone health. 

A number of medications are used to treat osteoporosis and prevent fractures. These include bisphosphonates, selective oestrogen receptor modulators and parathyroid hormone, as well as calcium and vitamin D supplements. While not routinely used, testosterone and Hormone Replacement Therapy (HRT) are treatments which also benefit bone health.  Men qualify for use of testosterone therapy only where low  levels of male sex hormones are the cause of their osteoporosis. Women using HRT for management of menopausal symptoms will benefit from HRT’s positive effects on bone. This is because HRT has been shown to keep bones strong and reduce fracture risk. However, it is important to note that HRT can have serious side effects, and therefore is not recommended for treating osteoporosis if menopause symptoms are absent.