Osteoporosis:

Osteoporosis is 'thinning' of the bones which makes them more likely to break. From the mid forties, there is a natural gradual thinning of the bones with loss of some of the tough elastic fibres (collagens) and hard gritty materials (minerals). This process of bone loss is very gradual and varies from one person to another. It is only when it becomes excessive that it is called osteoporosis. People with osteoporosis are more likely to suffer fractures, particularly in the vertebrae (spine), wrist and hip bones. Women are more at risk of osteoporosis than men as they develop bone loss about three times as quickly, particularly when oestrogen hormone levels fall after the menopause (cessation of periods). Men are, however, not immune and upto 20% of spine fractures and 30% of hip fractures occur in them rather than women.

Facts:

In the UK osteoporosis results in over 200,000 fractures each year, causing severe pain, disability and not infrequently death.
These fractures cost the National Health Service approximately £950,000,000 in 1999.

Which groups of people are most at risk of osteoporosis ?

Everybody has a slight chance of developing osteoporosis as they become older. There are, however, certain situations which increase your risk and should prompt you and your doctor to discuss osteoporosis:

As oestrogen levels fall in menopausal women, they become more susceptible to bone loss. This is particularly relevant for women who finish their periods before the age of 45 years or who have a hysterectomy before their natural menopause.
Women who have participated in very strenuous exercise such as marathons. In some such women this can result in a reduced level of oestrogen and cessation of periods. There is evidence, however, that exercise in moderation is good for maintaining bone strength.
Women who have had infrequent periods for any reason.
People who have suffered a fractured bone after minor trauma such as falling from normal standing height rather than off a ladder.
People who have dieted for long periods of time, particularly those with eating disorders. As in strenuous exercise, women who diet to extremes often have low levels of oestrogen and this, in combination with a poor diet, can affect the bones.
People who are on long-term steroid tablet treatment, perhaps for severe asthma or rheumatoid arthritis (a side effect of steroids is bone loss).
Smokers and those who drink alcohol to excess.
People with certain medical conditions, particularly ones that cause reduced mobility.
People who are immobile or do not undertake any degree of regular exercise.
People who have a history in their family of thinning of the bones, perhaps of relatives who fractured a hip or developed a 'Dowager's hump' (deformed, bent back) in later life.

How is osteoporosis diagnosed ?

Thinning of the bones is sometimes noted on routine X rays. Osteoporosis can only be confirmed, however, by specialist investigations looking at the density of minerals in the bones.

Are there particular symptoms to look out for which may indicate osteoporosis ?

Most people develop thinning of the bones very slowly without any particular symptoms. Often it is only after a significant amount of bone has been lost that symptoms occur.

Some people notice a reduction in their height and stooping. This may occur when the bones in the spine become broken and ‘crushed’.

Back pain may also result following breaks in the bones of the spine.

The biggest problem with osteoporisis is developing fractures. These occur surprisingly commonly and particularly affect the wrist, hips and vertebrae (bones of the spine). It may only take a very minor injury to cause such fractures. Hip fractures especially can be potentially very serious.

Facts:

An estimated 60,000 hip fractures occur each year in the UK, mainly in the elderly and most are due to osteoporosis.
Approximately 14% of women and 3% of men will suffer a hip fracture at some stage in their life.
Hip fracture can be fatal and of those affected that survive, only about 25% will be able to live independently in the community one year later (50% will be in residential/nursing care and 25% will be requiring care at home)

Preventing falls:

This is very important in reducing the chances of a fracture in someone with osteoporosis. Useful general measures include taking care in icy weather, avoiding medications that cause drowsiness, regular weight-bearing exercise and being aware of hazards in the home such as trailing wires and uneven rugs. There are now special ‘hip protectors’ available which can be particularly useful in the elderly to help reduce the risks of fractures caused by falls.

How can osteoporosis be treated ?

Hormone Replacement Therapy (HRT) can help to prevent thinning of the bones when oestrogen levels fall after the menopause and can also be used to treat women who already have osteoporosis. It effectively stops further bone loss and also helps to increase the strength of the bones.
Calcium and Vitamin D tablets are often useful as the body requires good supplies of these substances in order to make healthy bone. Often people who develop osteoporosis do not have sufficient calcium or vitamin D in their diet.
There are some other medications (eg the bisphosphonates) which specifically work on the cells that make bone and therefore help to prevent bone loss and promote bone formation. These medications may be used to treat men with osteoporosis or women who cannot take HRT for whatever reason.

How can osteoporosis be prevented ?

There is no treatment available which will restore bones completely. Therefore prevention of osteoporosis is extremely important and having the right lifestyle, from early on, can make a big difference.

Lifestyle Factors:

Diet - calcium and vitamin D are both very important for bone formation and therefore foods should be eaten which are rich in calcium such as milk and cheese. Supplements may be recommended for certain groups of people who do not have sufficient calcium in their diet, for example elderly people. Similarly, as sunshine is needed for the body to use vitamin D, people who are housebound may also require these supplements.
Exercise - regular, moderate, ‘weight-bearing’ exercise is a good way to reduce the risks of developing osteoporosis. Undertaking exercise throughout life is the best option but it is never too late to start. In particular for older people, a regular brisk walk can help. Other beneficial exercises include such things as dancing, aerobics, brisk walking etc. The cells which make bone are stimulated by exertion and this leads to strengthening of the bones. Exercise also helps to improve the muscles around the bones and joints which gives extra support and may help to prevent falls. As mentioned above, exercising to excess may actually be harmful rather than beneficial because of the reduction in oestrogen levels.
Excess alcohol drinking can cause thinning of the bones. Alcohol should therefore only be taken in moderation.
Smoking can also exacerbate osteoporosis.

Medication:

Hormone Replacement Therapy contains oestrogen and therefore can help to prevent bone loss. Ideally it should be started within a year of menstrual periods stopping. However, it can still prevent bone loss from getting worse if started at any stage. Maximum benefit is gained from taking HRT for at least 5-10 years. It is particularly advisable for those who have had a hysterectomy before their natural menopause and those who have gone through the menopause at an early age (before the age of 45). This is because these groups of women are exposed to lower oestrogen levels for a longer than average time.
Other medications - For people in the ‘at risk’ groups it may also be advisable to take the specific medications mentioned previously (eg the bisphosphonates) for preventive reasons before there is any evidence of bone thinning.

Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.