Osteoporosis

Osteoporosis is a weakening of the bones, usually in later life and most commonly in women. This means the bones break more easily.

What is Osteoporosis?

The bones are made up of a hard outer surface of solid bone called cortical bone and a honeycomb-like matrix of 'trabecular' or spongy bone on the inside. It is this trabecular bone which looses strength in cases of osteoporosis.

Up to the age of 25, bone density gradually increases. It is then maintained until 35-40, when a gradual decrease in density occurs with age. In women, a more rapid decrease occurs in the years following the menopause, hence osteoporosis occurring in 1 in 2 women over the age of 50. The number in men is approximately 1 in 5.

Osteoporosis causes an increased risk of fractures as the bones are weakened and become more fragile. Usually, the individual does not know that they have osteoporosis, as there are no symptoms as such, until they fracture a bone, or even suffer multiple fractures. The wrists, hips and spinal vertebrae are the most commonly fractured areas in those with osteoporosis.

Following a fracture, bone mineral density can be measured using Bone density tests (DXA) and the results compared to the diagnostic health criteria provided by the World Health Organisation. Although 'more at risk of fractures', people with osteoporosis still heal as effectively as those without the condition, in around 6-8 weeks.

Are you at risk?

As already discussed, women over the age of 50 are the most likely to suffer from osteoporosis, however there are other factors which can increase (or decrease) your chances of developing 'brittle bones':

  • Genes - If you parents or grandparents have suffered from osteoporosis, this increases your risk.
  • Race - People who are black afro-carribean are less likely to suffer from osteoporosis as they have stronger, thicker bones.
  • Low body weight - those whose bmi (body mass index) is below 19 are at greater risk due to the lower strain placed on the bones everyday.
  • Previous fractures - if you have suffered a broken bone before, then this increases your chances.
  • Rheumatoid arthritis can increase your risk
  • Low oestrogen levels in women due to early hysterectomy, anorexia nervosa or turners syndrome.
  • Low testosterone levels in men, often following surgery for some cancers and in cases of Klinefelters disease.
  • Hyperthyroidism.
  • Conditions which affect food absorption, such as crohns and coeliac disease.
  • Any other condition which causes long periods of immobility.
  • Prolonged use of corticosteroids (for conditions such as asthma and arthritis).
  • Epilepsy medication.
  • Some breast and prostate cancer treatments.
  • Smoking may increase your risk.
  • Regularly drinking more than 3 units of alcohol a day may also increase your risk.

Treatment

A number of medications are available, with the aim of reducing the rate of bone mineral density decrease. Biphosphonates are the most commonly prescribed drugs for the treatment of osteoporosis, which are usually in tablet form, to be taken either daily or weekly. These drugs are licensed for use in post-menopausal women, some forms are also suitable for men and those who take long-term courses of corticosteroids (for conditions such as asthma or arthritis) which have been shown to increase bone mineral density losses. These drugs may not be suitable for people with stomach, bowel or kidney problems and may cause irritation of the gullet.

Other options are available, including Raloxifene (Evista), Strontium ranelate (Protelos), Parathyroid hormone (PTH) treatment (Preotact, Forsteo) and hormone replacement therapy.

How to Prevent Osteoporosis

Whilst preventing osteoporosis may not be entirely possible, it is certainly possible to reduce it's severity.The chances of developing osteoporosis in later life can be reduced in our adolescence through increasing and essentially, stocking up on, bone mineral density. This is done by eating a diet high in calcium (available from dairy products such as cheese and milk, as well as many green leafy vegetables, nuts and seeds) and undertaking plenty of weight bearing exercise and activity.

The rate of bone density loss can also be slowed in older people through the continuation of weight bearing activities and resistance training as well as maintaining a high calcium intake (studies recommend 1200mg per day). Whole body vibration training is the latest form of exercise shown to delay bone mineral density losses. Vitamin D is also associated with bone health and is usually obtained through the skin from sunlight. For those who may not have access or the ability to spend long periods outside, vitamin D supplementation is recommended.

Another preventative measure, is to attempt to reduce the risk of falls in the elderly. Repeated falls may be due to any number of factors, including muscle weakness, decreased sense of balance, visual impairment and musculoskeletal disabilities. Assessment and treatment of any contributing factors should be undertaken. Exercises to improve strength and balance should be implemented.