Osteoporosis

The loss of bone is a normal part of ageing, especially for women after menopause. But there are a number of situations that can accelerate this condition.

Drinking or smoking heavily, having reduced levels of activity, or having a low BMI (for example due to eating disorders) puts you at greater risk of developing osteoporosis. There are also certain medications that increase your risk, such as taking high-dose steroids for more than 3 months or being on anti-oestrogen tablets after breast cancer. A family history of osteoporosis, as well as certain medical conditions such as inflammatory or hormone-related conditions, also increases your risk.

Because bone thinning cannot be felt or seen, most people with osteoporosis are not aware of any problem until they suffer a fracture, and as such can genuinely be called a ‘silent’ disease. Although X-rays will readily show up broken bones, osteoporosis will only become apparent when at least 30% of the bone density has been lost. This means more accurate assessment is needed and so a bone density scan called a Dual Energy X-ray Absorptiometry (DEXA) scan is often used. This scan is recommended for people who are at high risk of osteoporosis and results of these scans show how your bone density compares to the average for your age and sex, and so whether bone thinning is present. Osteoporosis does not generally slow or stop the healing process so bones that break because of osteoporosis will still heal in the same way as they do in people who do not have osteoporosis, which is usually about six to eight weeks.

How will your doctor diagnose osteoporosis?

By using a risk calculator such as the FRAX or Q-fracture tools, your doctor will be able to calculate the probability of you having osteoporosis in the future. If the risk is high, your doctor will refer you for a DEXA scan for confirmation.

The first way to begin strengthening your skeleton is with a ‘bone friendly diet’, rich in calcium, using sources such as cheese, milk and yoghurt. Low-fat varieties contain just as much calcium as the fuller fat varieties, and do not forget that bread, green leafy vegetables, bony fish and tofu are also rich in calcium. Take care here not to eat too much salt or drink lots of caffeine-containing drinks as these can reduce calcium absorption.

Vitamin D is needed to help calcium uptake in the body, and sunshine is the best source of this – enjoying 20 minutes of sunlight daily during summer can enable the body to store enough vitamin D to last the rest of the year. (If diet is a problem for any reason then calcium supplements are an acceptable alternative.) It is not only diet that is useful here, but exercise also plays a key role in keeping bones strong and healthy. This can range from brisk walking to swimming or cycling, but whatever the preferred activity it is important it is performed for at least 20 minutes 3-4 times a week. Even jumping on the spot 50-60 times a day can increase bone density in pre-menopausal women.

Unfortunately for all of us, once bone has been lost it cannot be replaced completely and treatment is therefore always aimed at helping to prevent further bone loss. There is currently a range of treatments available including hormone replacement therapy, calcium and vitamin D supplements and testosterone treatment for men with osteoporosis. Biphosphonates are non-hormonal treatments that work by switching off the cells that break down bone, and selective oestrogen receptor modulators (‘SERMs’) are synthetic hormones that work to reduce bone thinning but which do not increase the risk of breast or womb cancer.

There are few conditions where the term ‘prevention is better than cure’ applies more accurately than osteoporosis. Fortunately, a healthy lifestyle is the best medicine for most people and a prescription for sunshine, exercise and a sensible diet is the best one.