16 Jan Osteoporosis
Osteoporosis occurs when bones lose minerals such as calcium more quickly than the body can replace them. They become less dense, lose strength and break more easily.
Until a break occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. After a broken bone, chronic pain and a decreased ability to carry out normal activities may occur.
The good news is that if you have osteoporosis, lifestyle changes and medical treatment can prevent further bone density loss and reduce your risk of bone fractures.
Most people don’t realise they have osteoporosis until a fracture occurs. It particularly affects women in their middle and later years, although some men are also affected.
Bone fracture is a common symptom of osteoporosis. Acute and chronic pain in the elderly is often attributed to fractures from osteoporosis and can lead to further disability and early mortality.
The most common fractures associated with osteoporosis affect the wrist, spine, shoulder and hip. Those with osteoporosis may also suffer from a vertebral collapse (“compression fracture”) the symptoms of which are sudden back pain, often with radicular pain (shooting pain due to nerve root compression) and rarely with spinal cord compression or cauda equina syndrome.
Fractures of the long bones acutely impair mobility and may require surgery. Hip fracture, in particular, usually requires prompt surgery, as serious risks are associated with it, such as deep vein thrombosis and pulmonary embolism, and increased mortality.
Osteoporosis is caused by bones losing density of calcium and other minerals. Bone density naturally decreases from about the age of 35, but people with osteoporosis have lost bone density faster than normal, meaning they are then at risk of fracturing their bones.
Women are at greater risk of developing osteoporosis than men, because changes in hormone levels can affect bone density. The female hormone oestrogen is essential for healthy bones. After menopause, the level of oestrogen in the body falls, which can lead to a rapid decrease in bone density. Women are at an even greater risk of developing osteoporosis when:
- they have an early menopause (before the age of 45)
- they have a hysterectomy before the age of 45, particularly when the ovaries are also removed
- their periods are absent for a long time (more than 6 months) as a result of over-exercising or over-dieting.
For most men who develop osteoporosis, the cause is unknown. However, there is a link to the male hormone testosterone, which helps to keep the bones healthy. Men continue to produce this hormone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone.
Risks and complications
There is an increased risk of falls associated with aging, with serious implications for those with osteoporosis.
Some medications may increase your risk of osteoporosis, including those prescribed for:
- hyperthyroidism (overactive thyroid gland)
- disorders of the adrenal glands, such as Cushing’s syndrome
- reduced amounts of sex hormones (oestrogen and testosterone)
- disorders of the pituitary gland (a small hormone producing gland under the brain)
- hyperparathyroidism (overactivity of the parathyroid glands)
- conditions that mean you don’t absorb minerals properly, such as coeliac disease and inflammatory bowel disease
- some chronic diseases like rheumatoid arthritis, chronic liver or kidney disease
- breast cancer, prostate cancer, epilepsy and some antidepressants.
The most reliable way to diagnose osteoporosis is to measure bone density with a dual-energy absorptiometry scan or DXA. A DXA scan is a short, painless scan that measures the density of your bones, usually at the hip and spine and, in some cases, the forearm.
Lifestyle factors thought to increase the risk of osteoporosis and broken bones include:
- low levels of physical activity
- excessive alcohol intake
- being either underweight or obese.
Osteoporosis risk can also be reduced by:
- Eating calcium-rich foods, including dairy foods, oily fish, nuts and green vegetables.
- Ensuring your Vitamin D levels are adequate, either from sunlight or a supplement.
- Exercising incorporating resistance training and weight bearing exercises to maintain bone strength.
If you have osteoporosis, it is never too late to seek treatment, as age is one of the main risk factors for osteoporosis and breaks. Treatment can halt bone loss and significantly reduce the risk of fractures. If you have osteoporosis, the strategies listed to prevent osteoporosis will help to manage the condition, but you may also need to discuss with your doctor:
- safer exercise options
- falls prevention (such as trip-proofing your home)
- medication options, such as Biphosphonate medications which are useful in those with previous broken bones due to osteoporosis.