Getting to the bones of osteoporosis...
Almost three million Brits have osteoporosis – a condition which weakens the bones – and an estimated 500,000 fractures occur because of the condition every year. MICHELE O’CONNOR reveals what you need to know about your bones
‘OSTEOPOROSIS is a condition in which bones lose their strength and are more likely to break, usually following a minor bump or fall,” says Sarah Leyland, Osteoporosis Nurse Consultant at the National Osteoporosis Society (nos.org.uk).
“It can cause painful and debilitating broken bones in various parts of the body, but the wrists, hips and spine are the most commonly affected sites.”
She explains that, just like muscle, bone is a living, growing tissue that is continually broken down and rebuilt in a process known as “bone remodelling”.
During childhood and adolescence, bone is laid down faster than it is lost, so our bones become increasingly dense until the age of 18-25, when peak bone mass is achieved.
After this point, bones undergo a constant process of renewal, whereby worn-out bone is removed and replaced by new tissue. If you lose more than you replace, they slowly become weaker, which can lead to osteoporosis – thinner, fragile bones.
WHY IS IT A KILLER?
“WE KNOW that people who fracture easily live shorter lives,” says Sarah. “In particular, when people suffer hip fractures, they are much less likely to recover. It’s not the actual fracture that kills them, it’s the fact they become more prone to other problems when they’re immobile, such as urinary tract infections, chest infections, blood clots and just being less well in general.”
Take note if you’re aware you – or a loved one – are getting shorter, she adds. “A loss of height is a red flag for multiple spinal fractures, as the bones of the spinal column become weakened and compressed. This impacts on quality of life, mobility and increasing frailness.”
RISK FACTORS
■ Age: As you get older, bones become more fragile and are generally more likely to break – partly because of generally reduced bone strength, but also as a result of the increased risk of falling as we get older.
■ Gender: Osteoporosis and fractures are more common in women because bone loss is more rapid for several years after the menopause, when oestrogen hormone levels decrease. Women also tend to have smaller bones than men and live longer – with loss of bone tissue continuing – making broken bones due to osteoporosis more likely.
■ Genes: These determine our risk of osteoporosis to a large extent, although there isn’t a simple genetic test for osteoporosis. Research has shown if one of your parents had a broken hip, you’re more likely to break one yourself.
■ Some medications: The side effects of certain drugs can increase risk. These include glucocorticoid (steroid) tablets, anti-epileptic drugs, breast cancer treatments such as aromatase inhibitors, and some prostate cancer drugs. The DepoProvera contraceptive jab is also known to affect bone density.
■ Some medical conditions: Rheumatoid arthritis, low levels of testosterone in men, low levels of oestrogen in women (eg early menopause, anorexia nervosa, hysterectomy before age 45), Crohn’s, coeliac disease and certain thyroid diseases are linked to osteoporosis.
■ Smoking: Women who smoke tend to have an earlier menopause, upping their risk, and the habit seems to affect bone-building cells.
■ Drinking too much alcohol:
Alcohol seems to affect cells that build and break down bone and, of course, under the influence, you become unsteady – increasing your risk of falls.
■ Over-exercising: Over-training, together with not eating enough for endurance workouts, can negatively impact bone health.
This is something known as the “female athlete triad” or “relative energy deficiency in sport” (as it can affect men, too).
■ Diet: People who are vegan or lactose intolerant should ensure they get calcium from other sources, such as tofu, dried fruit, pulses, almonds and broccoli.
And be wary about extreme diets that eliminate dairy, warns Sarah. Vitamin D – from exposure to sunlight, oily fish and eggs – is vital for calcium absorption.
AM I AT RISK?
OSTEOPOROSIS doesn’t necessarily have any symptoms. In fact, most sufferers are unaware of their condition until they suffer a fracture.
“Broken wrists in middle-age women, following a minor fall or bump, are classic warning signs,” says Sarah.
“However, some might notice they suffer back pain or a loss of height.”
If you have had an eating disorder, suffered a fracture after a minor fall, reached the menopause early, have a history of missed periods, or are on a long-term course of corticosteroid drugs, ask your GP for a referral to a specialist for a fracture risk assessment. This may include a bone density (DEXA) scan to help measure your bone strength.
Assess your risk of osteoporosis by taking the Stop at One quiz: stopatone.nos.org.uk
HOW IS IT TREATED?
DRUGS to reduce fracture risk act in different ways – reducing resorption or increasing bone formation. Most are antiresorptive drugs that slow down the activity of cells that break down old bone, while anabolic drugs stimulate cells that build new bone.