Osteoporosis
affects 1 in 3 women and 1 in 12 men over the age of 50.
The
skeleton becomes so porous that the simplest knock or fall can break a
bone,particularly in the wrist, spine and hip. But fractures are not an
inevitable part of getting older and osteoporosis can now be largely prevented
and treated.
What is
osteoporosis?
Osteoporosis literally means porous bones. The bones in our skeleton are made of a thick outer shell and a strong inner mesh filled with collagen (protein), calcium salts and other minerals. The inside looks like honeycomb, with blood vessels and bone marrow in the spaces between bone. Osteoporosis occurs when those spaces between bone become bigger, making bones fragile and liable to break easily.
Bone is alive
and constantly changing. Old, worn out bone is broken down by cells called
osteoclasts and replaced by bone-building cells, called osteoblasts. This
process of renewal is called bone turnover.
Who
is at risk?
We are all
potentially at risk of osteoporosis because of the bone loss that occurs as we
get older, particularly as we are living longer as a population.
Women are more
at risk of developing osteoporosis than men. They have smaller bones, which are
less dense, and they also experience the menopause, which greatly accelerates
bone loss for several years. At the menopause (normally around the age of 50)
the ovaries stop producing the female hormone oestrogen, which is essential to
bone health. It is this lack of oestrogen which causes the increase in bone
loss. Younger women can similarly be at risk of osteoporosis if they have low
circulating levels of oestrogen. Over-exercising and eating disorders, such as
anorexia nervosa, can also upset the normal hormone balance and lead to bone
loss.
Men generally
have bigger, denser bones than women and do not undergo the rapid bone loss
associated with the female menopause. Osteoporosis in men is often the result
of another health problem. Low levels of the male hormone testosterone can lead
to osteoporosis, due to a problem with the testes themselves or the pituitary
gland, which controls hormone levels. There may be no obvious signs or symptoms
but some men do find they need to shave less regularly, have a low sex drive
and feel excessively tired. In nearly half of all men with osteoporosis the
cause is unknown (called idiopathic osteoporosis) and further research is
needed to establish why excessive bone loss occurs.
Am
I at risk?
There are many
factors, which can increase your risk of osteoporosis.
A lack of
oestrogen, caused by
early menopause (before the age of 45)
early hysterectomy (before the age of
45), especially if both ovaries are
removed (oophorectomy)
missing periods for six months or more
(excluding pregnancy) as a result of
over-exercising or over-dieting
: low
levels of the male hormone, testosterone (hypogonadism)
:
long-term use of corticosteroid tablets (for conditions such as asthma)
:
maternal history of a hip fracture
: malabsorption, inflammatory bowel disease
(Crohn's disease or
ulcerative colitis) and gastric
surgery
:
long-term immobility
:
heavy drinking
:
smoking
:
low body weight
If you think
you may have one or more of these risk factors, you are at increased risk of
developing osteoporosis. You need to discuss your risk with your doctor and
find out how to prevent and treat the disease. Alternatively, call the NOS
helpline on 01761 472721, for further information. Staffed by a team of nurses
based at NOS headquarters, the helpline is open from 10.00am - 5.30pm on
Mondays and 9.30am - 5.30pm Tuesday to Friday.
If you have
already broken a bone after a minor bump or fall you may already have
osteoporosis. Other warning signs include height loss and kyphosis (curvature
of the spine). If you have one of these warning signs you may want to discuss
your risk of osteoporosis with your doctor.
Do I have
osteoporosis?
Because you
cannot see or feel your bones getting thinner you will probably be quite
unaware of any problems with your bone health. Osteoporosis is a silent disease
and for most people, the first sign that something is wrong can be when they
break a bone, often in the wrist or spine after a minor incident, although not
all fractures are due to osteoporosis.
A normal X-ray
of bone cannot reliably measure bone density but is useful to identify spinal
fractures, explain back pain, height loss or kyphosis.
A bone density
scan, called a Dual Energy X-ray Absorptiometry (DXA) scan, is used to measure
the density of bones and compare this to a normal range. This test is currently
the most accurate and reliable means of assessing the strength of your bones
and your risk of fracture. It is a simple, painless procedure that uses very
low doses of radiation. You will be asked to lie down on the machine for 10-15
minutes whilst an X-ray arm passes over you to take an image of your spine and
hip. Some centres may have machines which measure the density of the wrist or
heel. A bone density scan can diagnose osteoporosis, assess risk of fracture
and monitor the effects of treatment.
Bone density
scans are only recommended for people who are at high risk of osteoporosis, so
you should discuss your medical history with your doctor, who will decide
whether to refer you to hospital for a scan. The doctor may use the results to
help with decisions about treatment, or you may be asked to see a specialist
consultant. In some areas of the UK, access to bone density scans is very
limited, so your doctor may go ahead and prescribe treatment without a scan if
a fracture has been identified by X-ray, or if the doctor decides there is
sufficient risk of osteoporosis (such as an early menopause). Women who take
hormone replacement therapy (HRT) at the menopause would probably not need a
bone density scan.
Can
I prevent osteoporosis?
Genes determine
the potential height and strength of the skeleton but lifestyle factors can
influence the amount of bone laid down in the bone `bank' during critical
growth years and how much density is maintained later in life.
During
childhood, adolescence and early adulthood, when the skeleton is increasing in
bone density, it is vitally important to try to maximise peak bone mass. Making
the most of bone mass will put your skeleton in a better position to withstand
the natural bone loss that occurs later. If you are in your mid-thirties or
older it is important to aim to maintain the strength of your bones.
Healthy bones
need a well-balanced diet, incorporating minerals and vitamins from different
food groups, including bread, potatoes, pasta and cereals; fruit and
vegetables; milk and dairy products; meat, fish, eggs, pulses, nuts and seeds.
Calcium is
especially important in the diet because it is the most abundant mineral in our
bones and helps to give them strength and rigidity. The most readily available
sources of calcium are milk and dairy products such as cheese and yogurt. Don't
worry if you are watching your weight as low-fat varieties usually contain just
as much calcium as their full-fat counterparts. If you do not like or are
unable to eat dairy products, you should be able to get enough calcium from nondairy
sources but it might take a bit more planning. Non-dairy products such as green
leafy vegetables, baked beans, bony fish and dried fruit all contain useful
quantities of calcium. Be careful not to have too much animal protein, salt or
caffeine because, in excessive quantities, these can reduce the body's ability
to absorb or retain calcium.
Please see NOS
Diet and Bone Health booklet for further information.
Like muscles
and other parts of the body, bones suffer if they are not used. They need
regular weight-bearing exercise, which puts force through the bone, stimulating
growth and therefore strength. Good bone-building exercises include running,
skipping, aerobics, tennis and weight-training.
Even a brisk
walk can be of some benefit.
Try to exercise
at least three times a week for a minimum of 20 minutes but most importantly
choose exercise that you enjoy and stick to a regular routine. If you haven't
exercised for a while, start gently and check with your doctor if you have
another health problem and are concerned about exercising.
Please see NOS
Exercise and Bone Health booklet for further information.
If you a smoker
- give up! Smoking has a toxic effect on bone in men and women. It can cause
women to have an earlier menopause and may increase the risk of hip fracture in
later life. Not smoking will benefit bone and general health.
Watch what you
drink! Drinking too much alcohol is damaging to bone turnover. Limit your
alcohol intake to a maximum of 3-4 units per day for men and 2-3 units for
women. These limits are not targets to drink up to and having alcohol free days
is advisable. One unit of alcohol is equivalent to a glass of wine; a measure
of spirits; or half a pint of normal strength beer or cider. The good news is
that a moderate intake of one or two glasses of red wine a day may have
beneficial effects on the skeleton as well as the heart.
What
about treatment?
The treatment
of osteoporosis depends on a number of factors including age, sex, medical
history and which bones are broken. Lost bone cannot be replaced but doctors
can prescribe treatment aimed at strengthening existing bone to help prevent
further bone loss and fracture. Treatments are available for postmenopausal
women and for anyone taking corticosteroid tablets for at least six months.
Treatments include:
non hormonal
drugs which help maintain bone density and reduce fracture rates
Hormone
replacement therapy (HRT)
oestrogen
replacement for women at the menopause, which help maintain bone density and
reduce fracture rates for the duration of therapy
Selective
Estrogen Receptor Modulators (SERMs)
drugs which act
in a similar way to oestrogen on the bone, helping to maintain bone density and
reduce fracture rates specifically at the spine
testosterone
replacement for men with low testosterone levels to help maintain bone density
supplements of
calcium and vitamin D can be of benefit for older people to reduce the risk of
hip fracture
Please see NOS
Treatments booklet for further information.
© National
Osteoporosis Society
Registered
Charity Number: 292660
Website:www.nos.org.uk
National
Osteoporosis Society
Camerton, Bath
BA2 OPJ
tel: 01761
471771
fax: 01761
471104
helpline: 01761
472721