OSTEOPOROSIS

What is Osteoporosis?

Osteoporosis is a condition that affects the strength of bones. As you grow bone growth exceeds bone degeneration but as you get older this reverses and bones become less dense. The amount of bone loss can vary but if you have a lot of bone loss this is known as osteoporosis. If you have osteoporosis then bones are not as strong and as a result you are more prone to fractures. A milder form of bone loss is known as osteopenia.

What are the Risk Factors for Osteoporosis?

There are modifiable (factors you can change) and non-modifiable (factors you cannot change). Modifiable risk factors are alcohol intake, vitamin D deficiency, smoking, malnutrition, inactive lifestyle and low weight. Non-modifiable risk factors are elderly age (especially postmenopausal), female gender, European or Asian race, family history, previous fractures and small body physique.

Numerous medications such as steroids, antiepileptics, excess thyroxine, proton pump inhibitors such as omeprazole, lithium, anticoagulants such as warfarin and thiazolidinediones can lead to osteoporosis risk. Medical conditions leading to immobilisation, endocrine disorders such as Cushing’s syndrome and hyperthyroidism, hypogonadal conditions, rheumatological conditions such as rheumatoid arthritis, haematological disorders like multiple myeloma and inherited conditions such as osteogenesis imperfecta can contribute weaker bones leading to osteoporosis.

What are the Osteoporosis Symptoms?

A bone fracture after a minor injury such as a fall - Often the first sign or indication that you have osteoporosis. If you have osteoporosis, the force of a simple fall to the ground is often enough to fracture a bone. A simple fall to the ground such as this does not usually cause a fracture in someone without osteoporosis. A bone fracture after a minor injury like this is known as a fragility fracture (most commonly of the hip, wrist and vertebrae). A fractured bone in an older person can have serious consequences in some people. For example, about half the people who have a hip fracture are unable to live independently afterwards because of permanent mobility problems.

Loss of height, persistent back pain and a stooping (bent forward) posture - These symptoms can occur if you develop one or more fractured vertebrae. A vertebra affected by osteoporosis may fracture even without a fall or significant force on it. The vertebrae can become squashed with the weight of your body. If severe, a bent forward posture may affect your ability to go about your usual daily activities and may also affect your breathing, as your lungs have less room to expand within your chest.

How is Osteoporosis Diagnosed?

At present, there are no national screening programme for osteoporosis, however if you are at increased risk, your GP may refer you for a DEXA scan. A DEXA scan is a special X-ray machine that checks bone density and can confirm osteoporosis.

How is Osteoporosis Treated?

Regular exercise promotes bone remodelling and protection. Healthy eating and taking sufficient calcium and vitamin D is beneficial for prevention of osteoporotic fractures. Smoking is known to increase the risk of osteoporosis; therefore, stopping smoking is advised for osteoporosis management.

Calcium and Vitamin D tablets

Calcium and Vitamin D are very important for bone health. Calcium can be obtained from food such as milk and cheese. Vitamin D is made naturally by the body from sun exposure and can be obtained from cooked salmon or mackerel. Some people over the age of 50, or people who have poor diet and limited sunlight exposure may need to take supplements as they are unable to get adequate amounts of calcium or vitamin D.

Bisphosphonates

These are the most commonly used drug to treat osteoporosis, this includes Fosamax, Dignorel, Actinel, Alendronate, Risedronate and Etidronate. They work on the bone-making cells and help to restore the lost bone and prevent further loss.

 

Denosumab

Denosumab injection (Prolia) is used to treat osteoporosis in men and in women who have undergone menopause, who have an increased risk for fractures or who cannot take or did not respond to other medications for osteoporosis. Denosumab injection is in a class of medications called RANK ligand inhibitors. It works by decreasing bone breakdown and increasing bone strength and density (thickness).

 

Raloxifene

Raloxifene is used to prevent and treat osteoporosis in women who have undergone menopause (change of life; end of menstrual periods). Raloxifene is in a class of medications called selective Oestrogen receptor modulators (SERMs). Raloxifene prevents and treats osteoporosis by mimicking the effects of estrogen to increase the density (thickness) of bone.