Osteoporosis is often referred to as a ‘silent disease’ because there is very often little sign of it existing. However, osteoporosis is a condition that speeds up the loss of bone strength, the word literally means ‘porous bones’. Despite popular belief, it’s not confined to elderly frail ladies or post-menopausal women either. People of any age, particularly if your mobility is restricted due to spending a lot of time in wheelchairs or bed-bound, can suffer from it. Other causes can include poor nutrition, eating disorders, over-training in a particular sport, or chronic steroid use. Men can suffer from osteoporosis too.
Approximately 1 in 3 women and 1 in 12 men have osteoporosis. A simple fracture, especially when you’re younger, may seem a minor consequence of the disease but this can impact your personal, social and sports life as well as work commitments. In older patients however, the more common hip fracture can have much more serious outcomes. The estimated mortality rate following a hip fracture within the first month is 10%, and 21% in the first year. Many patients do not recover full mobility or independence following a hip fracture, which for some results in admission to a care facility.
Damage to your spine due to ‘crumbling’ vertebra can result in chronic pain and impact on your abdominal organs and lung capacity. The good news is that there are treatments available to reduce the amount of bone loss resulting from both age and osteoporosis. The very best thing you can do is to achieve the best peak bone mass when you’re young, through good nutrition and an active lifestyle.
However, many of us are past that stage in our lives, and need to maximise bone strength and prevent bone loss through regular weight bearing activities. The ironic thing is that the thought of participating in exercise or sport may be frightening, because you may worry about suffering a bone fracture with impact, loading or falling, but the research has proven the benefits of exercise, if done correctly and safely, FAR outweigh the risks of osteoporosis.
THE BONE CYCLE
Bone is made up of minerals, mainly calcium salts, bound together by strong collagen fibres. Bones have a thick, hard, outer shell called cortical bone. Inside is a softer mesh
of bone, called trabecular bone, which has a honeycomb-like structure. Bone is a living, active tissue that is constantly renewing itself. Old bone is broken down by cells called osteoclasts and is replaced by new bone material produced by osteoblast cells.
The balance between the breakdown of old bone and formation of new bone, changes through life. Everybody will experience a degree of loss in bone mass and density as they age. The amount of bone loss can vary across age, sex, race, health, activity level and underlying medical conditions. It is the rate of loss, accelerated by certain factors (like menopause in women, smoking, etc) that ultimately results in osteoporosis. When a bone is ‘weakened’ by osteoporosis, it is the “holes” in the spongy honeycomb that grow larger and more numerous, making the bone more fragile. Women are at the greatest risk following the menopause because they lose the protective benefits that come from the hormone, oestrogen. Oestrogen is responsible for facilitating the uptake and retention of calcium in bone. Hence the accelerated decline in bone mass following the menopause.
RISK FACTORS FOR OSTEOPOROSIS
Early menopause, before age of 45
Hysterectomy and removal of one or both ovaries (loss of oestrogen)
Family history of osteoporosis
BMI of 18.5 or less, if you are underweight
Eating disorder, anorexia, bulimia
Amenorrhea – your periods have stopped or are irregular for 6 months to a year prior to the age of menopause
Have taken or are taking chronic steroid medication
Smoke
Alcohol intake of more than 4 units per day
Lack calcium and/or vitamin D, poor diet and little exposure to sunlight
Not very mobile, wheelchair, confined to chair or bed
Underlying medical condition: hyperthyroidism, coeliac disease, Cushing’s, disease, Crohn’s disease, chronic kidney disease, rheumatoid arthritis, chronic liver disease, type 1 diabetes.
OSTEOPOROSIS SYMPTOMS
Osteoporosis usually develops slowly over several years, without any symptoms. The force of a simple fall to the ground (from the height of a standard chair or less) resulting in a fracture may be the first sign. The most common fragility fractures occur in the hip, wrist and spine and fracture healing may be delayed due to the reduced speed of bone formation when we’re older. Aches and pains are NOT a symptom of osteoporosis. It does not cause pain unless there is a fracture. Fractures in the spine (vertebrae) are often missed. So, if you have severe or chronic back pain, with risks factors of having osteoporosis, consult a doctor for further investigation. A vertebra affected by osteoporosis may fracture even without a fall or significant force, possibly just a sneeze or cough. The vertebrae become squashed/collapse following a fracture resulting in pain, height loss and stooping forward posture. This can affect your ability to perform daily activities, as well as your breathing, as your lungs have less room to expand within your chest.
DIAGNOSING OSTEOPOROSIS
In an ideal world, if you have any risk factors listed earlier or following the menopause you would go for screening for osteoporosis every two years, before you sustain a fracture. This involves measuring your bone mineral density (BMD) through a pain-free, non-invasive scan. From this you receive a score of your bone density which can be monitored over the years to track rate of bone loss and fracture risk. Medication can then be prescribed accordingly.
Check out Blackberry Clinic Online and see what Osteoscan UK Ltd can offer you if you think you would benefit from a scan of your bone density, with radiation free, diagnostic scanning to provide immediate bone mineral density results. A Consultant led service gives you the very best advice regarding your bone health. Using the EchoS system Osteoscan UK provides access to earlier measurement of bone mineral density than DEXA, with immediate easy-to-understand results.
Our next article about osteoporosis will deal with treatment and exercises so keep an eye out for that!
