Stronger Bones: Stronger you! Lets talk about Osteoporosis.
What is Osteoporosis?
Osteoporosis is a condition in which the bones become brittle and fragile and can break more easily. Osteoporosis is much more common as we age and is a significant cause of disability and even death. In fact, a hip fracture in the elderly is one of the leading causes of nursing home admission and mortality.
In Australia, osteoporosis is common but it is a condition which is well understood meaning that there are many ways that we can prevent, manage and treat.
Whilst the underlying cause of osteoporosis is losing bone faster that your body can replace it, there are several factors that can contribute to this occurring. These include:
Ageing. We reach our peak bone mass at about 25 years of age. From then on, our bones naturally and slowly become weaker and less dense.
Hormonal changes. As men age, their testosterone levels drop, which is associated with a drop in bone density and as women go through menopause their oestrogen levels drop, and this is also associated with a significant fall in their bone mass.
Diet. A diet low in calcium means that there will not be enough calcium to make strong bones.
Low vitamin D levels. Vitamin D is typically manufactured in the skin by the effect of sunlight. Vitamin D is needed so that your body can absorb the calcium from your diet.
Smoking. Smoking increases bone breakdown.
Drinking excessive alcohol. Drinking excessive alcohol changes the balance between bone breakdown and building so that bone is broken down faster than it is built and new bone is not as strong.
Sedentary lifestyle. Bones need weight bearing exercise with the muscle pushing on the bones to increase the strength of the bones, otherwise they become weaker and more fragile.
Certain medical conditions increase bone breakdown such as inflammatory conditions including rheumatoid arthritis, chronic kidney disease or thyroid disease.
Long term use of some medications can also weaken bones. E.g. corticosteroids.
How is Osteoporosis Diagnosed?
A bone density or Dual Energy X-ray Absorptiometry (DEXA) scan is typically recommended to diagnose osteoporosis. The usual age for your doctor recommending a DEXA scan is 70 years as this is when osteoporosis is most common. However, it may be useful to do a DEXA much earlier, around the age of 50 years. This is particularly useful in women, as this is when their oestrogen levels are about to drop so a baseline level of bone density can be gauged and interventions made to help prevent osteoporosis from developing.
A DEXA scan is essentially a low dose X-rays and is quick and painless.
Blood tests can be added to a DEXA to assess vitamin D and calcium levels and a thoracic spine X ray can assess for possible crush fracture which can also indicate low bone density.
A Fracture Risk Assessment (FRAX Score) can be calculated by your doctor to give an estimate of the chance of breaking a bone in the next 10 years due to osteoporosis. This tool takes into account:
Age, sex, weight, and height
History of previous fractures
Smoking and alcohol intake
Use of steroid medications
High risk medical conditions such as rheumatoid arthritis
The purpose of this tool is to help patients and their doctors decide whether bone density should be treated.
How Can We Manage Brittle Bones or Osteoporosis?
There are many ways in which we can treat osteoporosis. These include lifestyle and medications.
Lifestyle Measures Include:
A diet with plenty of calcium. Aim for 3 serves per day. You can calculate your daily calcium here https://www.osteoporosis.foundation/educational-hub/topic/calcium-calculator.
Plenty of sunlight or supplement with 25mcg or 1000 international units of vitamin D per day.
Regular weight bearing exercise. E.g. strength training, running, boxing.
Quit smoking
Limit alcohol intake
Prevent falls.
Medications:
Hormone replacement therapy (HRT) is now one of the first line recommended therapies for perimenopausal and menopausal women with osteoporosis.
Testosterone can also be used for men with osteoporosis.
Other medications which are most likely to be recommended are bisphosphonates such as alendronate and risedronate which slow down bone loss.
Denosumab is an injection that helps maintain bone density.
Both denosumab and bisphosphonates can have side effects that need to be discussed with your doctor before commencing therapy.
Take Home Message
Osteoporosis itself doesn’t cause symptoms unless you fall and break a bone which can be painful.
Currently, there is no cure for osteoporosis but early diagnosis and careful management with lifestyle measures and medications when indicated can strengthen bones and significantly improve outcomes. Talk to your doctor about whether you should be getting tested now.
References
National Osteoporosis Foundation. “Osteoporosis Prevention: Healthy Habits and Treatment.” www.nof.org
National Institute for Health and Care Excellence (NICE). “Osteoporosis: Diagnosis and Management.” www.nice.org.uk
International Osteoporosis Foundation. “Understanding Osteoporosis.” www.iofbonehealth.org