When I was studying to be an osteopath osteoporosis was something that we talked and studied about a lot. Bone health is vital part of everyone health especially later on in life. Osteoporosis is also something that needs to be taken into account when treating a patient. Not only is it important but it is also often not diagnosed straight away, I thought I would share some information about it with you, so lets start from the beginning:
What is Osteoporosis?
Osteoporosis is when you have a bone density T score of less then -2.5, the word literally means porous bone.
The structure of a bone is with a hard shell round the outside called the cortical bone with the trabecular which is a similar structure to honeycomb inside the outer shell. The trabecular is made so that it can provide as much strength to the bone without been too bulgy or heavy. The bone tissue is made up of hard calcium salt and other minerals to keep your bones as strong as possible. (Parafitt, 2001) Similar to every other structure your bones are ‘alive’ and are constantly changing and remodelling. Your body will break down worn out bone tissue with osteoclasts and replace them with newer bone cells called osteoblasts. It is the balance of the osteoblasts and osteoclasts that we are interested in with osteoporosis. Different bones have different thickness of the trabecular and so are more at risk of fractures. (Orwell, 2003)
Is a breakdown of the trabecular the (honeycomb structure) which will lead to bigger spaces in the bone causing the bone to be more porous making it brittle. Your bone density will keep increasing until the age of 30 when they will reach its peak and will naturally decrease. It generally takes longer to lay down new bone compared to the time it takes for the old bone to be broken down. (Raisz, 2005) For women there will be an increase in the rate of repair and remodelling of the bone after the menopause. The hormone oestrogen will work to protect the strength of the bones which will be significantly reduced with osteoporosis. (Seeman, 1997)
There are two types of Osteoporosis:
Primary: When there is no cause for the bone loss it can naturally happen
Secondary: When there is a underlying condition or risk such as prolonged steroids or conditions.
- Post menopausal women (due to the reduce oestrogen after the menopause) However 1 in 5 men will develop the condition.
- Low BMI or smaller frame
- Long term steroid use
- Older Age – over 70 yrs
- Low Calcium or Vitamin D
- Family History
- Alcohol intake of over 2 units daily
- Conditions such as: Rhumatoid Arthritis, thyroid issues, Crohns
- Reduced exercise or mobility
If they think you are at risk of osteoporosis they will send you for a DEXA Scan (dual energy X-ray absorptiometry). It will measure the amount of minerals in your bones which are called T scores. If your score is -2.5 or less then you have osteoporosis. You T score will be measured and compared to the average bone density for your gender and age.
You can also have a blood test to test for it and they will most likely do one to check your calcium and vitamin D levels.
- Can be asymptomatic it is often only picked up after a fracture
- Fractures: particularly wrist, arm, hip-(femur), spinal vertebrae
- Stooping posture: While spinal fractures do heal the bones don’t return to their original shape they normally end become a wedge shape. This is often why you hear the older generation complain about shrinking. Many of these fractures can be asymptomatic and cause no pain.
Luckily there is a lot you can do through simple lifestyle choices that can reduce your risk and severity of osteoporosis. (Kanis et al 2001)
It is important for bone health to get enough of both Vitamin D + Calcium. These are the minerals that are essential to help maintain the formation of the honeycomb. The best thing for vitamin D is to get outside and in the sunshine, any excuse to be in the sun and I am there! The recommendation is 10-15 minutes of average of sun exposure obviously that depends on the strength of the sun. Getting enough calcium is vital, obviously dairy products are the first thing that comes to mind when you say calcium. However there are non-diary alternatives such as sardines, leafy veg, fortified cereals, soya and tofu.
It’s not surprising but having a healthy lifestyle can help in preventing the risks of osteoporosis. These include reducing your alcohol intake, quitting smoking changing your diet which is mentioned above as well as getting regular exercise. A higher intake of alcohol increases your risk by 40% due to the effect it has on the metabolism of calcium. If you are diagnosed with osteoporosis you will be recommended dietary supplements for calcium and Vitamin D in the forms of tablets and liquid drops.
Regular exercise is will keep your bones stronger, ideally you want to aim for a weight baring activity that will load the joints. Obviously I am not recommending your 90 year old gran to run a marathon but a slow walk round the block could really help. Also being active and mobile can give you more confidence if you are worried about falling or unstable on your feet. The figures are staggering a women who sits for more than 9 hours a day is 50% more likely to get a hip fracture than someone who sits for 6 hours!!
Obviously the risk of falling especially in the elderly will increase the risk of fractures so its important to try to prevent falls generally. You can do this by making sure you have adequate and stable footwear, adding rails and supports for the bathroom. Furthermore make sure that any hazards round the house are out the way so there is less of a chance of tripping over them such as electric cables. (Woolf & Akesson 2003) Increase your confidence in walking and getting out and about will also help to prevent falls.
As I have said before it is very likely that you doctor will prescribe you some supplements for Vitamin D and calcium. You can also be prescribed bisphosphonates can also help to slow down the breakdown of the spongy bone tissue.
Depending on your gender and your age if you are at risk they may put you on HRT (Hormone replacement Therapy). It is normally prescribed for women that are more at risk of developing osteoporosis and are starting the menopause or have started the menopause. You will need to talk to your GP about this as there are risks to long-term hormone therapy and it is not always appropriate for every patient.
- Institute for Quality and Efficiency in Health Care (IQWiG). Osteodensitometry in primary and secondary osteoporosis: Final report; Commission D07-01. October 11, 2010 (Executive summary) (IQWiG reports; Volume 73). [PubMed]
- Pubmed Health, Osteoporosis: Overview from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072713/
- Seeman E. From density to structure: growing up and growing old on the surfaces of bone. Journal Bone Mineralization Resources 1997;12: 1–13
- Parfitt AM. Skeletal heterogeneity and the purposes of bone remodelling: implications for the understanding of osteoporosis. In: Marcus R, Zfeldman D, Kelsey J, eds. Osteoporosis. San Diego: Academic Press, 2001:433–44
- Orwoll ES. Toward an expanded understanding of the role of the periosteum in skeletal health. Journal Bone Mineralisation Research 2003;18:949-54
- Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. Journal Clinical Investigation. 2005;115(12):3318-25
- Kanis JA, Johnell O, Odén A, Dawson A, De LAet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnosis thresholds. Osteoporosis International 2001
- Woolf AD, Akesson K. Preventing fractures in elderly people. British Medical Journal 2003;327:89-95