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What is osteoporosis and are you at risk

Mr Panos Gikas - (BSc, MBBS, MD, PhD, FRCS)
Photo credit: RealPeopleGroup - Getty Images

From Netdoctor

Osteoporosis results in approximately 310,000 fractures in the UK each year, and yet it’s a condition that is often only diagnosed at the point when a bone breaks.

Mr Panos Gikas, Consultant Orthopaedic Surgeon at The Lister Hospital, part of HCA Healthcare UK, looks at the causes, symptoms and treatment options for osteoporosis:

What is osteoporosis?

Osteoporosis is a condition characterised by a reduction in the overall density of bone. In other words, overall there is less quantity of the material from which bone is made. This means that the quality remains the same – there is just less of it. Because there is less bone tissue available, bones become weaker and therefore are more likely to break.

What causes osteoporosis?

Osteoporosis is multifactorial and can be caused by a variety of conditions, diseases or certain lifestyles. These causes can be divided into three categories:

1. Unchangeable causes

These include factors such as:

  • Lower levels of oestrogen following the menopause
  • Increasing age
  • Family history of osteoporosis
  • A low body mass index (BMI)
  • Being female

2. Lifestyle causes

These include factors such as:

  • Smoking
  • Inactivity
  • Excessive alcohol intake
  • Poor diet, low in calcium and vitamin D

3. Medical causes

These include factors such as:

  • Hormone abnormalities, such as over-activity of the thyroid gland
  • Chronic liver or kidney disease
  • Crohn’s or coeliac disease
  • Steroid drug treatments (especially if continued for more than several weeks)
  • Early menopause (or ovary removal before the age of 45)

Osteoporosis risk factors

Osteoporosis is more common in women than in men (men have a higher peak bone density to begin with, hence they have more to lose before they become osteoporotic). Advanced age, premature menopause in women or conditions that decrease testosterone in men can also increase your risk of developing osteoporosis.

Osteoporosis signs and symptoms

Osteoporosis itself is not associated with any signs or symptoms. This means you will not know whether you have osteoporosis unless you are tested for it, or you break a bone. This is the main consequence that arises from having osteoporosis: the weakening of bone makes fractures more likely.

Osteoporosis diagnosis

The majority of people who suffer a fracture from osteoporosis are not known to have the condition prior to breaking their bone.

If you are aged 50 or over and have broken a hip, wrist or vertebrae simply after a minor fall or event (ie not in a major road crash or similar accident), you should talk to your GP about osteoporosis.

Those under the age of 74 should be sent for a DEXA scan, to confirm the diagnosis. A scan is not necessary for those over 74, who will simply advised to consider taking bone-protection drugs (as a degree of age-related osteoporosis will be assumed).

DEXA stands for Dual-Energy Xray Absorptiometry, and it’s a scan that measures the density of bone usual a special X-ray technique.

Osteoporosis treatment

In cases of established osteoporosis that have been diagnosed on DEXA scanning, there are various medical treatments that can be offered. The choice depends on patient characteristics and ideally your GP will be able to offer the best one for you, based on your medical and drug history and lifestyle.

Osteoporosis prevention

Making informed lifestyle choices is a key factor when aiming to prevent osteoporosis. These choices include:

• Exercise

The key lifestyle choice you can make when looking to reduce your risk of developing osteoporosis is exercise. Weight-bearing exercise, such as running and skipping, is particularly important to help improve and maintain bone density, as is resistance exercise, which will also strengthen your muscles. Resistance exercises include weight lifting or press-ups.

• Diet

Your diet should include plenty of calcium. For non-vegans, the majority of calcium comes from dairy foods. Vegans are at risk of low calcium intake and potentially therefore osteoporosis, if they don’t choose the right diet. Non-dairy sources of calcium include green leafy vegetables, pulses and dried fruits, as well as fortified non-dairy milks. These should be eaten as part of a vegan diet regularly, to ensure a healthy intake of calcium.

• Stopping smoking

Several studies have shown that there is a direct link between tobacco use and decreased bone density. This is thought to be because of the nicotine and toxins found in cigarettes, which, among other things, generate a huge amount of free radicals and also increase the level of cortisol in your body, leading to bone breakdown.

• Reducing alcohol intake

Alcohol impacts calcium absorption in the body. Therefore, chronic heavy drinking, especially in young adults, can dramatically impact bone health and increase the risk of developing osteoporosis in later life.

Last updated: 15-11-19

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