What is osteoporosis?
Osteoporosis is a disease where the
bones lose some of their calcium content and
strength, resulting in fractures occurring by
themselves or due to small accidents such as falls
and strains. It may be found by a measurement of
the amount of bone mineral content using a bone
scan.
The disease becomes more common with increasing
age and is seldom seen before the age of 55. Women
are affected more than men. In osteoporosis
sufferers, fractures can happen easily, especially
in the back, wrist and in the neck of the femur
(thigh bone). It may be prevented by a healthy
lifestyle, calcium and vitamin D supplements and,
for women, possibly hormone replacement treatment.
As the most dangerous fractures are almost always
in connection with a fall, prevention of falls is
of paramount importance. Osteoporosis is a chronic
disease, but medication is available to increase
the calcium content of the bones that reduces the
risk of new fractures.
Why do people get
osteoporosis?
No one knows why the natural loss
of bone matter which begins in your 30s, may lead
to osteoporosis for some but not others. It may be
hereditary, or a result of a small bone mass
produced in youth, or caused by too little
exercise, or consuming too little calcium (dairy
products) in your diet. An early menopause,
smoking, alcohol consumption, chronic diseases
(arthritis, bronchitis, some intestinal diseases,
and Cushing's syndrome) are all associated with
osteoporosis. Long-term treatment with
corticosteroids (eg prednisolone) may increase the
risk of osteoporosis - if the dose is above 7.5mg
per day. Unfortunately, corticosteroids are
unavoidable in the treatment of many diseases.
What does
osteoporosis feel like?
Many people have bone pains, often
in the back and groin, but symptoms may not
necessarily be present throughout the time of a
fracture. Reduced bone mass does not cause
symptoms in itself. If you have sustained a
fractured neck of the thigh bone (femur), you may
become dependent on a walking stick or frame. If
you develop a vertebral collapse of your back, a
stoop may develop and your ribcage and pelvis may
come closer to one another, causing pains when you
breathe.
What are
the danger signs?
-
Fractures with no external cause, or caused by a
small injury such as a light fall.
- A
crack in your back (vertebrae) with sudden,
heavy pains.
- An
early menopause.
- Low
bodyweight, smoking, and osteoporosis in the
family.
-
Long-term treatment with prednisolone or other
medicines that may soften your bones.
-
Illnesses that may be associated with
osteoporosis (for instance rheumatoid
arthritis).
What can I do to prevent
osteoporosis?
-
Take plenty of exercise throughout your life.
-
Have an adequate diet content of calcium and
vitamin D.
The
table below lists the recommendations for daily
calcium intake from the UK National Osteoporosis
Society.
|
Age |
Recommended calcium (mg/day) |
|
Children 7-12 |
800 |
|
13-19 |
1000 |
|
Men 20-60 |
1000 |
|
Women 20-45 |
1000 |
|
Pregnant and nursing women |
1200 |
|
Pregnant and nursing
teenagers |
1500 |
|
Women >45 |
1500 |
|
Women >45 on HRT |
1000 |
|
Men >60 |
1500 |
A good
rule-of-thumb for adults is to try to get 1000mg
of calcium per day (for instance 800ml of
semi-skimmed milk or 140g of cheddar cheese).
After the menopause, experts in osteoporosis
recommend a dose of 1200 to 1500mg of calcium per
day. The same amount applies if you are treated
with corticosteroids. If you do not like, or you
are allergic to, dairy products it is necessary to
take a calcium supplement. Excellent calcium
supplements with vitamin D can be bought without a
prescription. The amount of calcium tablets you
need depends on your intake of dairy products. The
calcium supplement should be combined with meals,
in two or three doses.
The recommended daily intake of vitamin D is 5
micrograms. This increases to 10 micrograms during
pregnancy and breastfeeding, and in men and women
over 65 years of age.
Vitamin D is found in oily fish, in tinned foods
such as marinated herring, sardines, salmon and
mackerel, and is also obtained from sunlight. In
summertime, the elderly are advised to be out in
the sun for at least half an hour to an hour per
day, and in the wintertime to eat oily fish
regularly. Otherwise a vitamin D supplement of
10micrograms (400 units) per day is required.
Osteoporosis sufferers may require larger doses of
vitamin D and calcium. Talk to your doctor about
this.
Smoking should be avoided and alcohol consumption
minimised. The yearly bone mass loss is doubled
for smokers - statistically one hip fracture in
six is caused by smoking.
Treatment with the female sex hormone oestrogen
should be considered, particularly if you have an
early menopause (especially before the age of 45).
This is known as hormone replacement therapy (HRT).
Exercising for 30 minutes at least three times a
week is beneficial and should be encouraged.
It is important that you arrange your home and
adjust your daily life to avoid falling. About 1
in 20 falls in the home cause fractures and of
these, one in five is a hip fracture.
How does the doctor
diagnose the patient?
With a 'low-energy' bone fracture
the cause is most often osteoporosis, and a bone
scan is not necessary. If you haven't had a bone
fracture, a bone scan (BMD examination), is
necessary to find out if you suffer from
osteoporosis. A scan of your groin and hips may
provide more accurate results compared to a
forearm scan when looking for osteoporosis.
Even though a bone scan is sometimes unnecessary
(with a 'low-energy' bone fracture), an ordinary
examination by a doctor and blood tests are
required to be sure that the problem is
osteoporosis. Bone fractures and calcium
deficiency in bones may also be a result of other
diseases that need different types of treatment to
osteoporosis. For instance, bone fractures may be
caused by some types of cancer, lack of vitamins
or illnesses in the bone marrow. However,
osteoporosis is the most common cause.
The future
When a bone fracture is caused by
osteoporosis, the risk of a new bone fracture is
more than doubled, but depends on the calcium
content of the bones and how often you fall. There
is an increased risk of death only if you have a
break in the neck of your thigh bone (femur).
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