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What is
osteoporosis?
Osteoporosis is a condition in
which the bone is weakened, making fractures more
likely. The most common fractures occur in the
bones of the hips and spine and those near the
wrists. Spine fractures may lead to a loss in
height.
What are the
symptoms of osteoporosis?
Osteoporosis does not cause any
symptoms unless a fracture occurs. It is a common
misconception that chronic aches and pains may be
a sign. Even in people with osteoporosis such
symptoms usually have another cause; backache is
more commonly due to wear and tear in the joints
of the spine. One rare cause of pain is when a
patient's spine has become so shortened that the
lower ribs touch the upper part of the pelvis.
Why do people get
osteoporosis?
The most common cause of thinning
of the bone is the natural loss of bone that
occurs in women following the
menopause.
However, the likelihood of bone fracture in later
life also depends on the amount of bone in the
body at the time of the menopause. This depends on
several factors including the amount of exercise
taken over the years and how much calcium has been
consumed in the diet.
Smoking damages
the bones; smoking 20 cigarettes a day leads to a
reduction of between 5 and 10 per cent in the
amount of bone and nearly doubles the risk of
fracture in later life.
Who is at
particular risk of osteoporosis?
The likelihood of bone thinning is
increased in women who have an early menopause
(before the age of 45) or who have had their
ovaries removed for any reason. It may occur in
people with intestinal disorders, where the
absorption of food is impaired.
It is a particular problem in women
and men who have disorders that need treatment
with
steroids such as
prednisolone. The
risk is thought to be particularly great in people
who need to take more than 7.5mg prednisolone (or
equivalent) a day for a long period of time. Short
courses of steroids do little harm.
Men who have lost their testes (the
source of male hormones) are at particular risk of
osteoporosis.
Who should be
concerned about osteoporosis?
-
Someone who has a fracture 'too easily', for
example with a minor injury.
-
Someone who has a spontaneous fracture, for
example in the spine.
-
A
woman who has an early menopause.
-
Someone who has to take steroid therapy long
term.
-
Someone with a lot of relatives who had
osteoporosis or unexplained fractures.
How is fracture
risk assessed?
One important method is by
bone density scans.
A variety of methods can be used. However, bone
density is only one factor in fracture risk.
Others include a history of previous fractures and
the future risk of falls. Preventing falls can do
as much or more to prevent fractures happening as
any medical treatment for osteoporosis.
What can be done to
prevent osteoporosis?
-
Take
regular exercise.
-
Have a
diet with adequate amounts of calcium (eg from
milk, cheese or yoghurt).
-
Ensure
getting adequate amounts of vitamin D either
from food, such as fatty fish and margarine, or
from moderate exposure to sunlight.
-
Do not
smoke.
-
Seek a
bone density check if you fit into one of the
high-risk groups above.
How are the
fractures treated?
Hip fractures are usually set using
a metal splint and screws. The upper end of the
thigh bone may also need to be replaced by an
artificial one (hip replacement). Fractures of the
forearm require a plaster cast for about four
weeks usually after the fragments have been reset.
Fractures of the spine need rest and pain relief.
The pain usually subsides gradually over about
three months.
How can we avoid
fractures?
People with osteoporosis should
avoid heavy lifting. Wearing flat shoes and the
correct glasses can prevent falls, as can using a
walking stick. Ensure you take medication
correctly as an excessive dose of some types may
cause dizzy spells. Those at high risk of hip
fractures may also find a hip protector useful.
What medicines may
help?
The medicines most widely used for
women with osteoporosis are:
Who should have
extra calcium and vitamin D?
Most people with osteoporosis
benefit from additional calcium and vitamin D.
These supplements are particularly useful for
those who have a low calcium intake, usually
because they take little milk, cheese or yoghurt.
What is the place
of hormone replacement therapy?
Hormone replacement therapy (HRT)
brings oestrogen levels in a woman's body back to
about the same levels as before the menopause. HRT
prevents further loss of bone, and bone density
increases a little. The fracture rate is reduced
to less than half. HRT can be given as tablets or
skin patches. HRT has been reported to lead to a
very small increase in the risk of
breast cancer.
However, it also reduces the risk of
heart attacks and
generally has a beneficial effect. HRT is
effective in relieving menopausal symptoms such as
'flushes'.
For women who have had a
hysterectomy
(removal of the womb) oestrogen alone is needed.
For women with a womb there are two main types of
HRT.
-
Sequential, with regular bleeds.
-
Continuous combined, with little or no bleeding.
What are selective
oestrogen receptor modulators?
Selective oestrogen receptor
modulators (SERMs) are medicines that mimic the
effect of oestrogen on the bones and blood vessels
but not on the breast or womb. These are
particularly useful in people who have had breast
cancer but also need treatment for osteoporosis.
Unlike HRT these medicines do not prevent
menopausal symptoms such as hot flushes.
What are
bisphosphonates?
In all people bone is continually
being broken down and replaced. The
bisphosphonates are medicines that reduce the rate
of bone removal and so increase the amount of
bone. The fracture rate falls and these medicines
are particularly useful in people with severe
osteoporosis. The number of fractures prevented is
too small to justify treatment in other patients.
Bisphosphonates are poorly absorbed
and need to be taken on an empty stomach (but with
water). Patients should avoid eating for two hours
afterwards. If calcium is being given it should
either be taken on different days or at a
different time of day.
What about men?
There have been no reliable
clinical trials about treating men with
osteoporosis. Doctors treat men who have low blood
levels of male sex hormones with
testosterone by
injection, implants, patches or tablets. Men with
severe osteoporosis who do not have this problem
are usually treated with bisphosphonates. |
