Osteoporosis is a reduction in bone mass which increases the risk of fracture, particularly at the hip, wrist and spine. The prevalence increases with age and is more common in women after the menopause. Patients with osteoporosis do not experience any pain until they have a fracture. Fractures in the spine may lead to height reduction and curvature of the spine. Osteoporosis may be detected early using a special x- ray called a DEXA Scan. This is short for Dual energy X-ray Absorptiometry. This measures bone strength and gives a risk of how likely the bones are to fracture in the future.
Screening for osteoporosis
Anyone who experiences a fragility fracture or who feels they are at risk of osteoporosis should consider being screened for osteoporosis as treatments are available which can reduce the rate of bone loss or increase bone strength.
A fragility fracture is defined as a fracture which occurs following from a fall no greater than the persons standing height or with normal use.
Risk factors are
-Premature menopause (occurring before the age of 45 without HRT)
-Low body mass index (height/weight squared = <17.5)
-Family history of osteoporosis or hip fracture
-History of eating disorder
-Lack of exercise
-Low calcium intake
-Prolonged steroid use
Prevention of osteoporosis
There is a great deal that can be done to reduce the risk of osteoporosis
Healthy diet. Children and adults need a diet which has enough calcium. The best sources of this are milk, cheese and yoghurt, and oily fish. If there are concerns about weight it is important to note that skimmed milk contains more calcium than full fat milk.
Exercise. Weight bearing exercise such as walking and running is beneficial.
Alcohol. Keep to the recommended daily maximum allowance.
Calcium and vitamin D supplements. Patients whose diet is deficient in calcium and vitamin D, particularly the elderly may benefit from supplements. Vitamin D is made in the skin in response to sunlight, so people who lack sun exposure may also benefit.
Bisphosphonates. These are medications which reduce the rate at which bone is broken down. Examples include alendronate and risedronate. These are taken on a weekly basis.
Strontium ranelate. This is a liquid preparation which is usually taken at night.
Parathyroid hormone. This increases bone formation and is a course of daily injections over 18 months. It is usually reserved for patients who have severe osteoporosis who have not responded to, or who cannot tolerate the oral preparations.
Denosumab. This is an injection which reduces the rate at which bone is broken down and and is given every 6 months.