Osteoporosis: how to avoid losing bone density
Osteoporosis is a growing concern for patients, particularly as we live longer and become more prone to conditions more common in our later years.
A consultant rheumatologist at Chase Lodge Hospital, Dr Malcolm Persey, discusses the importance of understanding osteoporosis as a risk factor for fracturing bones and the latest strategies for both prevention and treatment.
What is osteoporosis, and who is at risk?
Osteoporosis is a term used to describe low bone density and as a result, a tendency for bones to break with minimal or no trauma. Bone can be viewed as a brittle sponge; in younger life we fill in the holes, through middle life the holes remain the same size and then when older and in various other conditions, the holes become bigger and the bone more liable to break. While it can affect both men and women, it is more common in postmenopausal women, but other at-risk groups include:
- Older adults, typically over 65
- People with a family history of osteoporosis
- Individuals with low body weight
- Those with certain medical conditions (e.g., rheumatoid arthritis)
- Long-term use of medications like corticosteroids
How can I detect osteoporosis early?
Unfortunately, osteoporosis often goes undetected until a fracture occurs, but early detection is possible with bone density scans. The most commonly used diagnostic tool is a DEXA (dual-energy X-ray absorptiometry) scan, which usually measures the density of bones in the hips and spine.
It is not practical or cost-effective to scan everyone, and it is important to appreciate that bone density is just one of many factors which can influence the risk of breaking bones. Therefore, the decision to have a bone density scan and consider treatment needs to take into account other factors such as personal and family medical history as well as lifestyle considerations.
Screening for low bone density is recommended for people for whom interventions such as medical treatment and lifestyle modifications would be influenced by the result, which is not always the case. Groups more likely to be benefit from scans include postmenopausal women and individuals over 50 who have had a bone fracture. In the UK, the National Institute for Health and Care Excellence (NICE) supports these assessments, making it easier to access DEXA scans.
What can I do to prevent osteoporosis?
Loss of bone density is a natural part of ageing and the best way to mitigate its effects is to ensure bone density is well maintained when younger, so that the bone loss starts from a better base-line. Important measures are
- Adequate calcium and Vitamin D intake: calcium is essential for strong bones, and vitamin D helps the body absorb it. Calcium-rich foods include dairy products, leafy greens, and fortified foods. Vitamin D is synthesised in the skin through sun exposure, but in the UK this is limited between September and May and of course has to be offset against the damaging effects of too much exposure to UV light. Supplements may be necessary.
- Regular exercise: weight-bearing exercises, such as walking, jogging, and resistance training, help maintain bone density. It is important to incorporate these into a routine, as physical activity stimulates bone formation and slows down bone loss.
- Avoid smoking and limit alcohol: smoking is directly linked to reduced bone density, and excessive alcohol can interfere with the ability to absorb calcium. Limiting alcohol intake and quitting smoking, along with all their other health benefits, helps maintain bone health.
What are the treatment options for osteoporosis?
If appropriate and taking into account other factors, fracture risk can be reduced by maintaining bone strength through a number of medical interventions:
Medications
- Bisphosphonates: the most common class of drugs prescribed to slow down bone loss, usually given by mouth, with very few risks and are very effective.
- Hormone Replacement Therapy (HRT): for some postmenopausal women, HRT is an effective option, as it replaces the oestrogen lost during menopause.
- Denosumab: given by injection every six months, helps reduce bone breakdown, but if discontinued, would usually need to be replaced with an alternative.
Other treatment options are usually only appropriate where the risk of fracture is particularly high or other treatments are not tolerated.
Calcium and Vitamin D Supplements
- If dietary intake is insufficient, supplements may be recommended, particularly in the UK where vitamin D deficiency is common, as adequate sunlight exposure is often limited.
Can osteoporosis affect younger people?
While osteoporosis is more common in older adults, it can also affect younger individuals. Conditions like anorexia nervosa, excessive dieting, or over-exercising can lead to low bone density. Additionally, long-term use of certain medications, such as steroids, can contribute to early-onset osteoporosis. For younger people, it is vital to address any underlying risk factors early, maintain a balanced diet, and ensure they are engaging in weight-bearing activities. While osteoporosis is more common in older adults, it can also affect younger individuals. Conditions like anorexia nervosa, excessive dieting, or over-exercising can lead to low bone density. Additionally, long-term use of certain medications, such as steroids, can contribute to early-onset osteoporosis. For younger people, it is vital to address any underlying risk factors early, maintain a balanced diet, and ensure the undertaking of weight-bearing activities.
What are the recent advances in osteoporosis management?
Recent developments in osteoporosis management focus on personalised treatment plans based on genetic risk factors and overall health. Research into bone-building medications, like romosozumab, offers promising options for those with severe osteoporosis. Newer drugs not only slow bone loss but also help to actively rebuild bone. While not yet widely available on the NHS, advancements in treatment may soon provide more targeted approaches to preventing fractures.
