Osteoporosis

Specialty of Orthopaedic surgery

What is osteoporosis?

Osteoporosis, meaning “porous bone”, is a disease in which the bones become weak and brittle due to the body either losing too much bone or making too little. On a microscopic level, the structure of healthy bone resembles a honeycomb, with hollows and spaces. In bones affected by osteoporosis, these hollows and spaces are much wider, meaning the bones are less dense, and therefore weaker than they should be. This makes them susceptible to breaks and fractures.

Symptoms of osteoporosis

Most of the time, a person will not realise they have osteoporosis until they break or fracture a bone. The hip and wrist are the most common places that fractures occur, while spinal fractures are also relatively common.

Stooped posture (in older people) and particularly significant loss of height (>2 inches) should always prompt investigation for osteoporosis.

Medical tests to diagnose osteoporosis

The DEXA or DXA scan is a reliable method to measure bone mineral density using a low-intensity X-ray. It is painless, straight-forward, and involves minimal radiation – in fact, the operator sits in the same room as the patient. After the scan is done, the results are compared to that of a young, healthy individual, and based on accepted criteria a diagnosis of osteoporosis may be made.

What are the causes of osteoporosis?

Losing bone is a natural part of getting older, but some people will lose bone density faster than others. In general, women have a higher risk of getting osteoporosis than men, especially in the years following the onset of the menopause, when bone density is lost more rapidly.

Things that can increase the risk of osteoporosis include:

  • A family history of osteoporosis
  • Certain other medical conditions, e.g. inflammatory conditions, malabsorption problems, some hormone-related conditions, etc.
  • Certain medications  (corticosteroids in particular).
  • Heavy drinking and/or smoking
  • Low BMI (body mass index)

Can osteoporosis be prevented?

While it is impossible to prevent a condition like osteoporosis with 100% certainty, you can lower the risk of getting the disease by taking steps in your lifestyle to keep your bones healthy:

  • Regular exercise
  • Diet - a healthy, calcium-rich diet, and vitamin D supplementation
  • Give up smoking and reduce alcohol intake.

Treatments for osteoporosis

Treating osteoporosis revolves around treating fractures caused by the condition and trying to improve bone strength, which may involve medication. Your doctor will advise you on treatment depending on the results of your DXA scan and the cause of your osteoporosis.

Most of the therapies available slow down the rate of bone loss and decrease fracture risk except for parathyroid hormone analogues which effectively stimulate bone formation.

Possible treatments include:

  • Biphosphonates to slow the rate of bone loss
  • HRT  – in menopausal women
  • Testosterone treatment – if osteoporosis is a result of hypogonadism in men.
  • Selective oestrogen receptor modulators (SERMs)
  • Denosumab (Prolia) – subcutaneous injections at six monthly intervals
  • Parathyroid hormone analogues – delivered via subcutaneous injection, this hormone can actually increase bone density

Which type of specialist treats osteoporosis?

Endocrinologists and rheumatologists treat osteoporosis.

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