- What is osteoporosis?
- What are the symptoms of osteoporosis?
- What are the medical tests to diagnose osteoporosis?
- What are the causes of osteoporosis?
- Can osteoporosis be prevented?
- What is the treatment for osteoporosis?
- Which type of specialist treats osteoporosis?
- Are osteoporosis and osteoarthritis the same?
- Are osteoporosis and scoliosis related?
- Are osteoporosis and osteopenia the same?
- Can osteoporosis be reversed?
Osteoporosis, meaning “porous bone”, is a condition 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 bones resemble 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.
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.
Breaks can also occur in the arms or pelvis, however, and sometimes a sneeze or a cough will lead to a broken rib or the partial collapse of a spinal bone.
Stooped posture (in older people) and particularly significant loss of height (>2 inches) should always prompt investigation for osteoporosis.
Signs and symptoms may appear once the bones have been weakened by osteoporosis. These can include:
- Loss of height
- An easily breakable bone
- Back pain
- A stooped posture
Over 500,000 people in the UK receive treatment for fragility fractures every year due to osteoporosis. These fractures are bones that break after falling from standing height or less.
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 (taking 10 to 20 minutes), 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. The difference is called a T score: a T score of above -1 is normal, while a T score below -2.5 reveals bone loss and is osteoporosis.
Your risk of breaking a bone can be calculated using a programme, like FRAX.
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. This is especially the case for women who have had their ovaries removed or if menopause has begun early (before the age of 45).
Factors that can increase the risk of osteoporosis include:
- A family history of osteoporosis
- Certain medical conditions, e.g. inflammatory conditions, malabsorption problems, some hormone-related conditions, etc.
- Lack of exercise
- Certain medications (corticosteroids in particular).
- Heavy drinking and/or smoking
- Low BMI (body mass index)
- Long-term intake of high-dose steroid tablets (more than three months)
- Eating disorders
While it is impossible to prevent a condition like osteoporosis with 100 per cent certainty, you can lower the risk of getting the disease by taking steps in your lifestyle to keep your bones healthy:
- Regular exercise, such as any moderate-intensity activity, weight-bearing exercise and resistance exercise to strengthen your bones and improve bone density
- Diet - a healthy, calcium-rich diet of green vegetables, fruit, tofu and yoghurt, and vitamin D supplementation
- Getting regular sunlight, this will help your body absorb calcium
- Giving up smoking and reducing alcohol intake
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 starting treatment depending on the T-score 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. They include alendronic acid, risedronic acid or zoledronic acid. They're taken as tablets or as an injection.
- Hormone replacement therapy (HRT) – sometimes recommended for menopausal women, as it can control symptoms and help to maintain the strength of the bones. However, due to its serious side effects, HRT is rarely used for treating osteoporosis.
- Testosterone treatment – if osteoporosis is a result of hypogonadism (low production of male sex hormones) in men.
- Selective oestrogen receptor modulators (SERMs) - to maintain bone density and lower the risk of bone fracture. The only type of SERM available for osteoporosis is raloxifene, which is taken as a tablet.
- Denosumab (Prolia) – subcutaneous injections at six monthly intervals
- Parathyroid hormone analogues – delivered via subcutaneous injection, this hormone can actually increase bone density by stimulating the cells that create new bones. They're administered by injection.
Endocrinologists and rheumatologists treat osteoporosis.
While people can have osteoporosis and osteoarthritis at the same time, osteoarthritis is a degenerative joint disease caused by injuries or everyday wear and tear, which leads to the loss of the cartilage between the bones. Osteoporosis, on the other hand, is the loss of bone mass, which increases the risk of bone fractures.
Although osteoporosis and scoliosis both affect the spine, scoliosis is a sideways curvature of the spine that mostly affects younger patients. It is also possible for a person to have scoliosis and osteoporosis at the same time.
An elderly person with osteoporosis can end up developing scoliosis as well, because osteoporosis can cause bones in the spine to weaken to the point of crumpling. This leads to loss of height and a curved spine.
Osteopenia is the stage of bone loss before osteoporosis: when your bone density is lower than the average for your age, but not low enough to be classified as osteoporosis.
With the appropriate treatment to keep your bones healthy, osteopenia will not always lead to osteoporosis. However, this depends on many factors.
While osteoporosis is a chronic condition that cannot be completely reversed, treatment and lifestyle changes can help to prevent further bone loss and improve bone density.