Osteoporosis

Here you will find a brief overview of osteoporosis - its diagnosis and treatment - as well suggestions of where you can go for more specialist information and support. You can also learn more about common risk factors for osteoporosis and steps you can take to reduce your risk.

What is osteoporosis?

Osteoporosis is a progressive condition that affects your bones as you get older. It makes bones fragile and more prone to break easily with the bones in your wrist, hip and spine being particularly susceptible.  

Why does it happen?

Bone is a living tissue with new bone replacing old bone throughout your life. In fact your whole skeleton is replaced over a period of around 7 years.

By your mid 20’s, your bones are at their strongest.  In your mid 30’s, they gradually start to become weaker and more fragile due to normal age-related bone loss - the special cells in your bones that build new bone cannot work as quickly as the cells that break down old bone. Bone loss becomes more rapid in women for several years following the menopause and can lead to osteoporosis and an increased risk of broken bones. The stronger your bones are when you reach your 30’s, the longer it will take for bone loss to lead to osteoporosis.

Could you be at risk?

Your risk of developing of osteoporosis and suffering a broken bone is linked to your:

Family history – if one of your parents has broken a hip, you are more likely to have a fracture yourself.

Age – osteoporosis becomes more likely, the older you are. It affects around 50% of people over the age of 75. Over the age of 50, one in two women and one in five men will break a bone, mainly due to poor bone health.

Gender – osteoporosis is found in men but is more common in women.  Women have smaller bones and also experience the menopause.  A woman’s risk also increases if she has an early menopause or a hysterectomy with removal of the ovaries before the age of 45.

Anorexia nervosa – this is characterised by low body weight, low levels of oestrogen and often a diet lacking the calcium needed to build strong bones.

Certain medical conditions and their treatment:

• cancer treatment that affects male or female hormone levels;
• conditions like Crohns or coeliac disease or colitis that affect absorption of food;
• conditions like arthritis or asthma if you  treated with corticosteroids;
• some treatments prescribed for epilepsy;
• conditions that mean you are relatively immobile or in bed for long periods.

Lifestyle risk factors include:

• smoking;
• drinking more than 3 units of alcohol daily;
• taking little weight bearing exercise;
• low dietary calcium and insufficient vitamin D;
• being very slim with a low body mass index (BMI) below 19kg/m2.

Can you delay the onset or reduce your risk?

Although your genes play a major role in deciding the strength of your bones, taking steps to build up your bones before your mid 20s, means you’ll maximise the strength of your bones and so be better protected against osteoporosis and fractures later on.

This is an important message for young people but you need to take action throughout your life to keep your bones strong.  Try to make sure you:

• eat a healthy diet with plenty of calcium rich foods;
• get enough vitamin D which in the UK comes mainly from summer sunshine. If you don’t get outside often or cover your skin for cultural reasons, you may want to take a supplement;
• keep a healthy weight;
• take part regularly in weight-bearing activities, as this stimulates bone formation. Try activities like walking, dancing, netball, football or tennis;
• don’t start to smoke or if you are a smoker, seek help to give up;
• drink in moderation.
  

Recognising symptoms

Unfortunately osteoporosis has no symptoms and usually goes undetected until a relatively minor incident causes a broken bone in your wrist or hip or the collapse of a bone, known as a vertebra, in your spine. 

Diagnosis and treatment

Waiting until you break a bone is not the ideal way to detect osteoporosis. So if several of the above risk factors above apply to you, including a family member with osteoporosis or who broke their hip after a minor fall, discuss this with your GP. 

If you appear to be at high risk of breaking a bone or have broken a bone after a relatively minor fall, you may be sent for a bone density scan.
This is the most common way to diagnose osteoporosis and uses a machine, known as a DXA (Dual energy X-ray Absorptiometry) scanner.  To have a DXA scan you will need to wear loose clothing and lie on your back on a couch, while your hip and spine are scanned using low doses of radiation.  It takes about 10 - 20 minutes. Your bone density is compared with the average to produce a ‘T score’. A ‘T score’ of minus 2.5 standard deviations (SD) or less indicates osteoporosis.

Your scan results are looked at alongside other risk factors such as your age and family history. This helps decide if you are currently at a high risk of breaking a bone and whether drug treatment should be considered.

Before ordering a scan, your doctor may also use the World Health Organisation (WHO) FRAX® tool.  This calculates your risk, over the next 10 years, of breaking a bone in your hip or other bone such as wrist, upper arm or bone in your spine.  This tool can be used for women after the menopause and for men over 50. 

If you are at low risk, you are likely to be given advice about diet, exercise, drinking and smoking.  If your risk is high, then medication can be considered without the need for a bone scan.  If your risk is between low and high, a doctor may request a bone scan and then recalculate your risk of a broken bone and what steps can be taken to reduce your risk. 

Best treatment guidance

In October 2008, the National Institute for Health and Clinical Excellence (NICE) issued two guidance documents for the treatment of:

• post menopausal women diagnosed with osteoporosis but who have not had a fracture
• post menopausal women who have had a fracture because of osteoporosis

The guidance explains circumstances when drugs named in one or both guidance documents should and should not be used to prevent bone fractures.  As the drugs work best when you are getting enough calcium and vitamin D, you may be prescribed supplements. The guidance takes account of significant risk factors as well as bone density.

A patient version of this guidance is available on request or can be read on the NICE website. You can find out how to contact their orderline in the Further information section.

This guidance does not apply to postmenopausal women who are on long-term steroids.

In October 2008, the National Osteoporosis Guideline Group issued a UK guideline for the diagnosis and management of osteoporosis in post menopausal women and men from the age of 50. 

This guideline updates the Royal College of Physicians’ (RCP) guidance and is produced with the support of the RCP and other specialist medical societies. You can find out how to read this guidance in the further information section. 

Help and support

The National Osteoporosis Society is the only UK-wide national charity dedicated to improving the prevention, diagnosis and treatment of osteoporosis. The charity provides advice and information on all aspects of osteoporosis through its helpline and information booklets, as well as offering people with osteoporosis support through its network of over 100 local support groups.

Social care support

If you break a bone or are suffering from collapse of vertebrae in your spine as a result of osteoporosis, you may find it difficult, at least initially, to manage everyday tasks such as getting dressed or preparing a meal. 

If a broken bone results in a stay in hospital, you can ask your local social services to assess the help you need at home before you leave or, if you are not admitted to hospital, they can visit you at home.  Social services can arrange assistance for you and for the loan of aids to make tasks easier, although there may be a charge.

If you break your hip, a specialist team of falls nurses, physiotherapists and occupational therapists is likely to be involved before and after you leave hospital. They can help you regain your confidence and independence and suggest how you can reduce your risk of having another fall.

Financial support

If you need long-term help with personal care or watching over to make sure you are all right, you may be eligible to claim Disability Living Allowance if you are under 65, or Attendance Allowance if you are 65 and over. Both are non means-tested benefits. 

Further information

Directgov
www.direct.gov.uk
This government website has useful information under the headings ‘money, tax and benefits’ and ‘caring for someone’.

National Osteoporosis Society Camerton Bath BA2 0PJ
www.nos.org.uk
Helpline: 0845 450 0230
Switchboard: 0845 130 3076

NICE Technical appraisals of drugs to prevent fractures in post menopausal women
TA160 Alendronate, etidronate, risedronate, strontium ranelate and raloxifene for preventing bone fractures in post menopausal women with osteoporosis who have not had a fracture.
www.nice.org.uk

TA161 Alendronate, etidronate, risedronate, raloxifene strontium ranelate and teriparatide for secondary prevention of osteoporotic fragility fractures in post menopausal women.
www.nice.org.uk

The patient versions of the guidance can be found under the heading Understanding NICE guidance.

National Osteoporosis Guideline Group
Guideline for the diagnosis and management of osteoporosis in post menopausal women and men over the age of 50.
A leaflet for patients explaining the guideline can be downloaded from
www.shef.ac.uk  Select Information for patients