OSTEOPOROSIS
Contents
- Overview
- Causes
- Treatment
- Living with
- Prevention
Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture).
The most common injuries in people with osteoporosis are:
- broken wrist
- broken hip
- broken spinal bones (vertebrae)
However, breaks can also happen in other bones, such as in the arm or pelvis. Sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine.
Osteoporosis is not usually painful until a bone is broken, but broken bones in the spine are a common cause of long-term pain.
Although a broken bone is often the first sign of osteoporosis, some older people develop the characteristic stooped (bent forward) posture. It happens when the bones in the spine have broken, making it difficult to support the weight of the body.
Osteoporosis can be treated with bone strengthening medicines.
Bone loss before osteoporosis (osteopenia)
The stage before osteoporosis is called osteopenia. This is when a bone density scan shows you have lower bone density than the average for your age, but not low enough to be classed as osteoporosis.
Osteopenia does not always lead to osteoporosis. It depends on many factors.
If you have osteopenia, there are steps you can take to keep your bones healthy and reduce your risk of developing osteoporosis.
Your doctor may also prescribe one of the bone-strengthening treatments that are given to people with osteoporosis, depending on how weak your bones are and your risk of breaking a bone.
Who’s affected by osteoporosis?
Osteoporosis affects over 3 million people in the UK.
More than 500,000 people receive hospital treatment for fragility fractures (bones that break after falling from standing height or less) every year because of osteoporosis.
Causes of osteoporosis
Losing bone is a normal part of ageing, but some people lose bone much faster than normal. This can lead to osteoporosis and an increased risk of broken bones.
Women also lose bone rapidly in the first few years after the menopause. Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45) or they’ve had their ovaries removed.
However, osteoporosis can also affect men, younger women, and children.
Many other factors can also increase the risk of developing osteoporosis, including:
- taking high dose steroid tablets for more than 3 months
- other medical conditions – such as inflammatory conditions, hormone-related conditions, or malabsorption problems
- a family history of osteoporosis – particularly a hip fracture in a parent
- long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer
- having or having had an eating disorder such as anorexia or bulimia
- having a low body mass index (BMI)
- not exercising regularly
- heavy drinking and smoking
Osteoporosis is more likely to occur in people who have:
- Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. …
- Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women.
- Gastrointestinal surgery.
What are the symptoms of osteoporosis?
Usually, there are no symptoms of osteoporosis. That is why it is sometimes called a silent disease. However, you should watch out for the following things:
- Loss of height (getting shorter by an inch or more).
- Change in posture (stooping or bending forward).
- Shortness of breath (smaller lung capacity due to compressed disks).
- Bone fractures.
- Pain in the lower back.
Diagnosing osteoporosis and osteopenia
If your doctor suspects you have osteoporosis, they can work out your future risk of breaking a bone using an online programme, such as FRAX or Q-Fracture.
Bone density scan (DEXA scan)
They may also refer you for a bone density scan to measure your bone strength. It’s a short, painless procedure that takes 10 to 20 minutes, depending on the part of the body being scanned.
Your bone density can be compared to that of a healthy young adult.
The difference is calculated as a standard deviation (SD) and is called a T score.
Standard deviation is a measure of variability based on an average or expected value. A T score of:
- above -1 SD is normal
- between -1 and -2.5 SD shows bone loss and is defined as osteopenia
- below -2.5 shows bone loss and is defined as osteoporosis
Treating osteoporosis
Treatment for osteoporosis is based on treating and preventing broken bones and taking medicine to strengthen your bones.
The decision about whether you need treatment depends on your risk of breaking a bone in the future. This will be based on a number of factors such as your age, sex and the results of your bone density scan.
How is osteoporosis treated?
Treatments for established osteoporosis may include exercise, vitamin and mineral supplements, and medications. Exercise and supplementation are often suggested to help you prevent osteoporosis. Weight-bearing, resistance and balance exercises are all important.
What medications are used to treat osteoporosis?
There are several classes of medications used to treat osteoporosis. Your healthcare provider will work with you to find the best fit. It’s not really possible to say there is one best medication to treat osteoporosis. The ‘best’ treatment is the one that is best for you.
Hormone and hormone-related therapy
This class includes estrogen, testosterone and the selective estrogen receptor modulator raloxifene (Evista®). Because of the potential for blood clots, certain cancers and heart disease, estrogen therapy is likely to be used in women who need to treat menopause symptoms and in younger women.
Testosterone might be prescribed to increase your bone density if you are a man with low levels of this hormone.
Raloxifene acts like estrogen with the bones. The drug is available in tablet form and is taken every day. In addition to treating osteoporosis, raloxifene might be used to reduce the risk of breast cancer in some women. For osteoporosis, raloxifene is generally used for five years.
Calcitonin-salmon (Fortical® and Miacalcin®) is a synthetic hormone. It reduces the chance of spine fractures, but not necessarily hip fractures or other types of breaks. It can be injected or it can be inhaled through the nose. Side effects include runny nose or nosebleed and headaches for the inhaled form. Side effects include rashes and flushing for the injected form. It is not recommended as a first choice. There are possible more serious side effects, including a weak link to cancer.
Bisphosphonates
Bisphosphonate osteoporosis treatments are considered antiresorptive drugs. They stop the body from re-absorbing bone tissue. There are several formulations with various dosing schemes (monthly, daily, weekly and even yearly) and different brands:
Alendronate: Fosamax®, Fosamax Plus D®, Binosto®.
Ibandronate: Boniva®.
Risedronate: Actonel®, Atelvia®.
Zoledronic acid: Reclast®.
You may be able to stop taking bisphosphonates after three to five years and still get benefits after you stop. Also, these drugs are available as generic drugs. Of these products, Boniva and Atelvia are recommended only for women, while the others can be used by both women and men.
Possible side effects of bisphosphonates include flu-like symptoms (fever, headache), heartburn, and impaired kidney function. There are potentially serious side effects also, such as the rare occurrence of jaw bone damage (osteonecrosis of the jaw) or atypical femur fractures (low trauma fractures of the thigh). The risk of these rare events increases with prolonged use of the medication (>5 years).
Biologics
Denosumab (Prolia®) is product that is available as an injection given every six months to women and men. It is often used when other treatments have failed. Denosumab can be used even in some cases of reduced kidney function. Its long-term effects are not yet known, but there are potentially serious side effects. These include possible problems with bones in the thigh or jaw and serious infection.
Anabolic agents
These products build bone in people who have osteoporosis. There are three of these products currently approved:
Romososumab-aqqg (Evenity®) has been approved for postmenopausal women who are at a high risk of fracture. The product both enables new bone formation and decreases the breakdown of bone. You will get two injections, one right after the other, once per month. The time limit is one year of these injections.
Teriparatide (Forteo®) and Abaloparatide (Tymlos®) are injectable drugs given daily for 2 years. They are parathyroid hormones, or products similar in many ways to the hormones.
When should osteoporosis be treated with medication?
Women whose bone density test shows T-scores of -2.5 or lower, such as -3.3 or -3.8, should begin therapy to reduce their risk of fracture. Many women need treatment if they have osteopenia, which is bone weakness that is not as severe as osteoporosis. Your doctor might use the World Health Organization fracture risk assessment tool, or FRAX, to see if you qualify for treatment based on your risk factors and bone density results. People who have had a typical osteoporosis fracture, such as that of the wrist, spine or hip, should also be treated (sometimes even if the bone density results are normal).
Supplements
It’s important to remember that dietary supplements, although available everywhere over the counter and online, aren’t regulated in the same way that prescription medications are. Also, even though something is ‘natural,’ that doesn’t mean that it is always safe for everyone.
You might be told by your healthcare provider to get adequate amounts of calcium and vitamin D. This is important if you have osteoporosis or if you are trying to prevent it. It’s best if you can meet those needs with a food plan, but you might not be able to do that. There are plant-based calcium supplements, some of which are based on algae.
The recommended amount of daily calcium intake is 1,000 mg to 1,200 mg daily via diet and/or supplements. Taking more than this amount of calcium has not been shown to provide additional bone strength but may be associated with an increased risk of kidney stones, calcium buildup in the blood vessels and constipation.
There are different ideas about the necessary levels of vitamin D, but it’s true that many people do not have adequate levels and might need to take supplements. Your healthcare provider might test your blood levels and then make recommendations based on these results.
There are other supplements that have been touted as useful for osteoporosis. One of these is strontium, which has never been approved in the U.S. for osteoporosis. A prescription version of strontium ranelate had been available in the E.U., but it was taken off the market due to serious side effects.
You and your healthcare provider will always need to discuss whether the benefits of taking something, whether is a prescription drug or a supplement, outweigh the risks.
Preventing osteoporosis
If you’re at risk of developing osteoporosis, you should take steps to help keep your bones healthy. This may include:
- taking regular exercise to keep your bones as strong as possible
- healthy eating – including foods rich in calcium and vitamin D
- taking a daily supplement containing 10 micrograms of vitamin D
- making lifestyle changes – such as giving up smoking and reducing your alcohol consumption
Living with osteoporosis
If you’re diagnosed with osteoporosis, there are steps you can take to reduce your chances of a fall, such as removing hazards from your home and having regular sight tests and hearing tests.
To help you recover from a fracture, you can try using:
- hot and cold treatments such as warm baths and cold packs
- transcutaneous electrical nerve stimulation (TENS) – where a small battery-operated device is used to stimulate the nerves and reduce pain
- relaxation techniques
Speak to your GP or nurse if you’re worried about living with a long-term condition. They may be able to answer any questions you have.
You may also find it helpful to talk to a trained counsellor or psychologist, or other people with the condition.