Osteoporosis

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Osteoporosis is a condition that affects the strength of the bones. Translating directly as ‘porous bones’, osteoporosis is the term used to describe a weakening of the mesh-like structure of proteins and minerals inside the bones.

People with osteoporosis are more likely to suffer from bone breakages known as ‘fragility fractures’, although it is important to note that many people who have the condition will never experience a breakage.

The condition can affect anyone, but the majority of the estimated 3 million people in the UK who have osteoporosis are thought to be post-menopausal women over the age of 50¹.

When we are children, our bones grown at an extremely rapid rate. Bone repair occurs at a faster rate than bone break-down and this is called ‘peak bone mass’. This rate slows down significantly as we grow older. Bones cease to grow in length between the ages of 16 and 18, and cease to grow in density during the late 20s. At the age of 35, bones gradually lose their density. This is because bone break-down occurs faster than bone repair. This is a natural part of ageing, although it can result in osteoporosis and bone breakage.

Factors that determine bone health

There are usually no symptoms of osteoporosis until a ‘fragility fracture’ occurs. There are, however, certain predetermined factors that can make the condition more likely to occur. These include:

Gender - 1 in 2 women over the age of 50 suffer from bone breakages in relation to osteoporosis compared with 1 in 5 men over the age of 50. This is because when females go through the menopause, they begin to lose the bone-protecting oestrogen hormone¹.

Race - Individuals of Caucasian or Asian decent are more likely to suffer from osteoporosis than those of African or Caribbean decent.

Previous Surgery - Women who have had hysterectomies (especially those who have had double hysterectomies, when two ovaries are removed) prior to the age of 45 are more likely to suffer from osteoporosis¹.

Previous bone injury - Fractures often make bones weaker, resulting in a further loss of density which increases the risk of additional breakage.

Long-term immobility - A sedentary lifestyle and lack of any physical activity can result in the disintegration of muscles and bones.

Being underweight - Being underweight suggests a lack of nutrients that are essentially for building healthy bones.

Poor diet- Low levels of calcium and vitamin D have been proven to have an adverse effect on bone health.

There are certain medicines that have been known to cause osteoporosis, including:

Corticosteroids - used to treat serious allergies and inflammation. Extended use of this drug has been known to cause osteoporosis.

Aromatase inhibitors - used to treat breast cancer, this drug has also been known to weaken bones.

Certain preexisting conditions can also result in osteoporosis, including:

Digestive Problems- these can include chronic liver disease and Crohn’s disease.

Overactive thyroid- including conditions such as hyperthyroidism (thyroid gland makes too much thyroid hormone) or hyperpararthyroidism (parathyroid gland makes too much parathyroid hormone).

Hypogonadism- low levels of testosterone in the testicles.

Rheumatoid arthritis- this is when the immune cells enter the joints, causing inflammation.

How does the GP diagnose osteoporosis?

If you are identified as a ‘high risk patient’, you will be more likely to develop osteoporosis. In this case, the GP may refer you to have a bone density scan. This is known as a DXA scan, or a ‘dual energy X-ray absorptiometry’ scan.

The scan will measure bone mineral density, referred to as BMD. The measurement taken will then be compared with the BMD of a healthy young adult’s. The difference between the two numbers is known as a T score. There are 3 possible results:

A score between 0 and 1: this is considered within the normal range.
A score between -1 and -2.5: this is classed as osteopenia, the category between normal and osteoporosis.
A score of below -2.5: this is classed as osteoporosis.

The GP will assess whether or not you need treatment and if so, what course to take.

Treatment for osteoporosis

Treatment for osteoporosis is based on a number of factors identified via a GP assessment and DXA scan, and often depends on the health and condition of the individual.

Fragility fracture prevention

According to audits carried out by the Department of Health in England, standards of prevention, treatment and care for osteoporosis and bone fractures have often been found to be below standard. Not all patients have received the correct assessments or received appropriate treatment.

To help combat this problem, the Department of Health (DH) published a set of standards designed to help increase the quality of healthcare available to osteoporosis sufferers. This is known as the ‘National Service Framework (NSF) for Older People’. The standards include:

providing individual ‘person-centred’ care
eliminating age discrimination
fitting service around the patients’ needs rather than the other way round
promoting the health and independence of older people.

The DH also published a ‘prevention package’ aimed at healthcare professionals. It was designed to help minimize the likelihood of a fall or fracture by supporting the wellbeing, independence and health of older people. The most important messages for older people, family and carers highlighted in the prevention package are:

Although falling over is a risk for older people, it is not entirely inevitable and as such, can be prevented. Certain simple steps can be taken- from reducing household clutter, to investing in a stair-lift or using a walking stick for assistance.

Staying active is integral to physical health. Low-intensity exercise classes are often available to older people on the NHS such as chair-based exercise. This could help reduce the risk of injury.

At signs of unsteadiness and unbalance, you are encouraged to actively seek advice from you GP. Your GP can help with factors such as bad eyesight, balance and muscle weakness.

Drugs

The ‘National Institute for Health and Clinical Excellence (NICE) has made a number of recommendations regarding the prescription of osteoporosis drugs to patients. Factors taken into consideration include:

age
bone density measurement
whether patient has a history of risk factors.

(It is always advisable to consult your GP before deciding which course of treatment to take.)

Living with osteoporosis

Diet

Eating a balanced diet is essential for full health. Certain nutrients are considered to be especially significant for the bones:

Vitamin D

Vitamin D regulates calcium and phosphate, both of which work to keep bones healthy. Vitamin D is absorbed mostly from sunlight through the skin but it can also be found in certain foods. Good sources of dietary vitamin D include:

eggs
oily fish such as salmon and sardines
fortified fat spreads
powdered milk
fortified breakfast cereals.

The Department of Health states that you should be able to get all the vitamin D you need by enjoying a varied and balanced diet- without the need for supplements.

Any vitamin D not used by the body will be stored for future use. Too much vitamin D, however, can weaken the bones.

Calcium

Calcium is one of the main bone-forming minerals found in the body. It serves 3 main purposes:

to build strong teeth and bones
to regulate muscle contractions- this includes the heart
to ensure normal clotting of the blood.

Good sources of calcium include:

dairy- milk, cream, cheese etc.
green leafy vegetables such as cabbage, broccoli and okra (not spinach)
tofu
soya drinks with added calcium
soya beans
nuts
bakery produce made from fortified flour
fish with small edible bones, such as sardines and pilchards.

Doctors recommend a daily intake of 700mg of calcium per day. Too much calcium could result in stomach pain or diarrhoea.

Exercise

Regular exercise is extremely beneficial to health in general. As well as increasing the strength of bones, it can reduce the risk of obesity, heart disease, high blood pressure and high cholesterol. It is advisable to take 30 minutes of moderate to intensive exercise per week. Activities such as swimming and cycling put less strain on bones and joints than activities such as walking and running.

Prevent falls

It is advisable to assess the home for risk factors such as clutter, trailing wires or loose carpets. It mas also be a good idea to keep rubber mats near ‘wet areas’ such as the kitchen sink or the bath, as these could help prevent slipping.

Older people may wish to wear protective padding over their hips to cushion against a possible fall.

Having regular eye tests could also prevent possible accidents.

How can a nutritionist help with osteoporosis?

Although diet is not the main reason why some people develop osteoporosis, studies do suggest that nutrition has a part to play. A healthy diet is important for general physical and mental health regardless of osteoporosis, and can make a huge difference to the quality of your life. A nutritionist will apply expert knowledge to a diet plan tailored to your specific requirements. Consulting a nutritionist could help alleviate some of the pressure many people feel when it comes to choosing food; a nutritionist will sift through the diet fads and myths in order to devise an effective plan suitable for you personally.

If you would like to talk to a nutritionist, please visit the Nutritionist Resource homepage and use the search tool.

Further Help

National Osteoporosis Society

References

¹NHS, Osteoporosis

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