Looking after your bones and preventing osteoporosis

Osteoporosis is a fragile bone condition that can affect anyone and lead to painful fractures or breaks from minor falls. 

We tend to take bone health for granted, usually giving it little thought until a fracture or break occurs. After the age of 35, we all lose bone density and, whilst this is a natural part of ageing, for some people this can also result in osteoporosis. Osteoporosis results in damage to the honeycomb structure within bones, making them weak and prone to breaks. By the age of 75, half of the demographic will have osteoporosis.

Three million people are estimated to have osteoporosis in the UK and, between them, they suffer around 250,000 fractures a year. These fractures mainly occur in the spine, wrist and hips but also in the arms and pelvic area. 

What are the symptoms of osteoporosis?

Dr Nicola Peel is a consultant and clinical lead at the Northern General Hospital Metabolic Bone Centre, Sheffield: ‘Osteoporosis is known as the silent epidemic because people don’t realise they have it until a bone breaks,’ she says.

She adds that, whilst we don’t routinely screen for osteoporosis in the UK, there is now a screening tool called FRAX which can assess your risk of a fracture in the next 10 years. Dr Peel highlights that if your risk is assessed as high, you can discuss whether you need treatment or further investigation with a DXA scan (to measure your bone density) with your GP.

‘If you break a bone after the age of 50 from a low impact fall, it should be investigated – ideally by a fracture liaison nurse. You shouldn’t have to wait until you’ve had several breaks before your bone density is investigated.’

What are the risk factors of Osteoporosis?

Risk factors for osteoporosis generally include age, but also the following:

• History of previous fractures: Especially from a low impact fall – from standing height or less after the age of 40.
  
• Premature menopause in women: If you’ve had a premature menopause before age 45, or had a hysterectomy where your ovaries were removed before age 45, you may be at risk of osteoporosis because of low oestrogen levels, which protect you against bone loss.
  
• Family history: A first degree relative (mother, father or sibling) with a history of hip fracture before the age of 75. Although women are four times more likely to develop the condition, it can affect men too.
• Corticosteroid treatment: Long-term treatment with high dose steroids for conditions such as asthma and arthritis can also put you at higher risk.
  
• History of rheumatoid arthritis (RA) or other inflammatory diseases: These include not only RA but other types of inflammatory arthritis and inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.
  
• A history of eating disorders which interrupted your menstrual cycle: The lower levels of oestrogen may have affected your bone density.
  
• Being underweight: If you have a body mass index of less than 19kg/m2 you’ll be at greater risk of developing osteoporosis.

Osteoporosis treatment

There is medication available to slow down bone loss, such as bisphosphonates, which maintain bone density and reduce fracture risk. These include alendronate, ibandronate, risedronate and zoledronic acid.

Alenodronate is often the first recommended treatment and is taken once a week, usually with a calcium and vitamin D supplement to maintain healthy bones.

If you suffer side effects or don’t respond well to alendronate, the second line treatment is usually weekly risedronate or monthly courses of ibandronate. Alternatively, an injection of denosumab may be recommended once every six months to block a chemical which breaks down bone.

There are alternative drugs to maintain bone density, including strontium ranelate and raloxifene, but these are not suitable for all patients. For severe cases of osteoporosis, particularly when this has led to multiple spinal fractures, injections of parathyroid hormone (Teriparatide) can build bone density.

How to take care of your bones

There are ways you can protect your bones against osteoporosis, such as:

• Eating a healthy diet:A diet that is rich in fruit and vegetables is important for bone health as they alter the way acid is handled in the body. Your diet should also include calcium-rich foods such as milk and dairy products, dried fruits, fish such as pilchards and sardines and leafy green vegetables.
  
• Getting enough vitamin D:Spending time outdoors in the sun helps our bodies produce vitamin D. However, if you are at risk of vitamin D deficiency, or a blood test reveals your levels are low, your GP may recommend a supplement. You should also try to include more sources of vitamin D within your diet.
  
• Taking weight-bearing exercise: Weight-bearing exercise, such as brisk walking, jogging, pilates or aerobics, can be effective in helping to prevent osteoporosis and strengthen your bones.
  
• Repetitive weight training: Lifting weights safely in the gym or at home also helps to strengthen your muscle and bones.
  
  
• Not smoking: Smoking increases your risk of having a fracture, so if you are at risk of developing osteoporosis, it is recommended to stop.

Coping with osteoporosis

Osteoporosis can result in painful fractures. Hip fractures involve a lengthy recovery period in particular and, where vertebrae in the spine can fracture, this can cause height loss and increased curvature of the spine.

Bones usually heal within 6 to 8 weeks but pain, especially after spine fractures, can persist for much longer. The National Osteoporosis Society says painkillers, physiotherapy, hydrotherapy (where you exercise in water) and TENS machines may help you cope with the pain.

If you’d like to find out more about physiotherapy services or health and wellbeing classes to support or prevent osteoporosis, please contact us.