Osteoporosis

Introduction
If you are a woman going through the menopause, you could be at risk of the bone-thinning disease osteoporosis. Osteoporosis can affect anyone although women over 50 are most at risk due to falling levels of the bone-protecting hormone oestrogen during the perimenopause and menopause stage.

More than three million people in the UK are affected and as many as half of women over 50 will break a bone due to the condition. It can be a very painful and debilitating disease.

What is osteoporosis?

Osteoporosis literally means ‘porous bones’. It occurs when the struts that make up the structure within bones become thin, causing bones to become fragile and break more easily following a minor fall. These broken bones are often referred to as fragility fractures.

Although fractures can occur in different parts of the body, the wrists, hips and spine are most commonly affected. It is these broken bones or fractures which can lead to the pain associated with osteoporosis. Spinal fractures can also cause loss of height and curvature of the spine.

What causes osteoporosis?

The process of building new bone and breaking down old bone is a continuous process. Up to our mid-20s the building cells work harder, providing strength to our skeleton. From our 40s onwards, the demolition cells become more active, and our bones gradually lose their density.

Estrogen is an important hormone when it comes to the health of women’s bones, and women tend to lose bone density faster in the years following the menopause when estrogen levels start to decrease.

Who is most at risk from osteoporosis?

  • Menopausal women (particularly those with an early menopause or following early hysterectomy and removal of the ovaries)
  • Family history of osteoporosis
  • Women who have lost their periods with an eating disorder
  • Women on a steroid therapy
  • Smokers
  • History of a previous impact fracture.
Lifestyle and healthy bones

It is commonly known that calcium and vitamin D are both essential parts of maintaining healthy bones. However, as with our overall health, we need to have a well balanced diet that incorporates a range of minerals, vitamins, and protein from a range of different food groups.

Meals should include a wide variety of foods from the four main groups, including fruit and vegetables; carbohydrates such as good quality bread, potatoes, pasta and cereals; milk and dairy products; and protein such as meat, fish, eggs, pulses, nuts and seeds.

This balance is so important because no single food contains all the essential nutrients the body needs to function well.

Aiming for a healthy body weight along with regular weight bearing exercise, such as walking , Pilates and Yoga important to help maintain the strength of our bones.

The strength of our bones is determined from our early years, so whatever your age or sex, it is vital to make sure that what you eat today will help to keep your skeleton strong for the future. However, for women the need is greater, as the aging effects of the loss of estrogen during the menopause puts them at greater long term risk of osteoporosis.

Lifestyle options

Diet

Calcium and vitamin D are essential parts of maintaining healthy bones. However, as with our overall health, having a well-balanced diet that incorporates a range of different food groups.

Meals should also include a wide variety of foods from the four main groups:

  • fruit and vegetables;
  • carbohydrates such as good quality bread, potatoes, pasta and cereals;
  • milk and dairy products;
  • protein such as meat, fish, eggs, pulses, nuts and seeds.

The balance is so important because no single food contains all the essential nutrients the body needs to function well.

If necessary calcium and Vitamin D supplements may be recommended.

Exercise

Aiming for a healthy body weight along with regular weight bearing exercise, such as walking , Pilates and Yoga is important to help maintain the strength of our bones. Specific exercise plans can be designed to suit women, who may have a particular medical need (see Ten Clinical website).

Medical

Specific osteoporosis medicines:

  • Bisphosphonates – these are the most commonly used medicines, once a diagnosis of osteoporosis has been confirmed.
    These medications work by slowing bone loss. This effect helps maintain strong bones and reduce the risk of broken bones (fractures).

As with all medicines, there may be some side effects – the most common being: stomach pain, constipation, diarrhoea, gas, or nausea may occur. If any of these effects persist or worsen, tell your doctor or pharmacist.

  • Selective oestrogen receptor modulators (SERMs)
    SERMs are medicines that have a similar effect on bone as the hormone estrogen, ie they help to maintain bone density and reduce the risk of fracture, particularly of the spine.
    The advantage of using a SERM instead of estrogen is that they do not have the associated negative effects, due to their more specific actions on the estrogen receptor. This may be beneficial top women, who may not be able to take estrogen.
    Raloxifene is most widely used SERM for treating osteoporosis.

Other medicines

  • Hormone Replacement Therapy (HRT) – as well as helping to manage the acute symptoms of the menopause, HRT has been proven to help reduce the loss of bone density. This is especially relevant to women going through a premature menopause, when they are at an age when they may still be producing bone.
Diagnosis

What is a DEXA scan?

Dual energy x-ray absorptiometry (DEXA) bone density scanning is the most commonly used diagnostic technique for osteoporosis.

As osteoporosis causes no symptoms until a bone is broken, it has traditionally been difficult to identify who may have fragile bones before a fracture occurs. Due to advances in technology and the development of bone densitometry (the measurement of bone density), The lower the bone density, the higher the risk of bone fractures.

Using the DEXA scan we can now detect osteoporosis prior to any bones breaking. This gives individuals who are at a higher risk of fractures the opportunity to take treatments and adopt lifestyle changes in order to reduce their risk of breaking their bones.

Bone density scans are only recommended for people who are considered to be at risk of having a fragility fracture, such as:

  • menopausal women (particularly those with an early menopause or following early hysterectomy and removal of the ovaries)
  • family history of osteoporosis
  • women who have lost their periods with an eating disorder
  • women on a steroid therapy
  • smokers
  • history of a previous impact fracture.

What happens when one has a scan?

It is a simple, painless procedure that uses very low doses of radiation, which is similar to natural background radiation – less than one tenth of the dosage of a chest x-ray. A DEXA scan involves lying on a firm couch whilst a scanning arm passes over the body taking an image of the spine and hips.

A DEXA scan will take approximately ten minutes. It is a quick, simple and comfortable procedure.

It does not involve being enclosed in a mechanical tunnel or having any injections.

Usually you will not have to remove any of your clothing, but if there is a significant amount of metal near the hips or along the spinal area, this clothing may have to be removed so it does not affect the scan.

What do the results show?

A DEXA scan produces a printout in which your bone density is compared to a reference range of young healthy adults with average bone density. The difference between this average and your bone density is then calculated and expressed in terms of standard deviations (SD) or difference from the normal value and you are given a T score.

T-ScoreBone Health
0 to -0.9 SDNormal
-1 to -2.4 SDOsteopenia
Less than -2.5 SDOsteoporosis

Osteopenia is the name for the category between normal bone health and osteoporosis, when bone is less dense than the average but not low enough to be classed as osteoporosis.

Lifestyle changes such as the adoption of a well-balanced, calcium-rich diet and regular weight-bearing exercise are often recommended for people in this category.

If osteoporosis is diagnosed, suitable treatments will be discussed with you.

Should I have further scans in the future to monitor my progress?

The initial scan will help determine if your bone density is too low and whether you require treatment.

If your bone density is not sufficiently low to require treatment, a repeat scan might be performed after one to five years to monitor any further deterioration. Future bone scans will also be performed to monitor response to treatment.

What is the difference between a DEXA scan and an ultrasound?

Ultrasound is an alternative method of investigating the health of other organs in your body., such as imaging the womb, liver, kidney, gallbladder, spleen, ovaries, bladder, breasts and eyes.

It works by generating sound waves of a high frequency, which are beamed into the body. The echoes of the reflected sound, or the rate and path of transmission of the sound, are used to build up an electronic image or measurement of the structure being examined. Ultrasound does not use radiation