Osteoporosis

What is osteoporosis? How many people are affected? Do males and females suffer from the same type of the disease? What are the symptoms? Who is most vulnerable? Can we reduce the risk?

What is osteoporosis?

The word osteoporosis means "porous bones".  Osteoporosis occurs when bones lose a substantial amount of their proteins and minerals, particularly calcium. 

Bone is a living organ that is constantly being renewed. During childhood and early adulthood, more bone is produced than removed, reaching a maximum mass and strength by our mid-30s. However, after that, bone is lost at a faster rate than it is formed, so the amount of bone in our skeleton begins to slowly decline.

This explains why, as we get older, our bone mass, and its strength decreases. Consequently, bones become fragile and break easily. Even sudden movements may be enough to break a bone in those with severe osteoporosis. The most common bone fractures are in the hip and/or the wrist, with fractures of the spine also possible. 

How many people are affected?

Osteoporosis is an age-related condition, although it can also appear at any age following long-term application of certain medications such as glucocorticoids (steroids used to reduce inflammation, for instance in MS, rheumatoid arthritis, IBS and eczema).

It affects nearly half of people over the age of 75, although women are about five times more likely than men develop the illness. 

About 3 million people in the UK (and 54 million people in US) are affected by this condition. In the UK more than 500,000 people receive hospital treatment for fragility fractures every year as a result of osteoporosis. 

What are the symptoms? 

Osteoporosis is often called the "silent" disease, because the bone loss occurs with no obvious symptoms. Many people only get a diagnosis of osteoporosis after a fall. Fortunately there are fall prevention exercises and courses, which can help here.

Who is most vulnerable to Osteoporosis?

  • The over 65s (who account for ¾ of fractures due to osteoporosis).
  • Women after the menopause – including women who have an early menopause (women lose bone tissue more rapidly as they age. While women commonly lose 30 -50% of their bone mass over their lifetimes, men lose only 20-33%)
  • Caucasian and Asian women (who are more at risk than African and Hispanic women).
  • Women with small bones and those who are thin.

Other risk factors?

  • Anorexia and bulimia may lead to early menopause and consequently to bone loss
  • Smoking and drinking alcohol excessively
  • Not getting enough exercise
  • Poor diet, with  insufficient calcium and protein
  • Our genes e.g. variations of a specific gene is reported to make some post- menopausal women more likely to have osteoporosis. 

The diagnosis is normally confirmed using a bone mineral density scan, known as a dual energy X-ray absorptiometry (DEXA, or DXA) scan.

Can we reduce the risk of osteoporosis? 

People are living longer and age is a major risk factor. So it particularly important to find ways to reduce the risk. 

Fortunately there are a number of things we can do to help maintain or build strong bones – and so reduce the risk of or delay the onset of osteoporosis. These include:

A heathy diet, low in fats and animal products and high in whole grains, fresh fruits and vegetables, and calcium- rich foods (such as low fat dairy products, dark-green leafy vegetables, sardines, salmon and almonds).  

Regular Aerobic Exercise. Studies have shown that regular aerobic exercise enhances bone mass and prevents osteoporosis. Weight bearing exercises are especially helpful for maintaining bone mass in the hips, lower spine and legs. 

Sufficient Vitamin D. The best way to achieve this in the summer is exposing your arms and legs to regular, moderate exposure to the sun (15 – 20 minutes without sunscreen unless you have very fair skin). Don’t overdo it, as that would increase the risk of skin cancer. Other natural, but less powerful, sources of vitamin D include oily fishes like tuna or salmon. In winter or if you have dark skin, consider Vitamin D supplements.  

Don’t smoke and limit your alcohol intake, as smoking and alcohol are two other risk factors for osteoporosis.  

In a recent study published in Nature Communications in January 2019, US scientists have reported that blocking of signals from a small number of neurons in the brain of female, but not male mice resulted in generation of super-strong bones which were maintained into old age. These neurons appear to play an important role in controlling women's bone density. These findings have potential for the future treatment of Osteoporosis in women. 

Conclusions

  • Osteoporosis means our bones become more fragile and break easily.
  • It particularly affects women after the menopause (especially Caucasian and Asian women) and older people more generally.
  • Unfortunately bone loss can occur without any symptoms – although a bone mineral density scan can detect it.
  • To reduce or delay the risk, follow a healthy lifestyle – i.e. a healthy diet, regular exercise, sufficient Vitamin D, not smoking and not drinking too much alcohol. 

Reviewed and updated by Kayhan Nouri-Aria July 2019. Next review date July 2023.

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