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Osteoporosis

Osteoporosis literally means 'porous bones'. If you have this condition, your bones lose density causing them to become weak, brittle and more likely to break (fracture).

Animation: How osteoporosis develops

About osteoporosis

In the UK, about two in 10 men and five in 10 women over 50 will fracture a bone because of osteoporosis. Osteoporosis can affect all age groups, but it's most common in post-menopausal women. Having osteoporosis doesn't mean that your bones will definitely fracture; it just means that it's more likely.

Symptoms of osteoporosis

You can't see or feel your bones getting thinner, and you may only become aware of the condition when you fracture a bone. However, osteoporosis weakens the bones in your back (vertebrae), so some signs to look out for include back pain, your spine becoming curved and any reduction in your height.

Complications of osteoporosis

If you have osteoporosis, you’re more likely to fracture bones in your wrists, hip and back. Hip fractures are a particular problem for older women – they are usually a result of tripping or falling. However, you can fracture any bone in your body. This may result in pain, disability and loss of independence.

Causes of osteoporosis

Healthy bone consists of a strong mesh made of protein and minerals (particularly calcium) surrounded by a thick outer layer. This mesh is living tissue that is constantly being renewed by two types of cells. One type of cell (osteoblasts) builds up new bone and the other (osteoclasts) breaks down old bone. Although your bones don’t increase in length after the age of about 18, they continue to strengthen up until your mid-20s. After about the age of 35, your bones gradually lose their density as a natural part of ageing. This happens slowly at first, but the rate increases in women after they have been through the menopause

Illustration showing the structure of bone and bone affected by osteoporosis

Although the genes you inherit from your parents play an important role in how healthy your bones are, there are other factors that can affect your risk of osteoporosis.

  • Gender – women in their late 40s and early 50s start to go through the menopause. This means they lose the protective effects of the hormone oestrogen and have a higher risk of developing osteoporosis.
  • Race – Caucasian or Asian races are at greater risk than African-Caribbean people.
  • Total hysterectomy – women who have their uterus (womb) and ovaries removed before the age of 45 are at an increased risk of osteoporosis.
  • Previous bone injury – bone fractures make the bone weaker so affected bones lose their density more quickly.
  • Long-term immobility – bones and muscles become weak if your body isn't active and using them regularly.
  • Weight – if you're underweight, your body won't have the essential nutrients it needs to repair bones and keep them strong.
  • Poor diet – low levels of vitamin D or calcium mean your body can't repair bones and keep them strong.

Some medicines and health conditions can increase your risk of osteoporosis.

  • Long-term use of corticosteroids – used to treat severe allergies or inflammation.
  • Aromatase inhibitors – used in breast cancer treatment.
  • An overactive thyroid gland – such as hyperthyroidism or hyperparathyroidism.
  • Rheumatoid arthritis – this is when your immune cells attack your joints and cause inflammation.
  • A low level of testosterone in men – this can be caused by decreased function of the testicles (hypogonadism) or as a result of treatment for prostate cancer.
  • Digestive disorders – for example Crohn's disease or any other condition that decreases absorption from your digestive system.

Diagnosis of osteoporosis

Osteoporosis is often diagnosed in hospital, possibly after a fall or bone fracture.

If you have had a fracture or your GP thinks you may be at risk of osteoporosis, he or she may suggest measuring your bone density using a DXA scan. (dual X-ray absorptiometry scan). The scan is painless and takes 10 to 20 minutes. Osteoporosis is diagnosed if your bone density is found to be lower than average. If your bone density is slightly lower than average, it's known as osteopenia.

You may also have other tests, such as blood and urine tests, an X-ray or an ultrasound scan. These are to rule out other conditions or to help your GP understand what is happening with your bones.

Prevention of osteoporosis

Making some changes to your lifestyle could help to reduce your risk of developing osteoporosis. A healthy diet and regular exercise can increase bone mass, especially in younger people whose bones are still growing.

High-impact exercise, where you support your own weight, is best for strengthening bones and encouraging bones to grow. This type of exercise includes jogging, tennis, dancing and brisk walking. Try also to include some strengthening activity, such as yoga or t’ai chi, as this can help to improve your balance and muscle strength. If you aren't used to exercising, talk to your GP before you start and build up your exercise routine gradually.

Smoking can have a harmful effect on your bone strength and can also cause an early menopause in women. If you smoke, try to give up. Also be careful not to drink too much alcohol.

It’s important to eat a diet that is rich in calcium to maintain healthy bones. Adults should aim to have 700mg of calcium every day, which you should be able to get through healthy eating. Good sources of calcium include milk and dairy products, such as cheese and yoghurt, dried figs or apricots, oily fish, such as sardines, and some green leafy vegetables, such as broccoli and cabbage. See our frequently asked questions for more information.

Making sure you get enough vitamin D is also important for bone health as your body needs this to absorb calcium properly. Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, don’t let your skin redden. If you don’t get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you’re pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you’re taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

Treatment of osteoporosis

Medicines

Your GP may prescribe the following medicines to increase your bone density. Ask your GP for information and advice about which treatments are available and suitable for you.

  • Bisphosphonates – these work by slowing down bone loss. Examples include alendronate (eg Fosamax), etidronate (eg Didronel), risedronate (eg Actonel) and zoledronate (eg Aclasta).
  • Strontium ranelate (eg Protelos) – as well as reducing bone loss, this stimulates new bone to grow.
  • Calcitonin (eg Miacalcic) – this is a hormone usually made by the thyroid gland that causes less bone to be broken down.
  • Medicines that affect the action of your parathyroid gland – parathyroid hormone (eg Preotact) and teriparatide (eg Forsteo) help to increase calcium levels and the activity of bone-producing cells.
  • Raloxifene (eg Evista) – this is an artificial hormone that works by copying the effects of oestrogen on your bones.
  • Hormone replacement therapy (HRT) – this relieves symptoms of the menopause by restoring hormones to a pre-menopausal level. HRT has also been shown to reduce osteoporosis, so you may be offered it to treat the condition.
  • Denosumab (Prolia) – this is a biological treatment that works by blocking the formation of the cells that break down bone.

For men whose osteoporosis is caused by hypogonadism, your GP may prescribe testosterone replacement therapy.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Living with osteoporosis

If you have osteoporosis, you need to be careful of vigorous, high-impact exercise, such as running. However, leading an active lifestyle will improve your balance, co-ordination and develop muscle strength. This can reduce your risk of falling and fracturing a bone. Doing regular exercise is also good for your heart and your blood pressure. Beneficial exercise includes swimming, gardening, walking, golf and t'ai chi.

Aim to get 1,000 to 1,200mg of calcium every day, either in your diet or as a supplement. You can buy calcium tablets at a chemist, but always speak to your GP before taking supplements as your body can only cope with a certain amount of calcium – if you take too much, you may develop kidney stones or other complications. See our frequently asked questions for more information.

If you have a fracture, you may wish to take medicines for pain-relief. Over-the-counter painkillers such as paracetamol or ibuprofen may help with this. Always read the patient information leaflet that comes with your medicine. See our frequently asked questions for more information.

Physiotherapy, hydrotherapy (exercise in water), TENS (transcutaneous electrical nerve stimulation) and alternative therapies, such as acupuncture or aromatherapy, may also help. Always speak to your GP or pharmacist for advice before any treatment.

 

Produced by Polly Kerr, Bupa Health Information Team, October 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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