Osteoporosis affects over 3,000,000 people in the UK alone, and over 500,000 fractures treated every year are from people suffering from osteoporosis. As a condition that is capable of affecting any one of us as we age, we would like to talk to you about the facts of osteoporosis, the loss of bone density, and any preventative or curative measures that might be available.
Bone Density: What Is It?
When we talk about ‘density’, we talk about how much ‘stuff’ we can pack into a given space. The more ‘stuff’ we can pack into the same space, the denser that space gets.
When it comes to our bones, the more calcium our bones contain, the denser they become, the denser our bones become the stronger they are, and the stronger they are the more impact and daily use they are able to take.
Contrary to common belief, our bones are not static. When we are young, they are soft and still growing, and don’t fully settle into healthy adult bones until well into our teenage years. And as we grow our bones are constantly being added to and repaired and replaced. Every moment of every day our bodies take away old bits of bone and replaces them with new, healthy, stronger bone. And as we age, the rate at which bone is destroyed and removed begins to outpace the rate at which bone is replaced and repaired.
Gradually, over time, our bones begin to have less and less density. This creates a weakness throughout the bone, for whereas before it was like a solid brick wall, as bone density decreases it becomes more like a brittle hollow shell.
When a person has a low bone density, it is known as Osteopenia, a person can have low bone mass and not have a particular disease or condition, their bone mass is simply lower than the expected average but does not change over time.
If one continues to lose bone mass as they age so that their bone density continues to fall into dangerous territory, this is known as Osteoporosis and is the condition we are talking about today.
Osteoporosis: Who is at risk?
Osteoporosis can be present without you really noticing, until one day, from a simple accident a fracture occurs. It can be from something as subtle as sneezing too hard and cracking a rib, tripping on a rug and fracturing your arm, or having a vertebra in your spine collapse as it is no longer able to support the weight of the body.
So, whilst living with Osteoporosis isn’t painful in and of itself, the brittleness of the bones makes you susceptible to fractures which do cause pain, and discomfort, and become very difficult to heal and repair due to the nature of Osteoporosis itself.
Osteoporosis affects both men and women and can affect young people as well as the old. As the body naturally loses bone density as it ages, it is more common to find osteoporosis in older people. The body’s hormones also play a vital role in bone health and density, so women become more at risk of osteoporosis post-menopause.
This happens because oestrogen is vital for healthy bones, and after menopause, the oestrogen levels drop dramatically, which can cause a rapid decrease in bone density in the months and years that follow. This can be exacerbated if you had an early menopause, (before the age of 45), have had a hysterectomy (womb removal), or have had absent periods for more than 6 months due to overexercising or too much dieting.
If you have had lower levels of oestrogen for any length of time, it can contribute to your risk of developing osteoporosis.
The cause in men is harder to pin down but is linked to the hormone testosterone, which is also required for healthy bones to grow. In men with lower levels of testosterone, the risk of developing osteoporosis is higher.
Finally, vitamin D is known to be vital in calcium absorption in the gut, without this ability to absorb calcium, your bones have nothing to grow with. In children, if they do not receive enough vitamin D, then their bones become too soft, and this is known as rickets. Thankfully Vitamin D supplements have rid most of the modern world of rickets, but into adulthood, our Vitamin D intake could be a contributor to how well our bone health is doing.
Low Bone Density Risk Factors
- Low levels of oestrogen in women
- Low levels of testosterone in men
- Low levels of vitamin D
- Overactive thyroid
- Family history of osteoporosis
- A BMI (body mass index) of 19 or less
- Long-term use of high-dose steroid tablets
- Eating disorders such as bulimia or anorexia
- Heavy drinking and/or smoking
- Malabsorption problems, as in coeliac and Crohn’s disease
- Long periods of inactivity, such as long-term bed rest
Bone Density Test
So, how do we determine whether someone has, or is at risk from, osteoporosis at present or later in life?
There is a really simple, non-intrusive test that can be performed called simply, a Bone Density Scan.
Using very low-powered X-rays a scan is taken of the bones, the way the X-rays scatter and bounce off the bone, and how far into the bone they can penetrate tells you just how dense the bones are. A bone with high density will appear as a very solid object, and as the bone decreases in density it becomes patchier and translucent due to the loss of bone mass.
The scan is quick, painless and more effective than a regular X-ray for identifying bone density specifically.
Your results are compared against a healthy control, the bone density of a young healthy adult, or an adult of your own age, gender and ethnicity. The score given is known as a Standard Deviation (SD), any deviation from this ‘Standard’ score, given by the control, is showing less and less bone density.
Low bone mass is a standard deviation between 0 (no deviation at all) and -1 (some deviation). A score that goes below -1 is showing signs of Osteoporosis and the risk of fractures and complications and things progressively getting worse as you age. Doctors will also do a fracture assessment to see how at-risk you are of breaking your bones.
Treatment & Prevention of Osteoporosis and Bone Density
Treatments for Osteoporosis vary according to your needs and the likely causes of Osteoporosis. There are several medicines available that your doctor would talk to you about.
These slow down the rate at which bone is broken down by your body, allowing you a little time to catch up and replace that which is being taken. They are given as a tablet, liquid or injection, take 6-12 months to work and are something you may continue to take for the rest of your life.
Selective Oestrogen Receptor Modulators (SERMs):
These are a group of medicines that have a similar effect on bone as the hormone oestrogen does, helping to keep the bones healthy and dense and reduce risks of fracture. It is recommended only for women and only after menopause.
This is produced naturally in the body and regulates the amount of calcium in the bones. Parathyroid treatments are used to stimulate new bone growth and are taken as an injection once a day. Other medicines may only slow down bone decay, but these can increase bone density again. However, it is only used in a small number of patients when other treatments show no signs of working.
Vitamin D and Calcium:
Calcium is the stuff bones are made of, and Vitamin D is the stuff that allows the calcium to get to the bones in the first place. Ensuring you meet your daily required intake of calcium and Vitamin D can be a good preventive measure to ensure good bone health long into old age.
If this article has raised any questions or concerns, our team of discrete and caring healthcare professionals are always available for a consultation to discuss your health needs and concerns and lead you in the right direction back to health. Register and book your consultation today.