Osteoporosis

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Osteoporosis is a condition where your bones become weak. Having weaker bones means that you are more prone to fracturing, or breaking them, from relatively minor bumps.

When you get a fracture from a relatively low impact bump, or fall, it is known as a fragility fracture. It is one of the signs that you may have osteoporosis and a trigger for your doctor to either investigate, or treat.

Who Is More Likely To Get Osteoporosis?

Through childhood and early adulthood, our bones slowly strengthen by taking on more and more calcium. Once we get into our thirties however, our bones steadily lose small amounts of calcium, which leads to steady weakening.

The reason this happens is that bone is continuously regenerating itself throughout life, just like skin. It naturally renews itself by breaking down old ‘bits’ and remaking new ‘bits’. Around your early thirties, it just doesn’t do it as well, and your bones will become less and less strong.

The development of osteoporosis then depends on how quickly our bones are becoming fragile, and how strong they were to begin with.

Some people will have weaker bones than others, even before they hit the time where calcium levels start to decrease. For example:

• Women generally have weaker bones than men to start with and have a higher overall lifetime risk for developing osteoporosis. This is contributed to by the hormone differences between men and women, and that generally, women have a lower muscle mass than men.
• White and Asian populations tend to be more at risk of developing osteoporosis than Hispanic and African populations.
• Malnutrition, leading to low calcium, or vitamin D levels.

One of the most significant risk factors for osteoporosis is age. Past the age of thirty, everyone’s bones are slowly weakening, so the longer you live, the more likely you are to develop osteoporosis.

Obviously, this means that the rate that our bones become weaker is very important. Suppose you live to 80, but cycled every day and never had any issues that caused your bones to weaken fast. In this case, you may never suffer from some of the problems that having osteoporosis brings.

There are a lot of factors that play into the rate that our bones become weaker. Some of these are:

• Certain medication use, such as steroids. Long term steroid use will weaken bones.
• Early menopause. Women who go through the process early are at a higher risk of developing brittle bones.
• Bones can be thought of as a little like muscles in this way. As bones slowly regenerate, they will strengthen themselves more if they are being used. Strength and muscle building exercises have the most significant impact on this. Conversely, if you are not using your bones at all, they will become weaker more rapidly.
• Malnutrition – an ongoing lack of calcium and vitamin D intake will mean a more rapid decline in bone strength. Your bones always need calcium for that breaking down and rebuilding process, and if they don’t have it, you will end up with a much weaker structure.
• Certain other medical conditions, including diabetes, rheumatoid arthritis, overactive thyroid, and kidney disease.
• Smoking and alcohol. Smoking and excessive alcohol intake also contribute to accelerating bone weakness.

Photo by Anand Dandekar from Pexels

There are no real symptoms of osteoporosis. Your doctor will consider investigating you for osteoporosis if you have risk factors which mean you may develop it, or because you got a fracture from an injury where you wouldn’t normally be expected to get one. An example of this would be falling out of your chair. This is a common presentation for people with broken hips.

Other common fragility fractures are broken wrists, broken upper arms, and broken “sitting bones” (the bony bits at the bottom of your pelvis when you sit down, or pubic rami.) Any of these fractures sustained from a simple fall from standing would be deemed a fragility fracture.

Another relatively common fragility fracture would be where one of the bones that make up your spine (vertebra) collapses without any injury sustained.

People often present with back pain and no history of trauma. These fractures can be very painful, but if the pain is controlled, and you continue to try to be as active as you were before, generally, a person doesn’t need any kind of specific treatment.

Getting fractures like these is likely to be the only sign you have of having osteoporosis.

If There Are No Real Symptoms, What Is The Problem?

Day-to-day, a person may have no real symptoms. If someone develops a fracture of a major bone, such as the hip, their quality of life can be severely impacted.

Following the example of the hip, a fracture requires a significant operation and likely replacement of the bone. A patient then has to go through physiotherapy. If their baseline health wasn’t fantastic to begin with, they are unlikely to reach the same function as they had before the fracture. In fact, 20% of people who have hip fractures will die within a year after sustaining that fracture.

Our bones are the things that give our bodies structure. They are essential to our ability to move and perform tasks, and they also serve a protective function. If they are weak and become damaged, these are the things that will suffer.

So What Can I Do To Stop Myself From Getting Osteoporosis? Is There A Way For Me To Strengthen My Bones?

Past a certain age, everyone’s bones weaken. If we can decrease the rate at which they decline, then we are less likely to suffer from osteoporosis.

Obviously, there are some things which affect our bone strength we cannot change, such as age and gender. There are however, things we can do to ensure that our bones stay healthy. Some examples of these lifestyle changes are:

• Exercising more often. The NHS recommends that people over 65 should try to exercise for at least 150 minutes every week. Some guidelines on the types of exercise and how often to do them can be found by clicking here.
• Eat more calcium. Some foods with high amounts of calcium include dairy products and green, leafy vegetables.
• Make sure you get enough Vitamin D. Vitamin D is essential for the prevention of osteoporosis because it helps our bodies to absorb calcium. Most of what we need is produced by our skin when it comes into contact with sunlight. However, certain factors, such as having darker skin and infrequently being outdoors, may mean that you are not getting enough vitamin D. There are some foods that contain vitamin D, such as eggs and certain types of fish. The National Osteoporosis Foundation has put together some recipes with high amounts of calcium and vitamin Ds.
• Maintaining a healthy body weight. Keeping a healthy body weight puts less stress on your bones and joints.

How Is Osteoporosis Diagnosed?

If you have recently suffered a fragility fracture, or have risk factors that mean you are more likely to develop osteoporosis, your GP may send you for a bone density scan. This is where a very low-dose radiation x-ray is taken of your bones, and then the amount of radiation absorbed by your bones can be measured. This is called a DEXA scan. DEXA scans are used to see how healthy your bones are and whether you have osteoporosis.

What Are The Treatments For Osteoporosis?

If you have recently been diagnosed with osteoporosis, your doctor will likely recommend a holistic approach to your treatment. The end goal is to ensure that your bones are strengthened, and the rate of weakening is decreased, while also trying to ensure that you do not get any fragility fractures.

With this in mind, the lifestyle changes discussed earlier are all essential in treating your osteoporosis. Making these changes themselves will decrease the rate at which your bones lose calcium and ensure that they stay stronger for longer.

Several different medications can be tried. Frequently, patients are put on calcium supplements to ensure that they are getting enough calcium.

Bone is constantly regenerating. The way it does this is to break down old parts of bone and reform it. This reformed part of the bone is likely to have less calcium the older you get, and this is what leads to bone weakening. With this in mind, medications either focus on slowing the breakdown of the old bone, or they focus on speeding up the reforming part.

There are many different types of drugs, and the one which your doctor recommends may differ based on your preferences and needs.

One of the commonly used classes of drugs that slows the breakdown process in bone are the bisphosphonates. These drugs cause your bones to take up more calcium from your blood, and therefore strengthen them. If you are given one of these medications as a regular oral tablet, they are generally taken once a week, in the morning before eating. You need to ensure that you remain upright and do not eat anything afterwards for at least thirty minutes. If you have been started on one of these medications and have any questions about taking them, you should speak to your GP, or pharmacist.

Some side effects which you can get from taking bisphosphonates include stomach pain and issues with swallowing.

If you have an underlying condition that is contributing to your osteoporosis, then your treatment is likely to include measures to address this. For example, if you are an asthmatic who is frequently on steroids, your doctor may suggest changes in your asthma treatment regime, to try to decrease the frequency of your need for these drugs.

I Have Been Diagnosed With Osteoporosis. How Do I Try To Make Sure That I Don’t Get Broken Bones?

It can be really scary to continue with exercise and normal daily activities once you have been diagnosed with osteoporosis. Often, it is diagnosed following a fracture, which is painful. Also, the fact that these fractures occur from relatively small slips and trips can leave people fearful of continuing about their daily lives, or trying to exercise.

This can lead to a steady decline where the fear of falls leads to immobility, which leads to increasing fragility, and so the cycle goes on. It is essential to try to ensure that people feel confident to continue with their typical day-to-day routines while also preventing situations that can lead to further fractures.

Using a bathroom grab rail in the house can help avoid slips and falls in the bathroom, as getting in and out of the bath is one of the leading causes of breaks and fractures at home.

Bath mats can also help you to avoid slips and falls in the bath and shower. Fall management items can be incredibly important at home.

Encouraging exercise which does not involve twisting, or bending at the waist, is a great way to combat this decline. You could consider using exercise equipment which allows you to sit down whilst doing strength exercises, as this reduces the risk of fracture whilst enabling effective training.

Some things to consider when trying to prevent falls are:

• Poor vision. Ensure that you have regular check-ups with your optician and that your prescription is up-to-date.
• Make sure you wear sensible footwear which is well fitted. You can even consider the use of specially formulated footwear, such as fall management slippers.
• Ensure adequate lighting around the home at night, and a lack of clutter.
• If you need to, ensure that you are using mobility aids, such as a Zimmer frame, or walking stick.
• Keep items that you frequently use nearby and within easy reach.

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The Royal Osteoporosis Society is a charity dedicated to helping patients with osteoporosis and supporting research into the condition. They operate a free helpline, and you can also chat with them online, or write to them.

If you are concerned about your fall risks in your home, or you are concerned for a family member, you can contact your GP and ask for a home hazard assessment. This is where a professional will visit your home and identify areas where you are at higher risk of falling, and things that can be done to mitigate that risk.

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Bisphosphonates – a class of drugs used to strengthen bones in the treatment of osteoporosis.

Calcium – a mineral that is an essential part of a healthy and balanced diet. It is an integral part of the structure of bone, and high levels of it within the bone increases its strength.

DEXA scan – a scan used in the diagnosis of osteoporosis. Low dose x-rays are used to determine the strength of bones.

Fragility fracture – a broken bone caused by an injury that you would not normally expect to cause a break. For example, tripping on a rug and causing a wrist fracture.

Malnutrition – not having the right amounts of the things that we need for a healthy body in our diets. Generally, people think of people who do not eat enough and are very underweight when they think of malnutrition. This can be the case, but it can also be someone who eats plenty, but not enough of a specific vitamin leading to there not being enough in the body for normal function. For example, never eating fruit, or vegetables, leading to a lack of vitamin C. 

Osteoporosis – a disease where a person has weakened bones, leading to an increased possibility of fractures.

Pubic rami – the bones at the bottom of your pelvis. You can feel the hard parts of them when you sit in contact with the surface that you are sitting on.

Steroids – medications that are used for the treatment of many different conditions, including asthma and COPD. They increase your risk of developing osteoporosis.

Vertebra – the bones which sit vertically on top of one another and make up your spine.

Vitamin D – a vitamin which is essential to ensure the absorption of calcium.