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Osteoporosis
What is it?
Osteoporosis means the person has thinner bones than average (for their age and sex)
Why is it important?
If you have osteoporosis, you will be at a higher risk of fracturing a bone more easily than someone who does not have osteoporosis. This is especially important as it can increase the risk of hip, pelvis and spine fractures and these fractures can be more difficult to recover from.
Who does it affect most frequently? Older age, female sex and certain drugs.
All of us lose bone as we age, so osteoporosis is more common the older we get, however, women are more commonly affected than men.
Women lose bone more quickly than men due to their menopause. For women over 80 there is a 60% chance they will have osteoporosis.
In addition, certain drugs can encourage bone loss e.g. using long term high dose steroids (Prednisolone > 5mg daily), aromatase inhibitor drugs etc.
What are the symptoms?
Osteoporosis itself does not cause any symptoms. The symptoms all come from fractures e.g. acute back pain following a vertebral fracture.
How is it diagnosed?
A bone density or DEXA scan is performed. This is a very simple scan (no tunnels to go through) and takes about 30 minutes. The DEXA scan measures the density of the bones in the bottom of the spine (lumbar spine) and hips.
Osteoporosis is defined as a bone density below a certain level and the scores used are ‘T score’ and ‘Z score’:
A T score compares your bone density to the average bone density of someone of the same sex in their 30s.
A Z score compares your bone density to someone of your own age and sex.
Osteoporosis is defined as a T score below -2.5.
How is it treated?
It is very important to make sure your bone health is as good as possible. This means you need enough calcium in your diet and must have enough Vitamin D3 as these are required to build bone.
In addition, it is important to avoid things that will encourage bone loss such as:
- Too much caffeine
- Too much alcohol
- Smoking
- Lack of weight bearing exercise
- Certain drugs etc.
There are two main groups of active treatment:
- Anti-resorptive drugs – these try to reduce bone loss. Examples of these are:
- Bisphosphonate drugs e.g. Alendronic Acid, Risedronate, IV Zoledronate
- Densoumab
- Bone building drugs – these are reserved for people with very severe osteoporosis.
- Examples of these would be Teriparatide, Romozusumab
In addition, HRT can be a very good choice of treatment in younger women.
