Osteoporosis: a silent disease

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; it is often called a “silent disease” because it typically has no symptoms until a fracture occurs. Think osteoporosis if you develop:

• severe, sudden back pain following a vertebral fracture
• height loss or stooped posture due to multiple vertebral fractures
• a hip, wrist or upper arm fracture following a minor fall

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.

Risk Assessment Tools

In some cases, especially in primary care, a FRAX® score may be calculated before a DEXA scan. This tool estimates the 10-year risk of a major osteoporotic fracture using clinical risk factors, with or without a bone density value.

How is it treated?

Improving bone health involves both lifestyle changes and medication.

1. Lifestyle and Nutritional Support

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.

• Take Vitamin D3 regularly – about 25mcg (800iu) daily – you can by this from your chemist or health food shop
• Some people are prescribed a combined calcium and Vitamin D3 by their GP (particularly if their diet is low in calcium)
• Also, weight bearing exercise is important– at least 20 mins daily – this can include walking, dancing, light resistance training etc.

It is important to avoid things that will encourage bone loss such as:

• Too much caffeine
• Too much alcohol
• Smoking
• Certain drugs etc.

2. Medications

There are two main groups of active treatments:

1. Anti-resorptive drugs – these slow down bone loss. Examples of these are:
   1. Bisphosphonate drugsg. oral medications – Alendronic Acid, Risedronate (taken weekly), and intravenous Zoledronate infusions (usually given every 12 months)
   2. Densoumab – given 6 monthly (N.B. this requires a follow up treatment plan as there is a risk of spinal fractures if it is stopped without another osteoporosis treatment in place)
2. Bone building drugs (anabolic drugs)– these are reserved for people with very severe osteoporosis (there is national guidance about their use – from NICE).
   1. Examples of these would be Teriparatide, Romozusumab, Abaloparatide (only Teriparatide is licenced for men)

In addition, HRT can be a very good choice of treatment in younger women particularly those under 60 with menopausal symptoms. It helps preserve bone density and may be used unless contraindicated.

Prevention and Monitoring

Ongoing review is essential. Treatment duration and monitoring should be tailored to individual risk factors.

Takeaway Tips for Stronger Bones

• Stay active with weight-bearing exercises
• Ensure daily calcium and vitamin D intake
• Avoid smoking and limit alcohol
• Get a bone density scan if you’re at risk
• Follow through with treatment and review regularly