Osteoporosis
What is it?
Bone is made up of two types of tissue. First there is a protein network which forms the structure for the bone. Secondly, there are calcium salts which are deposited and reinforce the protein network and give the bone its strength. Osteoporosis is a condition where both the protein network and the Calcium salts are deficient. This makes the bone softer. There may be very few symptoms until about one-third of the bone strength is lost. Then pain occurs due to distortion and fracture of the bone. It is usually in the spine, which carries the major weight load. One or more vertebrae of the spine may collapse completely, giving acute pain and later shortening of the spine. The deformity is responsible for some cases of so-called dowager's hump. Wrist and hip fractures are more likely to occur, especially in patients beyond the age of 65. They are mostly brought about by a minor fall or injury, which alone would not cause fractures in otherwise healthy people.
How does it occur?
Bone is made up of two types of tissue. First there is a protein network which forms the structure for the bone. Secondly, there are calcium salts which are deposited and reinforce the protein network and give the bone its strength. Osteoporosis is a condition where both the protein network and the Calcium salts are deficient. This makes the bone softer. There may be very few symptoms until about one-third of the bone strength is lost. Then pain occurs due to distortion and fracture of the bone. It is usually in the spine, which carries the major weight load. One or more vertebrae of the spine may collapse completely, giving acute pain and later shortening of the spine. The deformity is responsible for some cases of so-called dowager's hump. Wrist and hip fractures are more likely to occur, especially in patients beyond the age of 65. They are mostly brought about by a minor fall or injury, which alone would not cause fractures in otherwise healthy people.
How does it occur?
| Normal Bone | Osteoporotic Bone |
 |
 |
Osteoporosis is a gradual process which probably starts at least 20 years before the first symptom appears. It may result from a generally poor diet, especially one which is low in Calcium. It may also come from long periods of bed-rest, such as might occur with severe or prolonged illness. The pull of muscles, in ordinary body movements and particularly regular exercise, is now known to be an important way of keeping bones strong.
Most cases result simply from ageing. From the age of 35, most people have a gradual reduction in their bone strength. It is the strength of bone at this age which partly decides whether the bone loss which occurs with ageing will lead to serious bone thinning or not. Some people lose bone strength (Calcium) faster as they age; others lose much less. The sex hormones protect the bones to some extent from this ageing effect. For this reason, after menopause, women lose bone rather more rapidly than they did before the menopause. They also lose bone faster than men. It is therefore post-menopausal women who are at greatest risk from osteoporosis.
Why does it occur?
A menopause which occurs earlier than usual (as, for example, after removal of the ovaries and womb) is particularly likely to result in osteoporosis. Some disorders, like multiple myeloma, overactive thyroid and overactive parathyroid glands, can also produce general thinning of the bones. These are comparatively uncommon, but important to identify. These causes are treated by correcting the underlying condition. Certain drugs taken for a prolonged time, such as oral steroids, can also lead to osteoporosis. Because of this, people are often put on preventative treatment for osteoporosis whist taking their steroids. Steroid inhalers used for asthma are not linked to osteoporosis.
It can be hereditary. The two things which lead to osteoporosis are a reduced bone strength at the peak of maturity (approximately age 35), and the rate at which calcium is lost from the bones during the next 20-50 years.
What does treatment/management involve?
DIAGNOSIS Once pain or a fracture occurs, doctors set about working out why the thin bones occurred. Tests are done to try to find a cause. Sometimes it is obvious (for example removal of the ovaries at the age of 35, or a natural early menopause). Other blood and urine tests may be needed. The density of bone can be measured using either special x-ray systems (DEXA scans) or radioactive isotopes. Occasionally, a piece of bone (biopsy) is taken from the hip. Analysis may help to assess the severity and the cause of the problem. Doctors are always careful to exclude osteomalacia. This is another cause of "thin bones" which can be treated by giving vitamin D tablets.
TREATMENT Once osteoporosis occurs, it is hard to restore the strength of the bone. It may however be possible to stop further worsening. Newer forms of x-ray and isotope screening make it possible to pick up 'thin bones" before they cause symptoms, so that treatment can reduce the likelihood of further bone loss (and fracture). Once symptoms have occurred, a high-calcium diet is advised. Usually additional calcium tablets are given on a regular basis. You will be urged to keep up or develop regular weight bearing exercise like walking. This is known to help promote calcium back into the bones.
People who have osteoporosis are nearly always put on a drug called a bisphosphonate which helps promote increased bone strength. Bisphosphonates are most commonly taken as a tablet once a week but preparations are now becoming available that are taken monthly or even less often. Newer drugs are also being developed and we expect to see more of these in the future.
Giving sex hormones (hormone replacement therapy: HRT) to women is now known to slow down (but not totally prevent) the bone loss of ageing. The closer it is begun to the time of menopause, the more protection it gives. This protection only lasts whilst a woman takes HRT. Of course there are a lot of other issues and risks to consider when deciding whether to take or continue HRT. Other types of hormone (called anabolic steroids) are used in some patients. They are given either by tablet or by injection.
It is likely that picking up the condition early is the best way to deal with the problem.
Self-help group:
Most cases result simply from ageing. From the age of 35, most people have a gradual reduction in their bone strength. It is the strength of bone at this age which partly decides whether the bone loss which occurs with ageing will lead to serious bone thinning or not. Some people lose bone strength (Calcium) faster as they age; others lose much less. The sex hormones protect the bones to some extent from this ageing effect. For this reason, after menopause, women lose bone rather more rapidly than they did before the menopause. They also lose bone faster than men. It is therefore post-menopausal women who are at greatest risk from osteoporosis.
Why does it occur?
A menopause which occurs earlier than usual (as, for example, after removal of the ovaries and womb) is particularly likely to result in osteoporosis. Some disorders, like multiple myeloma, overactive thyroid and overactive parathyroid glands, can also produce general thinning of the bones. These are comparatively uncommon, but important to identify. These causes are treated by correcting the underlying condition. Certain drugs taken for a prolonged time, such as oral steroids, can also lead to osteoporosis. Because of this, people are often put on preventative treatment for osteoporosis whist taking their steroids. Steroid inhalers used for asthma are not linked to osteoporosis.
It can be hereditary. The two things which lead to osteoporosis are a reduced bone strength at the peak of maturity (approximately age 35), and the rate at which calcium is lost from the bones during the next 20-50 years.
What does treatment/management involve?
DIAGNOSIS Once pain or a fracture occurs, doctors set about working out why the thin bones occurred. Tests are done to try to find a cause. Sometimes it is obvious (for example removal of the ovaries at the age of 35, or a natural early menopause). Other blood and urine tests may be needed. The density of bone can be measured using either special x-ray systems (DEXA scans) or radioactive isotopes. Occasionally, a piece of bone (biopsy) is taken from the hip. Analysis may help to assess the severity and the cause of the problem. Doctors are always careful to exclude osteomalacia. This is another cause of "thin bones" which can be treated by giving vitamin D tablets.
TREATMENT Once osteoporosis occurs, it is hard to restore the strength of the bone. It may however be possible to stop further worsening. Newer forms of x-ray and isotope screening make it possible to pick up 'thin bones" before they cause symptoms, so that treatment can reduce the likelihood of further bone loss (and fracture). Once symptoms have occurred, a high-calcium diet is advised. Usually additional calcium tablets are given on a regular basis. You will be urged to keep up or develop regular weight bearing exercise like walking. This is known to help promote calcium back into the bones.
People who have osteoporosis are nearly always put on a drug called a bisphosphonate which helps promote increased bone strength. Bisphosphonates are most commonly taken as a tablet once a week but preparations are now becoming available that are taken monthly or even less often. Newer drugs are also being developed and we expect to see more of these in the future.
Giving sex hormones (hormone replacement therapy: HRT) to women is now known to slow down (but not totally prevent) the bone loss of ageing. The closer it is begun to the time of menopause, the more protection it gives. This protection only lasts whilst a woman takes HRT. Of course there are a lot of other issues and risks to consider when deciding whether to take or continue HRT. Other types of hormone (called anabolic steroids) are used in some patients. They are given either by tablet or by injection.
It is likely that picking up the condition early is the best way to deal with the problem.
Self-help group:
