Osteoporosis

Osteoporosis is a degenerative bone disease that causes the loss of bone mass and bone tissue. It develops when bone density decreases, or when the creation of new bone doesn’t keep up with the loss of old bone causing bones to become weak, fragile and break (fracture) easily. This occurs when bones lose minerals, such as calcium, faster than the body can replace them.

Osteoporosis means ‘porous bone’. Bone is a living, growing tissue that is flexible and strong. Under a microscope, healthy bone looks like honeycomb while bones with osteoporosis have much larger holes and spaces – making them less dense and more likely to break.

Fractures resulting from osteoporosis can result in chronic long-term pain, prolonged disability, loss of independence and premature death. Around 20 per cent of older people who break a hip die within one year and many require long-term nursing home care.

While one in four women over 75 has osteoporosis, up to 25 per cent of cases are in men and it also affects younger men, women and children.

For the general population, the likelihood of developing osteoporosis depends on how much bone mass was developed in youth. The greater bone mass a person has in store from youth, the less likely they are to develop osteoporosis in later life.

Bones are thickest and strongest in early adult life and most people reach their ‘peak bone bass’ in their early 20s. Loss of bone mass is a normal part of ageing, starting gradually in one’s 30s and speeding up after menopause in women and in men over aged 60.

There are other conditions which put people at increased risk of osteoporosis.  For example, autoimmune diseases, bowel diseases, neurological diseases, endocrine/hormonal disorders, kidney disease, liver disease, cancer and its treatments and blood disorders can all contribute to the risk of developing osteoporosis.

There are no early symptoms of bone loss. Most people become aware as a result of

• Back pain, caused by a fractured or collapsed vertebra
• Reduced height
• Easily broken bones
• Stooped (bent forward) posture. This can happen when bones in the spine have broken, making it difficult to support the body.

Osteoporosis risk factors that can’t be controlled include

Age | Osteoporosis is more common in older people. Lower bone strength comes with increasing age.

Body frame | People with small body frames have a higher risk, because they have less bone mass to draw on as they age.

Gender | Osteoporosis is not just a women’s disease. In men it is still more common over 50 than prostate cancer.

Family history | Having a parent or a sibling with osteoporosis or broken bones puts you at greater risk.

Race | Being Caucasian or Asian.

Hormones | Lowered hormones weaken bone mass. The reduction of oestrogen in women at menopause, in those who go through early menopause or have ovaries removed is a strong risk factor.  A women’s body can lose up to 20 per cent of their bone density after menopause. Other hormone producing glands that affect bone mass are thyroid, parathyroid and the adrenal glands.

Reduced bone density, early bone loss and increased risk of fractures also happen as a result of

Poor nutrition | Low calcium intake contributes.

Low body weight | Restricting food intake and being underweight.

Physical inactivity | Movement strengthens muscles and bones in your arms and upper spine.

Gastrointestinal | Surgery that reduces the surface area available to absorb nutrients (eg. vitamin D and calcium).

Medications | Long term use of steroids and some medications for cancer, gastric reflux and seizures.

Osteoporosis prevention at all stages of life is important, including in youth when bone mass is developing. While genes determine a person’s height and skeleton strength, lifestyle choices such as diet and exercise determine how healthy bones. For maximum bone health

• Exercise regularly, especially weight bearing exercise (such as running, skipping, jumping) that helps posture. Exercise at least two and a half hours a week for strong bones.
• Eat plenty of fruit and vegetables, including foods rich in calcium and vitamin D. Good dietary sources include low-fat dairy, dark green leafy vegetables, soy products like tofu, oily fish, canned salmon or sardines with bones, fortified products like cereal, dried fruit, red meat, liver and egg yolks.
• Don’t smoke. Smoking slows down the cells that build bone. It also increases the chances of an earlier menopause.
• Follow alcohol guidelines. Alcohol affects the cells that build and break down bone. It also makes you more likely to trip, fall and break a bone.

A bone density test will confirm osteoporosis or the risk of developing it.  While there is no cure for osteoporosis, early identification allows osteoporosis to be managed and treatment can slow down the breakdown of bone and spur the growth of new bone.

Treatment is based on preventing and treating broken bones, lifestyle changes and taking medicine to strengthen bones. This includes increasing calcium and vitamin D intake and exercise, particularly weight bearing exercise.