Osteoporosis
Published by Bupa's health information team, September 2008.
This factsheet is for people who have osteoporosis, or who would like information about it.
Osteoporosis literally means "porous bones". It's a condition where bones lose density causing them to become weak and more likely to fracture (break).
- Animation - How osteoporosis develops
- About osteoporosis
- Symptoms of osteoporosis
- Complications of osteoporosis
- Causes of osteoporosis
- Diagnosis of osteoporosis
- Treatment of osteoporosis
- Prevention of osteoporosis
- Further information
- Questions and answers
- Related topics
- Sources
How osteoporosis develops
About osteoporosis
About one in two women and one in five men over 50 will fracture a bone because of osteoporosis. Osteoporosis can affect all age groups, but it's most common in postmenopausal women. Having osteoporosis doesn't automatically mean that your bones will fracture, it just means that it's more likely.
Symptoms of osteoporosis
You can't see or feel your bones getting thinner, and may be unaware of any problems until you fracture a bone or start to lose height.
Complications of osteoporosis
Broken wrists, hips and spinal bones are the most common fractures in people with osteoporosis. Fractures can, however, occur in any bone. They can result in pain, disability, loss of independence and a drop in self esteem.
Causes of osteoporosis
Healthy bone consists of a strong mesh made of protein and minerals (particularly calcium). This mesh is living tissue that is constantly being renewed by two types of cells. One type builds up new bone and the other breaks down old bone. Up to our mid-20s our skeleton is strengthened, but from our 40s onwards our bones gradually lose their density as a natural part of ageing.
The structure of bone and bone affected by osteoporosis
Our bone health is largely down to the genes we inherit from our parents. However, there are factors that can put you at greater risk of osteoporosis.
The breakdown of bone is quicker in women who have been through the menopause. This is because of a lack of the hormone oestrogen. Oestrogen reduces the amount of bone broken down and so helps to protect against osteoporosis. In women, oestrogen is made in the ovaries from puberty until the menopause. Anything that reduces the number of years that a woman produces oestrogen may increase the risk of osteoporosis. These include:
- an early menopause (before the age of 45)
- a hysterectomy before the age of 45 (especially if both ovaries are removed)
- excessive exercising - this can reduce your hormone levels and as a result your periods may stop for a prolonged time
The hormone testosterone has an important effect on bone strength in men. Men with a decreased function of the testicles (hypogonadism) have low levels of testosterone and a greater risk of osteoporosis.
Other factors include:
- age - the risk increases as you get older
- race - Caucasian or Asian races are at greater risk than African-Caribbean
- gender - women have smaller bones than men
- a family history of osteoporosis, particularly a history of hip fracture in a parent
- a previous fragility fracture (fracturing a bone after only a minor accident)
- long-term immobility (eg confined to bed)
- a very low body mass index (a way of combining weight and height measurements)
- excessive alcohol consumption or smoking
- low levels of vitamin D or dietary calcium
Some medicines and disorders can increase your risk including:
- long-term use of corticosteroids (medicines sometimes used to treat severe allergies or inflammation)
- long-term use of heparin (used to thin the blood)
- aromatase inhibitors (used in the treatment of breast cancer in women)
- overactive thyroid disorders (eg hyperthyroidism)
- rheumatoid arthritis
- digestive disorders that affect nutrient absorption, such as Crohn's Disease, chronic liver disease, or coeliac disease
- a disorder of calcium metabolism (hyperparathyroidism)
- other conditions, such as kidney disease and ankylosing spondylitis
Diagnosis of osteoporosis
Osteoporosis is usually diagnosed in hospital, often after a fall or if you fracture a bone. Your doctor will measure your bone density using a dual-energy X-ray absorptiometry (DEXA) scanner. Osteoporosis is diagnosed when bone density is found to be significantly lower than average. Scans are painless and take approximately 10 to 20 minutes.
Treatment of osteoporosis
Self-help
If you have osteoporosis you need to be careful of vigorous, high-impact exercise. However, leading an active lifestyle will improve balance, coordination and develop muscle strength. All these can reduce the risk of falling and fracturing a bone. Beneficial exercise includes swimming, gardening, walking, golf and Tai Chi.
Eating a diet rich in calcium is important for maintaining healthy bones. Good sources of calcium include milk and dairy products, such as hard cheese and yogurt, dried apricots or figs and some green leafy vegetables such as watercress and curly kale.
Postmenopausal women with osteoporosis should aim to take 1,000mg of calcium every day, either in their diet or as a supplement. This can be obtained from 600ml of milk with either 50g of hard cheese (eg Cheddar or Edam), one pot of yogurt, or 50g of sardines.
Your body also needs vitamin D to absorb calcium properly. Vitamin D is found in certain foods, including cod liver oil, oily fish such as sardines and herrings, margarine and egg yolks. It's also made by your skin when you're in the sunlight. The National Osteoporosis Society recommends about 20 minutes of sun exposure to the face and arms, every day during the summer, to provide you with enough vitamin D for the year. However, to reduce your risk of getting skin cancer, you should cover your skin between 11am and 3pm, and don't allow your skin to burn.
You should try not to drink fizzy drinks or have too much caffeine, salt or animal protein, as these can affect the balance of calcium in your body. Eating plenty of fruit and vegetables can help to cancel out the effects of too much protein in your diet.
Medicines
Your doctor may prescribe the following medicines to help prevent fractures and increase your bone density.
- Bisphosphonates work by slowing down bone loss. Examples include alendronate (eg Fosamax), etidronate (eg Didronel), risedronate (eg Actonel), ibandronate (eg Bonviva), and zoledronate (eg Aclasta).
- Strontium ranelate (eg Protelos) is a medicine that stimulates new bone to grow and reduces bone loss. You may be prescribed this if you can't take bisphosphonates.
- Calcitonin (eg Miacalcic) is a hormone made by the thyroid gland (a gland in the neck) that blocks the action of the cells that break down bone.
- Parathyroid hormone peptides (parathyroid hormone (Preotact) and teriparatide (Forsteo)). Teriparatide is very similar to parathyroid hormone - this hormone helps to regulate calcium levels and the activity of cells involved in bone formation.
- The selective oestrogen receptor modulator (SERM) (raloxifene eg Evista) is a synthetic hormone that works by copying the effects of oestrogen on the bones.
Hormone replacement therapy (HRT) is a prescription-only treatment that relieves symptoms of the menopause by restoring hormones to a premenopausal level. HRT has also been shown to reduce osteoporosis, but you probably won't be prescribed it to treat or prevent the condition. Deciding whether to take HRT is your choice and your GP will discuss the risks and benefits with you.
Pain management
If you fracture a bone, over-the-counter painkillers can help. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Physiotherapy, hydrotherapy (exercise in water) and TENS (transcutaneous electrical nerve stimulation) and alternative therapies, like acupuncture, may also help. Always ask your doctor or pharmacist for advice before any treatment.
Treatment for men
If your osteoporosis is caused by hypogonadism, your GP may prescribe testosterone replacement therapy. Your doctor may prescribe the bisphosphonates alendronate (eg Fosamax) or risedronate (eg Actonel) to slow down bone loss.
Prevention of osteoporosis
Lifestyle changes could help to reduce your chances of developing osteoporosis. A healthy diet and exercise can increase bone mass, especially in younger people with growing bones. Adults should aim to have 700mg of calcium every day, which you should be able to get through healthy eating.
High-impact exercise, where you support your own weight, is best for strengthening bones. The National Osteoporosis Society recommends jogging, aerobics, tennis, weight-training, dancing and brisk walking. If you aren't used to exercising, build up your exercise routine gradually. Talk to your GP before you start a new exercise routine.
Smoking can have a harmful effect on your bone strength and can also cause an early menopause. If you smoke, you should try to give up. You should also be careful not to drink too much alcohol.
Further information
- National Osteoporosis Society
0845 450 0230
www.nos.org.uk
Related topics
Sources
- Poole ES, Compston JE. Osteoporosis and its management. BMJ 2006; 333:1251-1256. www.bmj.com
- Osteoporosis - treatment (and prevention of fragility fractures). Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 11 March 2008
- Bisphosphonates (alendronate, etidronate, risedronate), raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. National Institute for Health and Clinical Excellence (NICE). 2007, 87. www.nice.org.uk
- About osteoporosis. National Osteoporosis Society. www.nos.org.uk, accessed 8 July 2008
- Management of osteoporosis. Scottish Intercollegiate Guidelines Network (SIGN). Guideline 71, 2003. www.sign.ac.uk
- Preventing skin cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 11 March 2008
- Joint Formulary Committee, British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
- Action on Smoking and Health (ASH). Smoking, sex and reproduction. 2006. www.ash.org.uk
- Antithrombotic therapy - heparins. Scottish Intercollegiate Guidelines Network (SIGN). Guideline 36, 1999. www.sign.ac.uk
- Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:568-569
- Actonel once a week 35mg film coated tablets. Electronic medicines compendium. www.medicines.org.uk, accessed 31 July 2008
- New SA, Millward DJ. Calcium, protein, and fruit and vegetables as dietary determinants of bone health. Am J Clin Nutr 2003; 77:1340-1341. www.ajcn.org
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer-reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: September 2008
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