Osteoporosis (Date: 01/01/2002)

What is osteoporosis?

Problems with bones can cause backache and bone pain. The most common cause of these is a condition called osteoporosis, in which the bones suffer demineralisation together with a loss of fibrous tissue components. Demineralisation means that the bones lose calcium, phosphate and other important minerals, becoming less solid and therefore increasingly weak and brittle. There is therefore thinning and weakening of the bone.
Bone is a constantly changing, living material. However, when the change involves a significant loss of bone, it is described as osteoporosis.

Symptoms

The condition may cause no symptoms at all or alternatively, it may give rise to bone pain and backache. Advanced cases suffer from deformities such as loss of height or a bent spine. This leads to continual backache, the spine becomes increasingly bent and very occasionally, the vertebrae can even crumble. The bones will tend to break rather easily, even as a result of some minor accident or trivial strain. A bad fall, compression of the spine in an accident and bone tumours will therefore cause bones affected by osteoporosis to break more easily.
The commonest fracture associated with the condition is collapse of one of the vertebrae of the spine. This may not hurt, or it may give rise to severe localised, unremitting pain that is intensified by movement. This may tend to improve without treatment over the next 2 or 3 months. In the long term, several of these fractures may occur and as a result the spine becomes shortened and bent, since the vertebrae often become wedge-shaped. The loss of height may sometimes be by as much as 15 cm. The intervertebral disc erode the surfaces of the vertebrae, making them concave. The net result is a shortening of the spine and the characteristic ’humped’ look and stoop often referred to as the ‘dowager’s hump’. About half of all women over 70 have osteoporosis therefore the name given to the kyphosis of elderly women. Kyphosis is the excessive backward curvature of the spine which, in its advanced form, is known as ‘hunchback’. Elderly people can develop a kyphosis as a result of osteoporosis. It is much more common in women than in men. Once a patient has develop kyphosis as a result of osteoporosis, treatment may be difficult and is unlikely to give much benefit. Calcium supplements may help to reduce pain from the bones. An osteoporotic fracture may be very painful and need painkillers.
The other common fracture sites are the hip and the wrist, which are more than usually vulnerable in old people whose poor balance and general stiffness make them liable to fall. If an elderly patient has osteoporosis, a relatively minor blow (trauma) will often be enough to break the hip-bone.


RISK FACTORS FOR OSTEOPOROSIS

Being elderly.
The most common cause is in fact age. From middle age onwards, everyone’s bones become lighter. This change is more marked in females after the menopause but in both men and women lighter bones are normal in old age. It is only when an excessive amount of bone is lost that symptoms of osteoporosis arise.



Being female.
Osteoporosis is much more common in women than in men. The contributing factor is the fluctuating hormonal levels in females usually not found in males.

Caucasian.
Osteoporosis affects white people more often than black people. The reason for this is still, as yet, unknown.

Thin body type.
Lightly-built, slim people are also more prone to it than more heavily built, stocky individuals.

Hypogonadism.
Low levels of the male sex hormone, testosterone, will lead to this condition.

Physical inactivity.
There is, however, one relatively common secondary cause generally described as immobilization and simply meaning that the patient is ‘laid up’ for some reason. Thus osteoporosis is often seen in the bones of a single limb which cannot be moved because of pain, paralysis or a broken – fractured – bone.

Steroid therapy.
Patients on long-term steroid therapy may also develop thinner bones (drugs to treat asthma, arthritis and other inflammatory conditions). These interfere with bone formation and remodelling.

Early menopause (<45 years)/hysterectomy.
This is particularly true if both ovaries are also removed before the age of 45. The situation will mimic an early menopause.

Low calcium/vitamin D.
Bones and teeth contain a large proportion of calcium. If low calcium levels are left untreated for months, other symptoms occur. The loss of calcium from the bones causes osteoporosis in elderly people. Many elderly people suffer from osteoporosis partly as a result of living on food with few vitamins. These people will benefit from additional calcium but their diet should really be generally improved. Vitamin D is also essential for maintaining our calcium balance. Without it, we cannot absorb calcium from our food.

Smoking
Smoking interferes with bone formation and with oestrogen levels.

High alcohol intake
Drinking excessive alcohol is known to reduce the body’s ability to absorb calcium – although the latest research shows that moderate, social drinking may increase bone density in women. So have a drink by all means, but stick to the generally accepted guidelines: 21 units a week for women and 28 for men.

Hereditary.
Having a close family history of osteoporosis does not help either since the condition has evidence of inheritance.
INVESTIGATIONS FOR OSTEOPOROSIS

Bone densitometry.
Bone density can be measured by a bone scanning machine called a Dual X-ray Absorptiometer (DEXA), which will measure the density of your bones and diagnose if you have osteoporosis.
X-rays
Often an X-ray taken for some other reason will reveal osteoporosis. However, a bone density loss of >30% must occur to be evident in X-rays.
Blood tests – for secondary conditions.
These are done mainly to check whether the patient has other diseases that have similar symptoms, or whether there is a disease which can cause secondary osteoporosis.

PREVENTION OF OSTEOPOROSIS

Can nothing be done to prevent osteoporosis? In some cases, total prevention is not possible but what can be done is to minimize all other contributing factors under our control, i.e.:

* Optimising peak bone mass:
* Exercise – must be regular and weight-bearing (such as walking or aerobics); excessive exercise may lead to bone loss.
* Dietary calcium/vitamin D – may be important, especially during growth.

* Reducing rate of bone mass loss:
* HRT
* Regular exercise
* Maintain calcium intake
* Moderate alcohol intake
* Stop smoking

OUTLOOK

Research is looking into newer and more effective drugs for treatment.However PREVENTION IS IMPORTANT. MAINTAINING MOBILITY at any age is of utmost importance.
Bone densitometry is the only available method of monitoring osteoporosis. For this reason, the service should be more readily available as a screening procedure in our national health service. Waiting lists of months should be banished and appointments should be available through one’s own GP.

Information compiled by Ms Doreen Micallef B.Sc., MLS, AIMLS.

For more information see also the following websites
www.nos.org.uk or www.nof.org