Osteoporosis is a health problem which spans the world, with a woman having a risk through her lifetime of getting an osteoporotic fracture of 30 to 40 percent. Men have a lower but still important risk of 13%. The development of osteoporosis is usually slow and without dramatic symptoms until an obvious symptom such as a fracture appears. It is now being recognised as a common condition and the value of early diagnosis and treatment is becoming widely accepted. Research into the risk factors, basic bone biology, drug treatment and physical management is ongoing.
Osteoporosis is a common condition, with half of all women above fifty years old affected and nearly 90 percent of women over 75 years. It is a very common cause of fractures, with 1.5 million fractures from osteoporosis in the United States per year alone. Fracture of the neck of femur, generally referred to as hip fractures, are common and 5-20% of sufferers die in the ensuing months of the complications. Osteoporosis also has very high health costs from fractures and from the disability resulting, especially the pain and restriction from vertebral fractures.
The greatest risk factor for getting osteoporosis is passing through the menopause, when the bone-protecting hormones stop being produced or are greatly reduced. The bone density of the person can then drop steeply unless they are diagnosed and treated. Other risk factors include being female, age, having a family history of osteoporosis, a hormone deficiency, having low calcium levels, drinking excessive alcohol and smoking cigarettes. If there is the menopause plus a number of risk factors, the woman is 65 years old or older or the person has had a fracture without significant trauma then they should be investigated for low bone density.
There are few signs and symptoms of osteoporosis until something goes wrong such as an acute spinal fracture whilst bending over or lifting a weight. Spinal fracture pain is very sharp and limiting so the patient has no doubt something has occurred. Lumbar and thoracic pain is common and the thoracic curve may be increased due to anterior compression fractures of the vertebral bodies, with a dowagers hump and a distinct loss of height from their normal adult level. Any fracture occurring in normal activity should be investigated for the cause. Osteoporosis may be a clear diagnosis with compression fractures and thin bones on x-ray but a DEXA scan can document the severity and the change with treatment.
Osteoporosis prevention encompasses lifestyle change, eating a diet rich in vitamin D and calcium, avoiding smoking and excessive alcohol and engaging in weight bearing exercise. HRT (hormone replacement therapy) is used to prevent this condition in women who are past the menopause. Drugs include bisphosphonates, HRT, selective oestrogen receptor modulators and calcium and vitamin D supplements. The development of new bone rather than stopping the loss might be achievable with an anabolic drug. When we are young we lay the groundwork for our bone mass so should be encouraged to eat well and engage in weightbearing exercises to ensure a good bone density.
Vertebroplasty is an innovation in treating the acute and severe pain of recent vertebral fracture by injecting cement into the anterior part of the vertebral body to take some of the strain that the bone struts are unable to take. Relief of pain can be considerable and the procedure is done by a radiologist under x-ray guidance. Falls are a particular risk as patients fracture so easily so exercise, stronger muscles, improved balance, coordination and agility are all helpful strategies to prevent risk. Due to the ongoing difficulties with this condition, psychological and practical help may be important parts of treatment.
There is a close relationship between the level of bone density and exercise and exercise instruction is given by physiotherapists in group classes. Young people and children are guided to participate in exercise as this builds a good basis of bone density to start off their life well. The loss of bone density can be slowed down by exercise and jarring exercises are better than non weight bearing ones such as swimming. There is no age limit to beginning to improve bone density and physiotherapists take classes for the very elderly.
