Osteoporosis occurs when a disruption of the normal architecture of bone due to loss of mineral (mostly calcium) leads to increased fragility and risk of fracture.
Most significant are fractures of the hip, spine and wrist although any bone can be regarded as vulnerable.
Osteoporosis is a ‘silent’ condition, causing no symptoms until a fracture occurs (similar in a way to high cholesterol and heart attacks).
The biggest risk for developing osteoporosis is increasing age but there are numerous other risk factors including:-
· Being underweight.
· Family history (of fractured hip).
· Premature menopause in women and lack of testosterone in men.
· Excess alcohol or smoking.
· Various medical conditions and medications, in particular steroid medication.
A bone density scan (DEXA) is a useful measurement that helps to predict future risk of fracture, but result must be put in context and interpreted together with the individual's other risk factors and not treated in isolation. There are a lot of individuals who have been diagnosed with osteopenia (low normal bone density), and prescribed drugs unnecessarily.
If a patient is at increased risk of future fracture, there are various treatments that can reduce the chance of fracture, usually by the order of 50%. These include oral medications, such as alendronic acid, Ibandronate and hormonal treatments. For those intolerant of these medications intravenous treatments (Zolendronate annually or Ibandronate 3 monthly) or subcutaneous injections (Denosumab 6 monthly) are useful alternatives. Daily subcutaneous injections of Teriparatide are sometimes useful in the most severe cases.
Supplements with Vitamin D and calcium are also very important.
Patients at risk should consider a 5-10 year course of treatment and those at highest risk will probably need treatment lifelong
Recommended website www.nos.org.uk