Five Top Tips on Osteoporosis

I bet you know someone who has osteoporosis...am I right?

Osteoporosis means “porous bone”, and is a major public health problem. It affects millions of people worldwide, predominately postmenopausal women (1).  It is estimated that one in three women and one in five men over the age of fifty worldwide will sustain an osteoporotic fracture.  Hip and spine fractures are the most serious and debilitating fractures, which often result in severe disability and even death (1).  Osteoporosis causes more than 8.9 million fractures annually worldwide (1).  Therefore, the direct costs of fractures run up to billions of dollars annually – in addition to reduced productivity at work.

TOP TIP # 1 - What is osteoporosis?

Osteoporosis is a condition where the bones become weaker, porous and more fragile, increasing the risk of fracture.  The bones are weaker due to reduced bone mineral density, and the porous bones become more compressible, like a sponge.  Osteopenia is defined as a less dense bone (often a thinner bone) but not to the degree of osteoporosis, and is often the first stage of developing osteoporosis.   The weakened bones are prone to cracking and compression, hence the large spinal curvature (dowagers hump) often seen in older adults.  This also relates to a reduced quality of life for people with osteoporosis, due to pain and reduced physical functioning (2, 3). 

TOP TIP # 2 - How is osteoporosis diagnosed?

The world health organisation defines osteoporosis as having bone mineral density that lies 2.5 standard deviations or more below the average value of young healthy women.  Therefore, if possible, bone mineral density should be assessed via dual x-ray densitometry (DEXA), before treatment is considered (4).  As not all countries have direct access to DEXA scanning, it is also acceptable practice to detect high risk patients and assess absolute fracture risk with validated instruments (such as the FRAX tool) (5), before pharmacological treatments are started (4).

TOP TIP # 3 - Risk factors for osteoporosis

The non-modifiable risk factors for osteoporosis include age, gender (females have higher risk), family history of osteoporosis or hip fractures, personal history of fractures/ breaks as an adult, inflammatory disease (e.g. rheumatoid arthritis), ethnicity (Caucasian or Asian race), malabsorption diseases (e.g. coeliac, inflammatory bowel disease), low estrogen levels in women, low testosterone levels in men, chemotherapy, amenorrhea (loss of the menstrual period), hyperthyroidism, hyperparathyroidism, inherited disorders of the connective tissue genetics, and some medications (1, 4).  Modifiable risk factors are a lack of physical activity, low dietary intake of calcium and vitamin D intake, low body mass index, smoking, and excessive alcohol intake (1).

TOP TIP # 4 - Signs and symptoms

Usually there are no signs or symptoms until a fracture occurs. Sometimes small fractures occur without detection, until a more significant break occurs.  Then a clinical examination with X-Ray or DEXA scanning may confirm low bone mineral density.  However, if you are aware of and can manage the risk factors for the development of osteoporosis, this will lead to a reduced risk of developing a fracture.

TOP TIP # 5 - Treatment for osteoporosis

Initially the modifiable risk factors should be addressed such as dietary habits, sunlight exposure, smoking, alcohol intake, body mass index, and physical activity.  There are many medications that may help calcium absorption and improve bone mineral density, in addition to daily supplements of calcium and vitamin D (1).  Some studies have shown that calcium and vitamin D independently reduce bone density loss, and therefore they are often given together to improve uptake of calcium into the bone further, and reduce the risk of fracture.  Recommended amounts are up to 1200 mg of calcium daily and 800 IU of Vitamin D3 (cholecalciferol) (6 - 8). 

Therefore, pop outside to get a healthy daily dose of Vitamin D, increase your dairy product consumption, exercise daily, stop smoking and reduce your alcohol consumption to delay the onset of osteoporosis.

References

1.      Ström, O., Borgström, F., Kanis, J. A., Compston, J., Cooper, C., McCloskey, E. V., & Jönsson, B. (2011). Osteoporosis: burden, health care provision and opportunities in the EU. Archives of osteoporosis, 6(1-2), 59-155.
2.      Rabenda, V., Manette, C., Lemmens, R., Mariani, A. M., Struvay, N., & Reginster, J. Y. (2007). Prevalence and impact of osteoarthritis and osteoporosis on health-related quality of life among active subjects. Aging clinical and experimental research, 19(1), 55-60.
3.      Kotz, K., Deleger, S., Cohen, R., Kamigaki, A., & Kurata, J. (2004). Peer Reviewed: Osteoporosis and Health-Related Quality-of-Life Outcomes in the Alameda County Study Population. Preventing chronic disease, 1(1).
4.      http://www.who.int/chp/topics/Osteoporosis.pdf
5.      Kanis, J. A., McCloskey, E. V., Johansson, H., Oden, A., Ström, O., & Borgström, F. (2010). Development and use of FRAX® in osteoporosis. Osteoporosis international, 21(2), 407-413.
6.      Bischoff-Ferrari, H. A., Willett, W. C., Wong, J. B., Giovannucci, E., Dietrich, T., & Dawson-Hughes, B. (2005). Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. Jama, 293(18), 2257-2264.
7.      Bischoff-Ferrari, H. A., Willett, W. C., Orav, E. J., Lips, P., Meunier, P. J., Lyons, R. A., ... & Meyer, H. E. (2012). A pooled analysis of vitamin D dose requirements for fracture prevention. New England Journal of Medicine, 367(1), 40-49.
8.      Tang, B. M., Eslick, G. D., Nowson, C., Smith, C., & Bensoussan, A. (2007). Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. The Lancet, 370(9588), 657-666.

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