No symptoms, no warning…then a fateful fracture
By ANNA HODGEKISS
What exactly is osteoporosis?
Put simply, it’s a condition that weakens your bones, making them fragile and more likely to break.
Our bones are made up of a thick outer shell and a strong inner mesh that looks like honeycomb. Osteoporosis (which means ‘porous bone’ in Greek) occurs when the holes in this honeycomb become bigger, making it fragile and liable to break easily.
As we age, our bones, like everything else in our body, become weaker. This is because our bones aren’t renewed as well as they used to be.
Normally special cells known as osteoblasts build new bone, while osteoclasts break down old bone.
After the age of 35, this process becomes less efficient, leading to a gradual reduction in bone density, with the risk of fractures becoming particularly high after we hit 50.
An estimated three million people in Britain are thought to have osteoporosis, but this number is likely to rise as the population ages.
Why is it so dangerous?
The great risk with osteoporosis is fracturing your hip. Shockingly, 10 per cent of hip fracture patients die within 30 days, while 30 per cent die within a year.
The fracture itself rarely proves fatal, but as patients are often frail, complications such as pneumonia, blood clots, bedsores and post-operative infection are common and can all lead to death. And the numbers are getting worse, according to the National Osteoporosis Society.
‘The problem with a hip fracture is that it can often mean an elderly person cannot continue with their living arrangements,’ says Sarah Leyland, senior osteoporosis nurse and helpline manager at the charity.
‘They may have to go into sheltered accommodation, which research shows is some people’s worst nightmare.’
As well as the high personal cost, broken bones caused by osteoporosis are also hugely expensive to treat: the combined annual cost of hospital and social care for patients with a hip fracture is estimated to be £2.3 billion — that’s more than £6 million a day.
Could I be at risk?
Age is the major risk factor — in Britain, one in two women and one in five men over the age of 50 will have a fracture primarily because of osteoporosis.
However, the disease can affect younger people, too. Genes play a huge role in determining bone strength — approximately 80 per cent of our bone health is inherited from our parents.
‘A single osteoporosis gene hasn’t been identified, but if any family member has had a hip fracture, this will double your risk of a hip fracture, regardless of bone density,’ says Dr Kassim Javaid, lecturer in metabolic bone disease at the University of Oxford.
‘If you are over 50 and someone (even someone younger) in the family has a fracture, you should have a Dual Energy X-Ray Absorptiometry (DXA) scan, which measures the amount of calcium in bones. You can get a referral from your GP.’
As well as age and family history, your sex is significant. Women are vulnerable because they have weaker bones to begin with, and they experience a rapid period of bone loss after the menopause.
The female hormone oestrogen has a protective effect on bones, so lower levels are a risk factor.
Lack of calcium in the diet is another major risk — so people who avoid dairy foods, which are the main dietary source of calcium, could be vulnerable.
Other risk factors include low body weight, heavy smoking or excessive alcohol consumption.
Lack of vitamin D, which we get mainly from sunlight, can also contribute to osteoporosis (so if you avoid the sun or use suncream this may be a concern).
That’s because vitamin D enables us to absorb calcium.
‘A vitamin D deficiency raises the risk of osteoporosis, bone breakages and fractures by up to 60 per cent,’ says Dr Javaid.
Medical conditions such as Crohn’s or coeliac disease, which affect the absorption of foods and nutrients are also risk factors.
Steroids — often prescribed for asthma and arthritis — inhibit bone formation and accelerate bone loss. They can also affect the amount of calcium absorbed from food and increase the calcium lost from the body in urine.
How do know if I’ve got it?
the first sign of the disease for many people is breaking a bone, as most are unaware they have osteoporosis until they suffer a fracture.
‘If you think you are at risk, you must discuss it with your GP,’ says Sarah Leyland. ‘He or she will assess your medical history, including whether you have broken any bones or lost height, and may decide to send you for a special bone scan.’
How is it treated?
The first line of treatment is usually alendronic acid, which is taken for several years, but sometimes for life.
This works by binding tightly to the bone to act as a barrier, preventing osteoclast cells from breaking down your old bone.
Calcium supplements and vitamin D may also be prescribed. Lifestyle changes are also key. A healthy diet — including calcium-rich foods — is essential.
The recommended amount is at least 700mg a day, the equivalent of a pint of milk. Other calcium-rich foods include green leafy vegetables such as watercress and curly kale, dried fruit such as currants and tinned fish containing bones such as sardines.
Exercise is also crucial. It must be of the weight-bearing variety, and could include walking briskly, running or playing tennis. This help strengthen muscles, ligaments and joints, improving bone and balance, to prevent falls.
‘You can reduce your risk of suffering a fragility fracture through good diet and exercise,’ says Dr Javaid.
‘We should eat a calcium-rich, balanced diet and take plenty of exercise.
‘We also need summer sunlight to generate the vitamin D that our bones need, or supplements in the winter.’
It is not always possible to get enough sun, or calcium through your diet, and where that is the case, it is sometimes wise to supplement your diet. Click below for your Vitamin D and Calcium supplements…