Osteoporosis

What is osteoporosis?

Osteoporosis quite simply means ‘bones with holes’. Bones lose their strength and density and break more easily.

What causes osteoporosis?

Osteoporosis occurs largely as a result of a lack of oestrogen brought on by menopause. However a lack of vitamin D and some steroid treatments and illnesses are also known to cause the condition, so it can also occur in men.

How do I know if I have osteoporosis?

Osteoporosis will often go undiagnosed until you break a bone. Fractures that occur after minimal trauma can be a clue. A bone density scan (or DEXA) performed by one of our doctors is the best way to confirm the condition, which is a safe, simple and needle-free test with minimal radiation exposure.

If a low score is found, we may take another x-ray and perform a blood test to gather information on your:

• Full blood count – to detect a systematic disease or anaemia.
• Erythrocyte sedimentation rate (ESR) – looking for inflammation, or a rare condition called myeloma.
• Kidney and liver function – problems here can aggravate bone loss.
• Blood calcium level – to detect blood calcium problems.
• Vitamin D level – a known cause of osteoporosis.
• Parathyroid hormone (PTH) level – to check how well your parathyroid glands are functioning. These glands regulate calcium absorption from the gut and the bones and keep your blood calcium level normal. A high PTH level points to a vitamin D deficiency, and sometimes because one or more of the parathyroid glands are hyperactive.
• Thyroid-stimulating hormone (TSH) levels – to check the thyroid gland is functioning and playing its part in maintaining your body’s bones.

How is osteoporosis treated?

Osteoporosis is not a curable disease. However, there are some lifestyle changes and medications available to alleviate your symptoms.

Diet and lifestyle

To get your daily dose of vitamin D without risking skin exposure to the sun, you can eat fatty fish such as salmon, trout or tuna and portobello mushrooms, as well as drinking fortified milk and orange juice.

Exercise is important for maintaining muscle and bone strength, and active people are far less likely to have a minor fall result in a fracture.

Medications

There are many bone treatments which are highly effective and will help to reduce the risk of further fractures. We’ll help you decide which one is right for you from the selection below:

• Hormone therapy (HRT or Livial®): HRT was the first effective treatment for menopausal osteoporosis. It may be an option for someone under the age of 60 years with bone loss. The risks of HRT tend to increase over the age of 60 years.
• Bisphosphonates (e.g. Fosamax®, Actonel®): usually taken weekly with water only and an increase in bone density over three to six years is typically seen. When the therapy is stopped, often bone mass is maintained for another 3-5 years.
• Evista®: effective for spinal osteoporosis and reduces the risk of breast cancer by 30-50%.
• Prolia®: a six-monthly injection that essentially immunises the bones against osteoporosis.
• Parathyroid hormone (PTH): a short course of PTH injections can increase bone mass dramatically, but it is not a long-term solution.

We recommend that you have a bone density scan (DEXA) every one to two years, regardless of your preferred treatment, to monitor your progress. You might also wish to schedule a blood test once or twice a year as well.