Osteoporosis happens when bone density decreases and the body stops producing as much bone as it did before.
As the bones become weaker, there is a higher risk of a fracture during a fall or even a fairly minor knock.
Fast facts on osteoporosis
Here are some key points about osteoporosis. More detail is in the body of this article.
What is osteoporosis?
Osteoporosis involves a gradual weakening of the bones.
Bone tissue is constantly being renewed, and new bone replaces old, damaged bone. In this way, the body maintains bone density and the integrity of its crystals and structure.
Bone density peaks when a person is in their late 20s. After the age of around 35 years, bone starts to become weaker. As we age, bone breaks down faster than it builds. If this happens excessively, osteoporosis results
A number of risk factors for osteoporosis have been identified. Some are modifiable, but others cannot be avoided.
Non-modifiable risk factors include:
Modifiable risk factors include:
Weight-bearing exercise helps prevent osteoporosis. It places stress on the bones, and this encourages bone growth.
Some diseases or medications cause changes in hormone levels, and some drugs reduce bone mass.
Diseases that affect hormone levels include hyperthyroidism, hyperparathyroidism, and Cushing’s disease.
Research published in 2015 suggests that transgender women who receive hormone treatment (HT) may be at higher risk of osteoporosis. However, using anti-androgens for a year before starting HT may reduce this risk. Transgender men do not appear to have a high risk of osteoporosis. More research is needed to confirm this.
Conditions that increase the risk include:
Medications that raise the risk include:
Glucocorticoid-induced osteoporosis is the most common type of drug-induced osteoporosis.
Bone loss that leads to osteoporosis develops slowly. There are often no symptoms or outward signs, and a person may not know they have it until they experience a fracture after a minor incident, such as a fall, or even a cough or sneeze.
Commonly affected areas are the hip, a wrist, or spinal vertebrae.
Breaks in the spine can lead to changes in posture, a stoop, and curvature of the spine
A doctor will consider the patient’s family history and their risk factors. If they suspect osteoporosis, they will request a scan, to measure bone mineral density (BMD).
As the spine weakens, osteoporosis can lead to a change in posture.
Bone density scanning uses a type of x-ray technology known as dual-energy X-ray absorptiometry (DEXA) and bone densitometry.
Combined with the patient’s risk factors, DEXA can indicate the likelihood of fractures occurring due to osteoporosis. It can also help monitor response to treatment.
Two types of device can carry out a DEXA scan:
The results of the test are given as a DEXA T-score or a Z-score.
The T-score compares the patient’s bone mass with peak bone mass of a younger person.
The Z-score compares the patient’s bone mass with that of other people with similar build and age.
The test is normally repeated every 2 years, as this allows for comparison between results.
An ultrasound scan of the heel bone is another way to assess for osteoporosis. It can be carried out in the primary care setting. It is less common than DEXA, and the measurements cannot be compared against DEXA T-scores.
Treatment aims to:
This is done through preventive lifestyle measure and the use of supplements and some drugs.
Calcium is essential for bones, and ensuring an adequate calcium intake is important.
Dairy produce is a good source of calcium and can help prevent osteoporosis.
Adults aged 19 years and above should consume 1,000 milligrams (mg) a day. Women aged 51 years and over, and all adults from 71 years should have a daily intake of 1,200 mg.
Dietary sources are preferable and include:
If a person’s dietary intake is not enough, supplements are an option.
Vitamin D plays a key role, as it helps the body absorb calcium. Dietary sources include fortified foods, saltwater fish, and liver.
However, most vitamin D does not come from food but from sun exposure, so moderate, regular exposure to sunlight is recommended.
Other ways to minimize the risk are:
Drugs that can help prevent and treat osteoporosis include:
Other types of estrogen and hormone therapy may help.
In future, treatment may include stem cell therapy. In 2016, researchers found that injecting a particular kind of stem cell into mice reversed osteoporosis and bone loss in a way that could, potentially, benefit humans too.
Findings published in 2015 suggested that growth hormone (GH) taken with calcium and vitamin D supplements could reduce the risk of fractures in the long term.
Also in 2015, researchers in the United Kingdom (U.K.) found evidence that a diet containing soy protein and isoflavones may offer protection from bone loss and osteoporosis during menopause.
Scientists believe that up to 75 percent of a person’s bone mineral density is determined by genetic factors. Researchers are investigating which genes are responsible for bone formation and loss, in the hope that this might offer new ways of preventing osteoporosis in future.
As bones become weaker, fractures occur more frequently, and, with age, they take longer to heal.
This can lead to ongoing pain and loss of stature, as bones in the spine begin to collapse. A broken hip can be hard to recover from, and the person may no longer be able to live independently.
It is important to take action to prevent falls among people with osteoporosis.
The United States Preventive Services Task Force (USPSTF) recommend screening for all women aged 65 years and over, and younger women who are at high risk of experiencing a fracture.
Anyone who is concerned that they may be at risk of osteoporosis should ask their doctor abo