Osteoporosis is a disease characterised by a decrease in bone density and subsequent bone fragility, that may lead to fractures. These fractures are usually vertebral and neck of femur and can happen with very minimal force. Some schools of thought suggest that the fractures may have occurred before the ‘event’ that causes the symptoms.

Bone Mineral Density (BMD) can be clinically divided into osteoporosis and osteopenia (a decrease in BMD but with a lower risk of fracture). BMD is the test to determine normal for age, osteopenia and osteoporosis and uses a mathematical calculation to make the assessment. The bones of interest are the vertebrae (spine), neck of femur (hip) and the bones in the forearm.

Risk factors

Fracture risk increases with advancing age. The most serious risk factors include a history of fractures, advanced age and decreased mobility. Other risk factors are: female gender; age greater than 50 years; neuromuscular conditions; and poor vision, balance, mobility and health. Family history, ethnicity and many lifestyle issues may put someone at greater risk of osteoporosis.

Symptoms

The most common indication that something is amiss is pain, especially in the lower back, hip, knee and obviously fractures that result after very minimal force. Deformities and difficulty in walking may also be a concern.

Screening

People with high risk factors should be screened. It involves a bone scan similar to an X-ray where the scan will assess the BMD and the risk of fracture in specific areas. For medical purposes, the report will indicate a T-score and/or a Z-score and this will then be used to determine severity and treatment requirements. Women without risk factors should still have a bone scan done from the age of 65 years. Prevention
Menopause or the lack of oestrogen is the main reason for this shift in bone density. To decrease the risk, certain things can and should be done from a young age. A healthy diet that contains calcium and vitamin D, some exercise and lifestyle changes such as the prevention of obesity, the decrease or stopping of cigarette smoking and drinking alcohol can decrease the risk. Also take care when chronic steroid tablets are prescribed and ensure that supplementation is also taken.

The calcium in our diet is sometimes not sufficient, therefore we need supplementation and a cheap source of vitamin D can be found by spending some time in the sun. Evidence has shown that the use of hormone replacement therapy in women (with no contraindications) should be used as soon as menopause starts. This proves the advantage of oestrogen in decreasing the risk of vertebral and neck of femur fractures.

Treatment

When osteopenia is diagnosed it should be seen as a warning to decrease risk factors and the need to go for regular follow-ups. However, Osteoporosis requires treatment to decrease the normal breakdown of bone that takes place during menopause. Besides the use of supplements a doctor should assess the need for biphosphonates and calcitonin, medication that can only be prescribed by a doctor.

Once fractures have occurred, orthopaedic intervention is necessary and modalities will be determined by the site of fracture, age of person, degree of mobility, motivation to comply with treatment, etc. Hip fractures are fairly common and partial or complete replacement is often required.

Conclusion

All experts agree that prevention is better than cure! Therefore you are never too young to start preventing osteoporosis. Consider light exercise, weight loss, a healthy diet and avoid cigarettes and alcohol. Remember to supplement your intake of calcium and vitamin D. Surgery should be the absolute last resort and reserved for those it would most benefit.

Please consult your doctor as there is much more information available and treatment, as well as risk factors, are highly individual.

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