Osteoporosis is common – it will affect 1 in 3 women, and 1 in 12 men, at some stage in their lives. It is most commonly referred to as thinning of the bones. Medically it is defined as a systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
The treatments for osteoporosis are very effective, yet every year there are 180,000 osteoporosis-related fractures in England and Wales. So why is osteoporosis causing so many fractures when the treatments are so effective...? The problem is that the process of bone deterioration is symptomless, and so many people are unaware of their thinning bones until a fracture occurs. The most common sites for osteoporotic bone fracture are the hip or wrist during a fall, or in the spine in a vertebral crush fracture where a vertebrae in the spine collapses upon itself under normal body weight. Amazingly it is thought that the majority of vertebral fractures (50–70%) are not reported to the patient’s GP.
Who is at risk…? In addition to age, the other major risk factor is declining hormone levels. This includes women with low oestrogen levels as a result of early menopause or hysterectomy, or men with low testosterone levels as a result of testicular problems. There is a hereditary risk for people with a family history of osteoporosis. And there are other more modifiable risk factors which include people on long-term oral corticosteroids (including asthma inhalers), smoking, high alcohol intake, and low physical inactivity, especially in those with a low body weight. If you are over 50 and have one or more of these risk factors you should probably get your bone health checked.
The best way of investigating whether you have, or are developing, osteoporosis is using a bone density scan. Bone mineral density (BMD) testing directly correlates with bone strength and its ability to bear weight: by measuring BMD it is possible to predict fracture risk. In patients with a BMD in the osteoporotic range there is approximately a five times increase in the occurrence of osteoporotic fracture.
The BMD is measured with a Dual Energy X-ray Absorptiometry (DEXA) scan. DEXA scans measure the calcium content in your bones, which cannot be measured in an ordinary X-ray. There are two different types of DEXA scanning devices: Central DEXA devices are large machines that can measure bone density in the centre of your skeleton, such as your hip and spine. Peripheral DEXA devices are smaller, portable machines that are used to measure bone density on the periphery of your skeleton, such as your wrist or heel. Both methods are painless, fast and accurate. Unfortunately mass population screening has not been shown to be economically viable on the NHS and so is currently reserved for high risk patients only.
As part of National Osteoporosis Awareness day, Norwich Osteopathic Clinic is holding an osteoporosis screening days in October. The service is open to all. A registered radiologist will take a DEXA scan of both wrists; you will receive printed results, and have them explained to you. Those shown to be at risk will be asked to consult their GP with a view to starting early treatment for fracture prevention. For more information and dates please click here