OSTEOPOROSIS

Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. Osteoporosis appears in people over 45- 50 years old and especially women after menopause. In people older than 70- 75 years old it is equally common in both sexes. Many osteoporotic people have to receive hospital treatment for fractures that occur from standing height, or less, every year as a result of the condition.

 

What are the symptoms of osteoporosis?

Osteoporosis develops slowly over several years. There are often no warning signs or symptoms until a fall or a sudden impact causes a bone fracture.

The most common injuries in people with osteoporosis are:

  • wrist fractures

  • hip fractures

  • fractures of the spinal bones (vertebrae)

In extreme cases, a simple cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine.

In older people, a fractured bone can be serious and result in long-term disability. For example, a hip fracture may lead to long-term mobility problems.

Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooping (bent forward). It happens when the bones in the spine have fractured, making it difficult to support the weight of the body.

 

Is osteoporosis painful?

Osteoporosis isn't usually painful until it causes a fracture. Although not always painful, spinal fractures are the most common cause of long-term (chronic) pain associated with osteoporosis. Often, this pain is only mild.

 

What causes osteoporosis?

Bones stop growing in length between the ages of 16 and 18, but continue to increase in density until you're in your late 20s. You gradually start to lose bone density from about 35 years of age. Women are more at risk of developing osteoporosis than men because the hormone changes that occur in the menopause directly affect bone density.

The female hormone oestrogen is essential for healthy bones. After the menopause, oestrogen levels fall. This can lead to a rapid decrease in bone density. There is a group of women (approximately το 25- 30% of all) that in the next 5- 10 years after menopause do not only lose 1- 2% of their bone mass but more, up to 5- 8% per year. The rate of their bone mass loss is much higher than normal. These women, especially if they had not managed to reach a high peak bone mass during their adolescence, are candidates of developing osteoporosis.

Women are at even greater risk of developing osteoporosis if they have:

  • an early menopause (before 45 years of age).

  • a hysterectomy (removal of the womb) before the age of 45, particularly when the ovaries are also removed.

  • absent periods for more than six months as a result of overexercising or too much dieting. Other factors that increase your risk of developing osteoporosis include:

  • inflammatory conditions, such as rheumatoid arthritis, Crohn's disease and chronic obstructive pulmonary disorder (COPD).

  • conditions that affect the hormone-producing glands, such as an overactive thyroid gland (hyperthyroidism) or an overactive parathyroid gland (hyperparathyroidism).

  • a family history of osteoporosis, particularly history of a hip fracture in a parent.

  • long-term use of certain medications that affect bone strength or hormone levels, such as oral prednisolone.

  • malabsorption problems.

  • heavy drinking and smoking.

 

How is osteoporosis diagnosed?

If there is suspicion of osteoporosis, we can make an assessment using an online programme, such as FRAX from Sheffield University, UK. We may also refer you for a scan to measure your bone mineral density.

This type of scan is known as a DEXA (DXA) scan. It's a short, painless procedure and your bone mineral density can then be used to assess your fracture risk. The scan measures your bone mineral density and compares it to the bone mineral density of a healthy young adult and someone who's the same age and sex as you.

The difference between the density of your bones and that of a healthy young adult is calculated as a standard deviation (SD) and is called a T score.

Standard deviation is a measure of variability based on an average or expected value. A T score of:

  • above -1 SD is normal

  • between -1 and -2.5 SD is defined as decreased bone mineral density compared with peak bone mass

  • below -2.5 is defined as osteoporosis

Although a bone density scan can help diagnose osteoporosis, your bone mineral density result isn't the only factor that determines your risk of fracturing a bone.

Your age, sex and any previous injuries will need to be taken into consideration before deciding whether you need treatment for osteoporosis.

Normal X-rays are a useful way of identifying fractures, but they aren't a reliable method of measuring bone density.

 

How is osteoporosis treated?

Treatment for osteoporosis is based on treating and preventing fractures and using medication to strengthen bones.

The decision about what treatment you have– if any – will depend on your risk of fracture. This will be based on a number of factors, such as your age, the risk of fracture, any previous injury history and the results of your DXA scan.

You may not need or want to take medication to treat osteoporosis. However, you should ensure that you're maintaining sufficient levels of calcium and vitamin D. To achieve this, your healthcare team will ask you about your diet and may recommend making changes or taking supplements.

Greek National Authorities have made some recommendations about who should be treated with medication for osteoporosis.

For postmenopausal women with osteoporosis who haven't had a fracture: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women.

For postmenopausal women with osteoporosis who've had a fracture: Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women.

Among women ≤55 yrs lacking risk factors (history of venous thromboembolism, breast cancer, etc) and experiencing menopausal symptoms, estrogens (HRT) could be the treatment of choice while reducing all osteoporotic fractures (vertebral, non-vertebral, hip)

The need to initiate treatment and the appropriate type of treatment always needs to be individualised.

 

How can osteoporosis be prevented?

Your genes are responsible for determining your height and the strength of your skeleton, but lifestyle factors such as diet and exercise influence how healthy your bones are. Until the age of 20- 25 ετών every day, our body builds a little bit more amount of bony tissue ( bone mass) than the amount destroyed. Therefore, when we are 25 years old we achieve the highest bone density in our entire life. This is called 'peak bone mass' and it plays an important role in whether we will develop osteoporosis later in life, or not. The most important factors to prevent osteoporosis are the following:

Regular exercise

Regular exercise is essential. Adults aged 19 to 64 should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week.

Weight-bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis.

As well as aerobic exercise, adults aged 19 to 64 should also do muscle-strengthening activities on two or more days a week by working all the major body muscle groups.

Healthy eating

Eating a healthy balanced diet is recommended for everyone. It can help prevent many serious health conditions, including heart disease, diabetes and many forms of cancer, as well as osteoporosis.

Calcium is important for maintaining strong bones. Adults need 700mg a day, which you should be able to get from your daily diet. Calcium-rich foods include leafy green vegetables, dried fruit and dairy products.

Vitamin D is also important for healthy bones and teeth because it helps your body absorb calcium. Vitamin D can be found in eggs, milk and oily fish.

However, most vitamin D is made in the skin in response to sunlight. Short exposure to sunlight without wearing sunscreen (10 minutes twice a day) throughout the summer should provide you with enough vitamin D for the whole year. Luckily enough, adequate sunlight does not constitute a problem for Greece! Women who are pregnant or breastfeeding may be at risk of not getting enough vitamin D due to their increased needs.

If you're at risk of not getting enough vitamin D through your diet or lifestyle, you can take a vitamin D supplement. For adults, 10 micrograms a day of vitamin D is recommended.

Other factors

Other lifestyle factors that can help prevent osteoporosis include:

quitting smoking – smoking is associated with an increased risk of osteoporosis

limiting your alcohol intake – the recommended daily limit is 2-3 units for women; it's also important to avoid binge drinking

 

Living with osteoporosis

The key points every elderly person, their family members and everyone involved in their care should know, are the following:

Having osteoporosis doesn't mean you'll definitely have a fracture. There are measures you can take to reduce your risk of a fall or break.

Check your home for hazards you may trip over, such as trailing wires. Make sure rugs and carpets are secure, and keep rubber mats by the sink and in the bath to prevent slipping.

Stay active and healthy – for example, through exercise and diet – is likely to keep you independent and reduce your risk of falling

If you're unsteady on your feet or fall, speak to your GP so possible causes of falls, such as poor eyesight, certain medications, and poor muscle strength and balance, can be identified and treated.