If you’re not sure exactly what osteoporosis is, the World Health Organization defines it as:
“A disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk”.
In simple terms this means that the bone is not as strong as it should be and there is therefore an increased risk of fractures. The term Osteopenia is also used in relation to osteoporosis. It actually means a condition where the bones are not as strong as they should be for a person’s age, but are not so bad as to be osteoporotic.
The two most important things to remember about osteoporosis are:
Not everyone will develop osteoporosis or osteopenia
The only way in which osteoporosis or osteopenia can be diagnosed is by having a bone density scan. It cannot be diagnosed from an ordinary X-Ray.
How and why does Osteoporosis develop?
Bone is a living tissue and, like all living tissues in the body, it is constantly being built up and broken down. This means that the bones that you have now are not the bones you had seven years ago!
As bone cells age, other cells called osteoclasts break them down which leaves minute holes in the bone. These holes are then filled up with new bone by cells called osteoblasts. For these cells to be able to build up new healthy bone it is essential that there is a normal hormone balance in the body, and that your diet or supplements are supplying the correct nutrients.
When we are young and growing, bone is built up much faster than it is broken down. In adult life this process slows down and bone is broken down and built up at about the same rate. Maximum bone density should be reached at about the age of 25. If maximum bone density is not reached by that time then the risk of osteoporosis in later life is increased. Maximum bone density may not be achieved if there is ill health, poor diet and either a lack of (or excessive) exercise during these formative years.
When the early thirties are reached bone starts to break down faster than it is built up. As a result the bone density decreases by about 1% a year. This 1% loss remains more or less constant for men for the rest of their lives, but not for women. When women approach their menopause the loss of bone density increases to 3% a year for about 3 to 4 years. The good news is that after the menopause the breakdown reverts to 1% a year.
It is this period of increased loss around the menopause that places women at greater risk of osteoporosis than men. This time of increased loss only occurs for the few years around the menopause and then slows down again, provided that the hormonal and nutritional balance is correct.
Bone retains its ability to build up as well as break down throughout life which means that even if you are diagnosed with osteoporosis, or shown to be at risk of developing osteoporosis, you can build up new bone and reverse the condition.
Factors that can increase your risk of osteoporosis:
There are a number of factors to take into account that can affect your chances of developing Osteoporosis. These include:
Family history of Osteoporosis
Being Caucasian or Asian in origin
Small build
Nutritional factors:
If you suffer from problems with food absorption
If you have suffered with anorexia or similar eating problems
If your diet does not include the nutrients required for bone synthesis
Excessive smoking and/or alcohol consumption
Excess amounts of caffeine and fizzy drinks
If you have exercised or trained to excess, but also lack of exercise
Lack of periods at any time during your fertile years
Early menopause
There are also certain medications that can have an impact:
The contraceptive pill
Long-term Hormone Replacement Therapy (HRT) and, when you stop HRT, cortico-steroid medication
Chemotherapy
Thyroid medication
Anticonvulsants
Immuno-suppressant drugs
Heparin
Also, some diseases such as:
Certain endocrine disorders
Rheumatoid arthritis
Any condition which leads to lack of mobility
If you find that you have more than three of these risk factors you should arrange to have a screening test for osteoporosis and your GP should be able to arrange this for you. There are two main methods of screening: one uses X-Rays and is known as a DEXA scan and the other is by ultra-sound. The DEXA scan is recognized as the ‘gold standard’ but the advantages of having an ultra-sound scan are that no X-rays are used and it is more widely available, less expensive and does not need to be done through a GP as you can arrange it yourself.
What you can do if you are at risk.
If you are at risk of developing, or already have, osteoporosis it is important to remember that there is a great deal that you can do to remedy the situation. Often patients are told that all that can be done is to stop the condition from deteriorating. This is indeed true if you just take orthodox medication. However bone is a living tissue and new bone can be built up at any age.
This means that your bones can be improved and that the condition can be reversed. This is what you should do:-
1 – It can be useful to arrange to have a Urinary Dpd test as this will tell you what your bone metabolism is doing at the present time. It will tell you whether you are breaking down bone now or whether the low bone density is a reflection of past problems. This will help your practitioner decide on the best treatment for you.
2 – You should look at your lifestyle and try to remove any factors that are listed above as likely to increase a risk of osteoporosis. BUT, if you are taking any medication that might affect your bones you must not stop it without consulting your doctor.
3 – You should make sure that you eat a healthy balanced diet containing the correct proportions of protein, carbohydrates and fats. The most important nutrients the bones need are calcium, magnesium, boron, silica zinc, and vitamins C, D and K. If you want to supplement your diet with these you must ensure that you find a special bone supplement that contains the nutrients in the correct proportions to each other. Many supplements contain a lot of calcium but not enough magnesium.
4 – You may need some hormone supplementation with either oestrogen or progesterone, or both. Progesterone is the hormone that speeds the build up of bone, provided the correct nutrients are present. This can improve your bone density long-term.
5 – If your bone density is very low and/or you are breaking down bone faster than you are building it up you may need some oestrogen as well as progesterone. Oestrogen slows bone breakdown and retains old bone. This effect only lasts while you are taking oestrogen. If you stop the oestrogen the old bone will all break down leaving you with low density again. This is what can occur when stopping traditional HRT as the ‘protection’ that the oestrogen has provided in slowing down bone loss is immediately lost.
6 – There are also drugs such as Fosamax, Didronel and Serms that your doctor or consultant may suggest. These act by slowing the breakdown of bone but often have serious or unpleasant side effects.
Tests for Bone Density
Harley Place Screening offers bone density screening for fracture risk using ultra-sound and a urinary Dpd test is also available to evaluate bone metabolism. Click this link for more information and contact details for Harley Place Screening.