Bone is a living tissue constantly being broken down and replaced. Bone cells called osteoclasts work to break down the old, worn out bone, which is then replaced with strong, new bone by osteoblasts.
Osteoporosis is where this process isn’t working as it should causing loss of structure and weak bones which can lead to fractures. Bone loss happens naturally as we age but in people with osteoporosis, the bone loss is much quicker than normal. This is why osteoporosis is seen more often in elderly people, but it can actually affect any age.
An estimated 300,000 people in Ireland have osteoporosis which is often referred to as the ‘silent disease’. This is due to the fact that there are usually no symptoms until a bone is fractured, most commonly the wrist, hip or spine.
The main risk factors that can increase your risk of developing osteoporosis are age (being over 40), postmenopausal, premature menopause, over active thyroid, family history of osteoporosis, some cancers, some medication, sedentary lifestyle, smoking, excessive alcohol consumption, low BMI and a diet low in calcium and vitamin D.
Prevention
The best way to prevent osteoporosis is getting enough calcium and vitamin D in your diet and with regular weight bearing exercise. Adults should exercise for at least 30 minutes per day which will improve muscle strength and improve balance. Weight bearing exercise such as walking, running and aerobics are best for increasing bone density.
Calcium and vitamin D both play an important role in bone strength. The best sources of calcium are dairy products, fortified bread, some oily fish, nuts and some dark green vegetables e.g. broccoli and spinach. Vitamin D is found in eggs, oily fish, dairy products and fortified bread and cereals. The best source of Vitamin D is sunlight. Due to our lack of sunshine in Ireland, many Irish people are deficient in vitamin D. Most adults need 1g of calcium per day and 400 to 600IU of vitamin D. Ensuring adequate levels of calcium and vitamin D in the diet or taking them in supplement form can help prevent osteoporosis.
Bone density test
For people at risk of osteoporosis or after a fracture, a DXA Scan is recommended. This is a quick, painless scan that will show the density of the bones. A repeat scan s recommended every 2 years after initial scan. The T-score is the initial results compared to the normal bone density for healthly men and women between the ages of 23 and 35 (peak bone mass). A normal T-score is greater than minus 1 and this indicates normal bone density with no sign of osteoporosis. A score of -1 to -2.5 indicates osteopaenia. This is the early stage of osteoporosis and taking steps in improving diet and exercise is extremely important to prevent bones becoming less dense and osteoporoisis developing.
A T-score of less than -2.5 indicates osteoporosis is present. In this case the treatment is usally necessary to prevent fractures occurring.
Treatment
There are several medications available for preventing and treating osteoporosis. The most used medication are bisphosphonates which work by preventing bone resorption (breakdown of bone). These include alendronate, risedronate and ibandronic acid.
HRT can reduce bone fractures. Women lose approximately 15% of bone density in the first five years after menopause. HRT is rarely used specifically for osteoporosis due to safer alternatives but when used for other reasons, it provides useful improvements to bone density.
SERMs (Selective Estrogen Receptor Modulators) such as Raloxifene (Evista®) are useful in improving bone density in postmenopausal women, especially those with spinal osteoporosis.
Monoclonal antibodies such as denosumab (Prolia®) are becoming increasing popular for increasing bone density by preventing resorption. It is given as an injection under the skin every six months.
Forms of parathyroid hormones can be used in cases where other treatments aren’t suitable. An example of this is Teriparatide (Forsteo®) which is a daily injection that stimulates new bone growth. It is generally used for 2 years before it is stopped and replaced with another osteoporosis drug.
Lifestyle Tips
An important factor to consider for anyone with osteoporosis is to protect your bones by preventing slips and falls. This can include wearing non slip shoes with low heels, replace or tape down loose carpets and rugs, having regular sight tests, clearing any clutter from the floor and keeping areas well-lit including a light beside your bed. Protecting your back is essential to prevent stress on the vertebrae. When carrying out day to day tasks ensure to carry items close to the body, bend your knees instead of your back while picking up items and ensure you maintain good posture.