What is Osteoporosis?

What is osteoporosis?

Osteoporosis literally means ‘porous bones’. Our bones are made up of a thick outer shell and a strong inner honeycomb mesh of tiny struts of bone.

Osteoporosis means some of these struts become thin or break. This makes the bone more fragile and prone to break. It often remains undetected until the time of this first broken bone.

Broken wrists, hips and spinal bones are the most common fractures in people with osteoporosis.

What causes osteoporosis?

Two types of cells are constantly at work in our bones.

One set builds up new bone while another set break down old bone. Up to our mid-20s the construction cells work harder building strength into our skeleton.

From our 40s onwards, the demolition cells overtake and our bones gradually lose their density as a natural part of ageing.

One in two women and one in five men over the age of 50 will break a bone, mainly because of osteoporosis. Exactly why this happens is still not fully understood. Research continues to build up a picture of the factors that influence our bones.

Who is at risk?

Our bone health is largely down to the genes we inherit from our parents.

But there are other factors that can put people at greater risk:

Women if they have had an early menopause or hysterectomy (before the age of 45)

Men if they have low levels of testosterone (known as hypogonadism)

People who have broken a bone after only a minor trauma (called a fragility fracture)

People who take corticosteroid tablets (for conditions such as asthma or arthritis)

People with a family history of osteoporosis, particularly if your mother has broken her hip

People with medical conditions which affect the absorption of foods, such as Crohn’s disease, coeliac disease or ulcerative colitis

People with medical conditions which leave them immobile for a long time

People who drink excessive amounts of alcohol

People who smoke

Women who are underweight or have developed an eating disorder

Osteoporosis can also affect children and young people and pregnant women. However, these conditions are extremely rare.

I think I might be at risk. Can I be tested for osteoporosis?

You cannot see or feel your bones getting thinner. Many people are unaware of any problems until they break a bone or start to lose height.

If you think you are at risk then discuss it further with your doctor. You may need a special scan which measures bone density, called a dual energy x-ray absorptiometry (DXA) scan. It is a simple, painless procedure and is recommended for those people considered at high risk of breaking a bone because of osteoporosis.

Osteoporosis diagnosed on a bone density scan does not always mean you have a high risk of breaking a bone at the time of the scan so a drug treatment is not always necessary or appropriate. Other factors, such as your age, will need to be taken into account.

If you have broken a bone because of osteoporosis there are a range of drug treatments. These will help to reduce your risk of breaking another bone. The way you live your life can also help.

The way we live our lives can have a major impact on the health of our bones. It's worth remembering that bones are alive and constantly changing. Old, worn out bone is replaced with new bone in a process called 'bone turnover'. A child's whole skeleton is replaced within about two years. In adults this process takes longer - about seven to 10 years. So while this is happening we need to give our bones a helping hand. We think our skeleton will provide a solid framework for life but it needs tender loving care just like our skin, hair or heart!

Can I prevent osteoporosis?

Our bone health is largely inherited from our parents. About 80 percent of our bone health lies deep within our bodies in our genes. Research reveals that a family history of the disease, particularly if your mother has broken a hip after only a minor fall, leaves you at greater risk of the same happening to you. But there are steps you can take to influence the 20 percent of bone health left in your hands! It doesn't sound much but it's still an important amount that can make a difference.



So what can I do?

Get physical!

There's not getting away from the fact that exercise is the best way to help your bones.

Bone boosters

Your skeleton grows stronger if you do weight-bearing exercise. This is any kind of physical activity where you are supporting the weight of your own body. Good examples are:

Jogging

Aerobics

Tennis

Weight lifting

Dancing

Brisk walking

A good way to boost your bones when you are younger is to do brief bouts of high impact exercise. This could be as simple as jumping up and down on the spot, which provides a useful jolt to the hip and spine. It is the impact when your feet hit the ground that can eventually strengthen these bones. Another type of bone-building exercise includes using weights, where the action of the tendons pulling on the bones seems to boost strength. But don't be put off, it could be as simple as lifting a tin of beans in front of the TV, which may help strengthen your wrist bones, a common site for broken bones due to osteoporosis.

Active lifestyles

If you have osteoporosis you may need to be careful of vigorous, high impact exercise but it's important to stay active and find something you enjoy. Gradually increasing the amount of physical activity you do at any age, even if you are in your 90s, will benefit your bones. Leading an active lifestyle will ensure you have good balance and co-ordination as well as develoing muscle strength. All these can reduce your risk of falling and therefore breaking a bone, particularly your hip. Good examples are:

Swimming

Gardening

Walking

Golf

Tai Chi

Healthy eating

It's important to tuck into bone friendly foods to provide the proper nourishment our skeleton needs. The body contains 1kg of calcium, 99 percent of which is stored in our bones. It is important we eat plenty of calcium but lots of other vitamins and minerals are also important. If you enjoy a wide variety of food you will get a mix of all the vitamins and minerals you need.

It's a good idea to avoid:

Too much protein - particularly animal protein such as meat and cheese. Excessive amounts of protein may upset the acid balance within the body which then takes calcium from the bones to neutralise it. Too many grain foods like cereal and bread may have the same effect, although how significant this is is unclear. Eating plenty of fruit and veg should keep your body's acid balance stable.

Lots of salt - high levels of sodium can increase the amount of calcium the body gets rid of through urine. Watch out for 'hidden' levels of salt in processed foods

Drinking lots of fizzy drinks - phosphate, in the form of phosphoric acid, is used to improve the flavour in a lot of fizzy drinks and too much can cause the body to use calcium to balance levels. While there is no hard scientific evidence about its effect on bone health it may be a good idea to only drink these in moderation, particularly for children who are still growing

Drinking too much caffeine - again, a high consumption of caffeine could affect the balance of calcium in the body. Try adding milk to your coffee to counteract this effect or try to limit your intake to one or two cups a day.

Letting your weight drop too low - being overweight is not good for general health but being underweight increases the risk of broken bones when you fall. In younger women severe weight loss may stop menstrual periods because hormone levels drop which can also increase your risk of breaking a bone.

What about dietary supplements?

If we eat a healthy, varied diet then we should be able to get all the vitamins and minerals we need from food. It's certainly a lot tastier than pills!
As we get older, we absorb nutrients less efficiently. Many older people also have smaller appetites so may benefit from supplements if they are getting insufficient nourishment from food. Studies have shown that calcium and vitamin D can help to cut the risk of broken hips in frail older people so this can be a prescribed drug treatment for this group.

Calcium and vitamin D supplements are often given to people on osteoporosis drug treatments.

Why is Vitamin D is important?

Vitamin D is vital to help the body absorb calcium. The main source is the sun through our skin which the body converts into Vitamin D and stores in our fat. In this way it can manufacture and store enough of the vitamin to see us through the winter months when the sun is not strong enough to have an effect. Most of us will get enough sun to help our bones if we get out and about in the summer without even thinking about it. But be careful not to burn.

Older people, those who do not go out much and people who cover up for religious or cultural reasons may become deficient and 400 iu (international units), or 10mg, a day is recommended.

Try to quit smoking

Smoking has a toxic effect on bone by inhibiting the construction cells from doing their work. It's another good reason to try to give up.

Drink moderately

Enjoying the odd glass of wine could actually help your bones. But drinking too much alcohol is damaging to our skeleton. It's always good for your general health to have alcohol free days as well. Be aware that drinking alcohol can make you unsteady and increase your risk of falling, and therefore breaking a bone.