Osteoporosis. How do I know if I have it, and what can I do to avoid fractures?
Osteoporosis leads to more time in hospital than many of the other major diseases. 1 in 5 men over 50 will break a bone due to osteoporosis, and 1 in 3 women. It is sometimes known as the silent epidemic, because most people don’t know they have it.
What is Osteoporosis?
Osteoporosis is associated with reduced bone density and an increased risk of fracture. The fractures that typically arise are of the hip, the spine and the wrist, accounting for over half of all fractures in older people.
Fractures or broken bones often occur with minimal trauma, due to the fragility of the bones. A fracture of the vertebra in the spine can occur when rolling over in bed, and sometimes the person has no idea it has happened, with no pain.
In osteoporosis there is a reduction in amount of collagen and minerals in the bones, making them weak.
Normally, bone renews itself, and over a period of 12 years or so this recycling and remodelling will get rid of the not-so-good bone such as that with little micro-cracks in it, replacing with good bone, eventually fully replacing your skeleton with new bones.
How do I know if I will get it, or have it?
In the menopause of women, the reduction of oestrogen can affect the cycle of bone formation and resorption.
An inadequacy of calcium absorption by vitamin D in the gut happens with advancing age which leads to older people being unable to maintain calcium balance and consequently have increased fracture risk.
Some people don’t know they are osteoporotic until they have a fracture and the doctor requests a DEXA scan which shows osteoporosis.
If you are found to have several risk factors associated with osteoporosis such as family history, low weight, height loss and high T-score on DEXA scan, and a high age, (70-80 years) you may be eligible for drug treatment.
What can I do to avoid fractures?
Exercise
Exercise can strengthen the muscles that support your joints, and the tension in these muscles can stimulate bone strengthening. The other main reason for exercise is to improve your balance which reduces the risk of falling.
Regular exercise is important, and weight-bearing exercise is best. Bearing your own weight as in walking is better than non-weight-bearing exercise such as swimming or cycling.
Brisk walking will load your bones and stimulate the new bone formation more than slow walking. Running, skipping (with a rope) and jumping will be more beneficial, but some people can’t manage this, particularly if they have arthritic joints or other problems. Walking for an hour, three days a week will improve your bone density and reduce your risk of falling by strengthening your muscles and improving your balance.
Resistance exercise is good, using weights or resistance bands. This will improve your bone density.
At Viney Hall we have Pilates Reformer machines which have springs and pulleys to provide resistance to exercise. Resistance exercise to strengthen muscles can help strengthen bones too. The Reformers also have a jump-board attachment, and these are great for providing the impact of jumping without doing it standing up – jumping lying down is an interesting concept – and fun!
Playing sport you enjoy is always great. The serving arm of a tennis player may have 15-20% higher bone density than the non-serving arm.
It may be helpful to consult a physiotherapist who will help you work out an exercise regime that is appropriate for you.
Diet
Good quality diet is essential, with plenty of plants – as much variety as possible because they are all sources of minerals helpful for bone formation.
It is now believed that it’s not all about eating more calcium-rich foods such as drinking more milk, or eating more protein. It’s more about the combination of foods rather than individual ingredients that may be available in supplement form. And there’s conflicting evidence that vitamin D supplementation for the vast majority of people is beneficial.
What other treatments are available?
Good news is that there are now drugs available to treat osteoporosis called bisphosphonates, eg alendronate or risedronate, taken in tablet form (with calcium and vit D) once a week, which have been shown to reduce the number of fractures by up to 50%. But they are only effective while you are taking it.
Then there’s intravenous zoledronic acid once a year. This is a bisohosphonate too and allows bone resorption to be reduced in a much more marked manner than taken orally.
Then the next line would be an injection every six months of denosumab.
Also HRT has a beneficial effect on bone health, so anyone taking HRT could get additional bone strength.
There are some side-effects related to the drugs.
It is felt best not to give the drugs too early – best to wait till your 70s or 80s to maximise the benefit.
Conclusion
It is useful to know if your bone density is compromised and your risk of fracture due to this. If the risk is high, with a combination of factors including low body weight, frailty and poor mobility, muscle strength and balance, then drug treatment should be discussed and considered, especially in the over 70s.
A varied diet rich in plants has been demonstrated to help with bone health as well as many other health benefits due to improved gut microbiome.
All of us would benefit from plenty of enjoyable exercise for many health reasons, and weight-bearing and resistance exercise is best to stimulate bone growth and strength.
As we get older, it is wise to work harder at exercise and maintaining a good diet in order to keep the bones as strong as we can. Improved balance and strength reduces the risk of falling and broken bones.
Further information:
https://www.vineyhallphysio.co.uk/services/pilates-in-the-forest-of-dean/pilates-reformer
The Royal Osteoporosis Society has a risk checker which is quick to do and very clear. You can donate to the charity online too.
https://theros.org.uk/information-and-support
