tell me all you know about osteoperosis?

Answer 1

About this booklet
This booklet has been produced for anyone interested in finding out more about osteoporosis. You may have the condition yourself, or you may be a friend or relative of someone with osteoporosis. Whatever reason you have for reading this, we hope you will find it useful.

We want to explain as much as we can about osteoporosis – what causes it, how it can be prevented, and how it can be treated.

Unfortunately we cannot hope to answer all your questions, because everyone is different and this booklet is no substitute for individual consultation with a doctor. If you want to find out more after reading this booklet, the organizations in the 'Useful addresses' section may be helpful. Terms that appear in italics when they are first used are explained in the glossary at the end of the booklet.

What is osteoporosis?
The word 'osteoporosis' means, literally, 'porous bone'. It is a condition where you gradually lose bone material so that your bones become more fragile. As a result, they are more likely to break even after a simple fall. Osteoporosis is quite common in Britain. Each year there are around 70,000 hip, 120,000 spine and 50,000 wrist fractures due to osteoporosis.

How does osteoporosis affect the bones?
Bone is made of fibres of a material called collagen filled in with minerals – mainly calcium salts – rather like reinforced concrete. The bones of the skeleton have a thick outer shell or 'cortex', inside which there is 'trabecular' bone which is formed in a meshwork, as shown in Figure 1(a). Osteoporosis causes bone to be lost, leaving gaps in the bone material, as shown in Figure 1(b).

What causes osteoporosis?
Our bones grow during childhood and adolescence and are at their strongest in the late 20s. As middle age approaches the bones very gradually begin to become weaker. This weakening or thinning of the bones continues as we get older.

The process speeds up in women in the 10 years after the menopause. This is because the ovaries stop producing the female sex hormone oestrogen – and oestrogen is one of the substances that helps keep bones strong. Men suffer less from osteoporosis, because their bones are stronger in the first place and they do not go through the menopause.


Figure 2. Graph showing typical total bone mass in men and women. Men develop a bigger skeleton during the years of growth and have a higher peak bone mass. Women have smaller skeletons and lower peak bone mass, and lose bone mass at an increased rate during the menopause.


Who is at risk?
All of us are at risk of developing osteoporosis as we get older, which is why elderly people are more likely to break bones when they fall. But there are some people who are more at risk of osteoporosis than others. These are some of the factors that can make a difference:

Steroids If you take prednisolone over a long period of time, it can lead to osteoporosis.

Oestrogen deficiency Women who have had an early menopause (before the age of 45), or a hysterectomy where one or both ovaries have been removed, are at greater risk. Removal of the ovaries
only (ovariectomy) is relatively rare, but is also associated with an increased risk of osteoporosis.
Lack of exercise Moderate exercise keeps the bones strong during childhood and throughout adulthood. Anyone who does not exercise, or has an illness or disability which makes exercise difficult, will be more prone to losing calcium from the bones, and so more likely to develop osteoporosis. Exercise is therefore very important in preventing osteoporosis. (However, there is one case in which this is not true: for the small number of people who exercise very intensively, particularly women who exercise so much that their periods stop, the risk of osteoporosis may actually be increased.)

Poor diet A diet which does not include enough calcium or vitamin D can make osteoporosis more likely (see below).

Heavy smoking Tobacco lowers the oestrogen level in women and may cause early menopause. In men, smoking lowers testosterone activity and this can weaken the bones.

Heavy drinking A high alcohol intake reduces the ability of the body's cells to make bone.

Family history Osteoporosis does run in families. This is probably because there are some inherited factors which affect the development of bone.
Can you prevent osteoporosis?
There is a great deal which can be done at different stages in your life to guard against the condition.

Healthy diet Children and adults need a diet which contains the right amount of calcium. The best sources of this are milk, cheese and yogurt and, as shown below, certain types of fish which are eaten with the bones. If you are watching your weight it's worth knowing that skimmed or semi-skimmed milk actually contains more calcium than full-fat milk. We recommend a daily intake of calcium of 1000 milligrams (mg) or 1500 mg if you are over 60. A pint of milk a day, together with a reasonable amount of other foods which contain calcium, should be sufficient (see Table 1). Vitamin D is needed for the body to absorb calcium. Vitamin D is produced by the body when sunlight falls on the skin, and it can be obtained from the diet (especially from oily fish) or vitamin supplements (see arc booklet 'Osteomalacia'). For people over 60 it may be helpful to take a supplement containing 10–20 micrograms (µg) of vitamin D.
Table 1. Approximate calcium content of some common foods

Food Calcium
content
115 g (4 oz) whitebait (fried in flour)

60 g (2 oz) sardines (including bones)

0.2 litre (1/3 pint) semi-skimmed milk

0.2 litre (1/3 pint) whole milk

3 large slices brown or white bread

125 g (41/2 oz) low-fat yogurt

30 g (1 oz) hard cheese

0.2 litre (1/3 pint) calcium-enriched soya milk

125 g (41/2 oz) calcium-enriched soya yogurt

115 g (4 oz) cottage cheese

3 large slices wholemeal bread

115 g (4 oz) baked beans

115 g (4 oz) boiled cabbage
980 mg

260 mg

230 mg

220 mg

215 mg

205 mg

190 mg

180 mg

150 mg

145 mg

125 mg

60 mg

40 mg

Note: measures shown in ounces or pints are approximate conversions only.


Children's exercise Children should actively take part in sports or other types of exercise to help strengthen their bones.

Adult exercise For the same reason, adults should keep physically active all the way into retirement. Choose 'weight-bearing' exercises (any activity which involves walking or running) which are of more benefit for bone strength than non-weight-bearing exercises such as swimming and cycling.

Smoking Avoid smoking. As previously mentioned, smoking can affect the hormones (in men and women) and may therefore increase the risk of osteoporosis.

Drinking Avoid drinking too much alcohol. The recommended daily maximum for a woman is 2–3 units. For a man it is 3–4 units. A unit is a single measure of 25 ml of spirits (40% alcohol by volume, or abv), or half a pint (0.3 litre) of normal-strength beer, lager or cider (3.5% abv), or a very small glass (no more than 85 ml) of wine (12% abv).

How can osteoporosis be detected?
There are no obvious, physical signs of osteoporosis, because no one can see the bones getting 'thinner'. Osteoporosis can go unnoticed for years without causing any symptoms. Quite often the first indication that someone has a problem is when s/he breaks a bone in what would normally have been a minor accident. Relatively minor fractures of the spinal bones can cause you to become round-shouldered and to lose height. These minor fractures may be painless but can cause back pain in some people.



If a doctor suspects osteoporosis, s/he can order a scan to test the strength or density of the bones. This scan is now available at many hospitals throughout the country. The results will tell how much risk there is of the bones fracturing. You will need to lie on a couch, fully clothed, for about 15 minutes while your bones are x-rayed. The dose of x-rays is tiny – about the same as spending a day out in the sun. The technique is called dual energy x-ray absorptiometry (DEXA).

What are the consequences of osteoporosis?
People with osteoporosis are more likely to break a bone even after a relatively minor accident. Fractures are most likely to the hip, spine or wrist. Hip and wrist fractures are usually sudden and the result of a fall. People who have previously had a fracture after a minor fall are at greater risk of further fractures.

Spinal problems occur if the bones in the spine (vertebrae) become weak and crush together. If several vertebrae are crushed, the spine will start to curve. This may cause back pain and loss of height and because there is then less space under the ribs, some people may have difficulty breathing. People who have this type of spinal problem also have an increased risk of fractures.

How can osteoporosis be treated?
Apart from the preventative measures already described there are other treatments available if you have osteoporosis. These may slow down the loss of bone or reduce the risk of fractures.

Calcium and vitamin D As mentioned earlier, people over 60 may benefit from taking small daily amounts of vitamin D, along with 1500 mg of calcium. Stronger vitamin D preparations are sometimes used to treat osteoporosis in younger people.
Bisphosphonates This group of drugs works by slowing bone loss; in many people, an increase in bone density can be measured over 5 years of treatment. Both alendronate (Fosamax) and risedronate (Actonel) reduce the risk of hip and spine fractures in patients with osteoporosis. These drugs cannot be taken with food, and specific instructions on how to take the tablets are provided as they can cause irritation of the gullet. They are available either as daily-dose tablets or weekly-dose tablets. Etidronate (Didronel) is a slightly weaker drug of the same group, which is well tolerated and is taken in 3-month cycles.

Hormone replacement therapy (HRT) Women who have been through the menopause may consider using hormone replacement therapy to reduce their menopausal symptoms. HRT is only beneficial for bones while it is being used. A very large clinical trial reported in 2002 that using the commonest type of HRT tablet is associated with a reduction in fracture, but also with an increase in the risk of heart disease and breast cancer. It can also increase the risk of venous thrombosis. If you are considering long-term HRT use, discuss the potential risks and benefits with your doctor.

Selective estrogen receptor modulators (SERMs) As previously mentioned, the hormone oestrogen helps to keep the bones strong. Raloxifene (Evista) is a SERM which mimics this effect and reduces spine fractures. It also reduces the risk of breast cancer without increasing the risk of heart disease. It is taken by mouth once a day without the need to follow special instructions. It may cause side-effects like menopausal 'flushing' and, as with HRT, may increase the risk of venous thrombosis.
Calcitonin (Miacalcic) Calcitonin is a substance which the body produces naturally and which helps keep the bones healthy. When used as a treatment it has enabled the bones of people with osteoporosis to grow stronger. Calcitonin can only be given in the form of an injection or by nasal spray. Injections of calcitonin are normally given only as a short-term treatment for painful vertebral fractures, but the nasal spray may be used as a long-term treatment for osteoporosis. Possible side-effects include hot flushes, nausea, an unpleasant taste in the mouth, tingling in the hands and, rarely, an allergic reaction. The nasal spray may also cause a blocked or runny nose, sneezing and headaches.

Teriparatide (Forsteo) Teriparatide is a new drug which helps new bone to form and therefore reduces the risk of fractures. It is taken by daily injection into the thigh or tummy (patients are shown how to do this themselves). It is used for up to 18 months, during which time the bones are strengthened. At present it is used mainly for people who have had fractures despite using other treatments, or who have had side-effects from other treatments. Side-effects of teriparatide include nausea, limb pain, headaches and dizziness, but because it is a new drug the long-term side-effects are not known.

Finally...
Leading an active healthy life and maintaining a diet with sufficient calcium is the best way of preventing osteoporosis. If you have the condition already, there are a number of treatments which can be effective, as described above.

Glossary
Collagen – the main substance in the white, fibrous connective tissue which is found in tendons, ligaments and cartilage. This very important protein is also found in skin and bone.

Oestrogen – one of a group of hormones in the body which control female sexual development.

Trabecular bone – this forms the inside part of bones in the skeleton. It is formed in a meshwork and is surrounded by a more dense outer shell of 'cortical' bone.

Venous thrombosis – a blood clot forming in a vein.

Useful addresses
The Arthritis Research Campaign (arc)
PO Box 177
Chesterfield
Derbyshire S41 7TQ
Phone: [phone]
www.arc.org.uk

As well as funding research, we produce a range of free information booklets and leaflets. Please contact the address above for a list of titles or, on this web site, see Publications for People with Arthritis.

Arthritis Care
18 Stephenson Way
London NW1 2HD
Phone: [phone]
Helplines: 020 7380 6555 (10am–4pm Mon–Fri)
or freephone: 0808 800 4050 (12pm–4pm Mon–Fri)
www.arthritiscare.org.uk

Offers self-help support, a helpline service (on both numbers above), and a range of leaflets on arthritis.

Food Standards Agency
Aviation House
125 Kingsway
London WC2B 6NH
Phone: [phone]
www.food.gov.uk

National Osteoporosis Society (NOS)
Camerton
Bath
BA2 0PJ
Phone: [phone]
Helpline: 0845 450 0230 (10am–3pm Mon–Fri)
www.nos.org.uk

Answer 2

it's lessening of the density of bones. Causes brittle bones, easier fractures, poor posture, and in some cases a loss of height. any woman after menopause starts is at risk. there is a once a month treatment called Boniva that has shown benefits. You also need to take 1000 mg of calcium daily to help the bone strength and density

Answer 3

nothing - but I can find out, a quick search on Google does wonders...

osteoporosis (ŏs'tēō'pərō`sĭs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia results when bone-mass loss is significant but not as severe as in osteoporosis. Although osteoporosis can occur in anyone, it is most common in thin white women after menopause.

Answer 4

you have some good answers already, it is the thinning of the bones, it usually comes after menopause in women, however men get it as well and so do younger people.
some medications have side effects that cause bone mass loss.

Answer 5

Osteoporosis
If you have osteoporosis it means that you have lost some bone material. The bones become less dense and more 'honeycombed'. This makes them more prone to break (fracture). Osteoporosis mainly affects older people and can affect anyone. However, some people have an increased risk of developing osteoporosis (detailed below). You can take measures to prevent or slow down bone loss. If you have osteoporosis, drugs can help to restore bone.

Understanding bones and osteoporosis
Bone is made of collagen fibres (tough, elastic fibres) and minerals (gritty, hard material). Bone is a living tissue and contains cells that make and mould bone. After about the age of 45, you lose a certain amount of bone material. The bones become less dense and less strong. The amount of bone loss can vary. If you have a lot of bone loss, then you have osteoporosis. If you have osteoporosis you have bones that will break more easily than normal, especially if you have an injury such as a fall.

How common is osteoporosis?
Women lose bone material more rapidly than men especially after the menopause when the level of oestrogen falls. Oestrogen is a female hormone and helps to protect against bone loss. By the age of 70 some women have lost 30% of their bone material. In the UK, about half of women and about 1 in 5 men over the age of 50 will fracture a bone, many as a result of osteoporosis.

Who is at risk of osteoporosis?
All men and women have some risk of developing osteoporosis as they become older, particularly over the age of 60. Women are more at risk than men. The following situations also increase the risk of developing bone loss and osteoporosis. If you:

are a woman who had your menopause before the age of 45.
have already had a bone fracture after a minor fall or bump.
have a strong family history of osteoporosis.
have a body mass index (BMI) of 19 or less. (That is, you are very underweight.) For example, if you have anorexia nervosa. In this situation the level of oestrogen is often low for long periods of time and, combined with a poor diet, can affect the bones.
are a woman and your periods stop for a year or more before the time of your menopause. This can happen for various reasons.
have taken, or are taking, a steroid medicine (such as prednisolone) for three months or more. A side-effect of steroids is to cause bone loss.
smoke
lack calcium and/or vitamin D (due to a poor diet and/or little exposure to sunlight.)
have never taken regular exercise, or have led a sedentary lifestyle (particularly during your teenage years).
have, or had, certain medical conditions that can affect the bones. For example, an overactive thyroid, Cushing's disease, and any condition that causes poor mobility.
How is osteoporosis diagnosed?

Your GP or other health professional may ask you questions to see how many of the risk factors listed above apply to you. If you may be at risk you may then be referred for a DEXA scan. DEXA stands for Dual Energy X-ray Absorptiometry. It is a scan that uses special X-ray machines that can check the bone density and confirm osteoporosis. However, osteoporosis is often first diagnosed when you break a bone after a minor bump or fall.

What are the symptoms and problems of osteoporosis?
Osteoporosis usually develops slowly over several years without any symptoms. However, after a certain amount of bone loss, the following may occur:

A bone fracture after a minor injury such as a fall
If you have osteoporosis, the force of a simple fall to the ground is often enough to fracture a bone. (A simple fall to the ground from standing does not usually cause a fracture if you do not have osteoporosis.) The fractures are most commonly of the hip, wrist, and vertebrae (the bones that make up the spine). A fractured bone in an older person can be serious. For example, about half the people who have a hip fracture are unable to live independently afterwards.

It is estimated that about 1 in 3 people over the age of 65 have a fall each year, increasing to 1 in 2 people aged 80 years and older. Over 60,000 people have a hip fracture each year in the UK, and about 19 in 20 of these are the result of a fall in those who have osteoporosis.

Loss of height, persistent back pain and a stooping (bent forward) posture
These symptoms occur if you develop one or more fractured vertebrae which become 'squashed' with the weight of the body. A vertebra with osteoporosis may fracture even without a fall or significant force on it. Over 120,000 vertebral fractures occur each year in the UK and only about 1 in 4 of these are caused by a fall.

What can I do to prevent osteoporosis?
The following helps to prevent, or slow down, bone loss. This advice is for everyone. But, it is particularly important if you have an increased risk of developing osteoporosis, or already have it.

Exercise
Regular weight-bearing exercise throughout life is best, but it is never too late to start. This means exercise such as brisk walking, aerobics, dancing, running, etc. For older people, a regular walk is a good start. However, the more vigorous the exercise, the better. For most benefit you should exercise regularly - at least 30 minutes of moderate exercise or physical activity at least 4-5 times per week. A separate leaflet called 'Exercise and Health' gives more details.

Exercise helps because the pulling and tugging on the bones by the muscles helps to stimulate bone-making cells and strengthens the bones. It also gives strength to the supporting muscles around bones. This helps to increase tone, balance, etc, which may help to prevent you from falling. Note: excessive exercise such as marathon running may not be so good.

Research studies have shown that moderate levels of activity, including walking, decreases the risk of having a hip fracture in older women.

Food and Diet
Calcium and vitamin D are important for bone health. The recommended daily intake for calcium in adults is 700 mg, but more may be required for people with osteoporosis. Everyone over 65 years should aim to take 400 IU of vitamin D daily. Briefly:

Calcium - you can get 700-1000 mg of calcium most easily by:

drinking a pint of milk a day, plus
eating 60 g (2 oz) hard cheese such as Cheddar or Edam, or one pot of yoghurt (125 g), or 60 g of sardines.
Bread, calcium-fortified soya milk, some vegetables (curly kale, okra, spinach, and watercress) and some fruits (dried apricots, dried figs, and mixed peel) are also good sources of calcium. Butter, cream, and soft cheeses do not contain much calcium.

Vitamin D - there are only a few foods that are a good source of vitamin D. Approximately 115 g (4 oz) of cooked salmon or cooked mackerel provide 400 IU of vitamin D. The same amount of vitamin D can also be obtained from 170 g (6 oz) of tuna fish or 80 g (3 oz) of sardines (both canned in oil). Vitamin D is also made by your body after exposure to the sun. (The ultraviolet rays in sunshine triggers your skin to make vitamin D.) For most people over 65, an adequate amount of vitamin D can only be achieved by taking vitamin D supplements. A dietary supplement of vitamin D is commonly recommended for people over the age of 65 and for others who may lack vitamin D such as people who have a poor diet and people whose exposure to sunlight is limited. For example, women whose whole body is always covered by clothing.

If you are unsure about whether you should have calcium or vitamin D supplements, ask your practice nurse or GP.

Smoking and drinking
Chemicals from tobacco in the bloodstream can affect the bones and make bone loss worse. If you smoke, you should make every effort to stop. Also, cut down on alcohol if you drink heavily.

Hormone replacement therapy (HRT)
HRT contains oestrogen. A few years ago HRT was widely used to prevent osteoporosis. However, the recent findings on the potential long-term health risks of HRT have meant that it is not now commonly used for this purpose (except in women who have had an early menopause).

What are the treatments for osteoporosis?

Medication and/or lifestyle advice may be advised if you develop osteoporosis.

Medication to prevent and treat bone loss
Various drugs are available. Once medication for osteoporosis is started, it is likely that you will need it for the rest of your life.

The bisphosphonates are a group of drugs that include alendronate, risedronate, etidronate, and ibandronate. These are the most commonly used drugs to treat osteoporosis. They work on the bone-making cells. They can help to restore some lost bone, and help to prevent further bone loss. Research studies have shown that the risk of bone fracture is reduced by taking one of these drugs.
Strontium ranelate is an alternative if a biphosphonate is not suitable.
Calcitonin, raloxifene and Parathyroid hormone are other alternative drugs that are used if a biphosphonate or strontium ranelate are not suitable. They too have research evidence to show that they reduce the risk of bone fractures.
Calcium and vitamin D tablets
These dietary supplements are commonly prescribed in addition to one of the above drugs. The body needs plenty of calcium and vitamin D to make bone.

Lifestyle
Medication will not restore all lost bone. Therefore, in addition to medication, lifestyle measures are also important (exercise, not smoking, etc, as described above).

Preventing falls
You can take measures to help prevent you from falling. This can reduce your risk of breaking a bone.

Check your home for hazards such as uneven rugs, trailing wires, slippery floors, etc.
Regular weight bearing exercise may help to prevent falls (as described above).
Are your vision and hearing as good as possible? Do they need checking? Do you need glasses or a hearing aid?
Beware of going out in icy weather.
Do you take any drugs that can make you drowsy? Can they be changed?
If you have had a fall, or have difficulty walking, you may be advised to have a formal 'falls risk assessment'. This involves various things such as a physical examination, checking your vision, hearing, and ability to walk, reviewing your medication, and reviewing your home circumstances. Following this, where appropriate, some people are offered things such as a muscle strengthening and balance programme, or recommendations on how to reduce potential hazards in the home.

Further information

National Osteoporosis Society
Camerton, Bath, BA2 0PJ
Helpline: 0845 4500230
Web: www.nos.org.uk

© EMIS and PIP 2006 Updated: May 2006 PRODIGY Validated