Osteoporosis and Osteopenia

Around three million people in this country have Osteoporosis. 1 in 2 women and 1 in 5 men over the age of 50 will have a fracture mainly because of this condition. Men naturally have a higher bone density than women which is why these conditions are more prevalent in women than men. Osteoporosis is a condition where the bones become thin and weak, and break easily. The spine, wrist and hips are particularly vulnerable to fracture.

You may also have come across another term of Osteopenia? This is bone density that is lower than normal for your age but not low enough to be classified as Osteoporosis. Being diagnosed with Osteopenia means you are at greater risk over time of developing osteoporosis.

There are a lot of causes and risk factors associated with these conditions. Bone is constantly being broken down and rebuilt by the body. In these conditions, bone cells are reabsorbed by the body faster than new bone is laid down. In general, the higher the concentration of calcium in the bones, the faster new bone is laid down. Bone is at its strongest in the third decade and then decreases thereafter. Its density is affected by exercise, hormone levels, genetics and many other factors. 

It is not obvious that a patient may have Osteopenia/Porosis, as frequently there are no symptoms at all. Sometimes a person may develop an increased forward curve in their upper back often due to alterations in the shape of the vertebra. Some people may also notice a loss of height (but this also occurs in combination with the natural thinning of the discs between the vertebra, so it’s not definitive).

X- rays are not particularly helpful in diagnosis as they are not sufficiently sensitive to what is often a subtle change in density, although this can sometimes be seen if previous imaging is available say from 6 months or a year prior. A bone density scan called a DEXA (dual-energy X-ray absorptiometry) is the normal and most accurate method available and can show 2% losses per year. On a reasonably regular basis, I recommend female patients have a DEXA scan done especially if there are obvious postural changes apparent, a strong family history, or they have had a fracture often a wrist in an incident that caused it should not have caused a fracture (mechanism of injury). As part of a case history I now nearly always ask older people if they have had a bone density screening done.

It’s important to consider whether you’re at higher than average risk for osteoporosis or osteopenia and seek help if you are. You may consider the following risk factors; early menopause, a history of spontaneous/unexpected fractures in the past, previous x-rays suggest thinning of the bones, steroids treatment for more than six months, a family history of osteoporosis, dietary problems or mal-absorption syndromes, chronic illness, excess smoking or drinking, low body weight, history of eating disorders.

There are many treatment options available if it’s confirmed you have osteoporosis. Medication may include; Calcium and vitamin D supplements, hormone treatments and other drugs that prevent further bone breakdown.