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Osteoporosis

Osteoporosis occurs when bones become thinner, and more prone to fractures and breaks. We naturally begin to lose bone density from the age of 35, and women tend to lose it faster as a result of the menopause.

  1. Can increase the risk of breaks and fractures
  2. Thought to affect around 3 million Britons
  3. Regular exercise and treatment can help to slow down bone loss

If you’re concerned about osteoporosis or want to talk to a doctor online about your treatment plan, you can through our secure video consultation service.

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Information

What is osteoporosis?

Osteoporosis is a condition where bones thin and lose density. It doesn’t cause any noticeable symptoms, but does mean that bones become more prone to breaks and fractures from falling. The condition usually affects older people, as we lose bone density as we age. However, osteoporosis can develop earlier in some people, for various reasons.

It’s fairly common. Around 3 million people in the UK are thought to be living with the condition. About half a million people are seen in hospitals each year with fragility fractures.

Bone is comprised of elastic fibres, and has cells which have the ability to create new bone, as well as mould and resorb it. From the age of 35, we start to lose bone as it stops forming as quickly. 

Who gets osteoporosis?

Hormones, such as oestrogen and testosterone, play a vital role in the development and maintenance of healthy bone. When women go through the menopause, their oestrogen levels begin to drop, which can result in a loss of bone density. One of the aims of HRT (hormone replacement therapy) in women is to prevent this from happening. 

Men with low testosterone (or hypogonadism) are more at risk of osteoporosis as well, so TRT (testosterone replacement therapy) is used to help lower the chances of osteoporosis developing.

Having osteoporosis means that you are more prone to bones breaking, particularly after an accident, but it doesn’t result in symptoms. It’s therefore often the case that someone will not realise they have it until they sustain a break or a fragility fracture, or until they have routine checks because they’re in a high risk group. 

A fragility fracture is when someone sustains a fracture after falling from a standing height or less. Bones in the normal category will usually be able to absorb falls from this height, but are less likely to be able to when osteoporosis is present.

The primary method of diagnosis for osteoporosis is a DEXA scan. This is an imaging test which measures bone density. Results are given as a value called a T score. This is based on something called standard deviation, which clarifies your bone mineral density as compared to someone with ‘peak’ bone mass.

  • If someone has a T score of above -1, they’re considered to be in normal range.
  • A score between -1 and -2.5 indicates loss of bone density, and is referred to as osteopenia.
  • Osteoporosis is said to be present if someone’s score is lower than -2.5.

What should I do if I have osteopenia?

If you have osteopenia (the stage before osteoporosis, where you have lower bone density than average for your age) you’ll likely be given advice from your doctor or a specialist on how to prevent further bone loss. This may include information on eating a healthy, balanced diet, and undertaking weight-bearing exercise. Vitamin D and calcium supplements may also be offered, to help strengthen bones and limit deterioration.

Treatments for osteoporosis include those mentioned above, as well as bisphosphonates (which help to stop bone from breaking down), examples include Fosamax and Fosavane, or selective estrogen receptor modulators (SERMs). You’ll also likely be recommended treatment for the underlying cause of the condition, whether it is the menopause, low testosterone, or a medical issue such as hypothyroidism or a pituitary gland disorder.

Our online video consultation service can provide the help you need if you’re concerned about osteoporosis, or want to speak to someone about your treatment plan. Book an appointment at a time that suits you to get started. 

Page last reviewed:  16/06/2020
Diagnosis and treatment

What are the causes of osteoporosis?

Our bones develop and become stronger throughout childhood and into adult life, peaking around our late 20s. From the age of 35, we begin to lose bone density. In some people, this loss can occur at a faster rate. Physical activity, hormones and nutrients play an important role in maintaining strong and healthy bones.

There are many possible causes of osteoporosis, ranging from underlying illnesses to lifestyle habits, that can contribute towards bone loss. For example, an underactive thyroid may cause hormone levels to fluctuate, affecting bone density. People who don’t get enough omega-3, calcium or vitamin D can also experience bone loss. 

In women, the menopause may increase the risk of osteoporosis, as the body's oestrogen levels decline (oestrogen is essential for strong bones). Similarly in men, low testosterone levels can affect bone strength.

The use of certain medications, such as steroids, may also affect bone density. Subsequently, people with autoimmune diseases that require long-term or repeated steroid treatment, such as asthma or ulcerative colitis, may be at higher risk.

Smoking, drinking too much alcohol and physical inactivity can also be factors in the development of osteoporosis.

How is osteoporosis diagnosed?

Osteoporosis doesn’t cause any outward symptoms. If someone is experiencing bone loss, they usually won’t know until they have a routine scan (because they’re going through the menopause for example, or are on long-term steroid treatment), or until they break a bone. 

If a doctor suspects you’re at risk of developing osteoporosis, or if you’ve sustained a break or fracture, you’ll likely be sent for a screening.

Will I need tests?

Usually, yes. Blood tests can give a doctor an indication of whether you’re vitamin D deficient. A DEXA scan is an imaging tool doctors can use to measure bone density, and can confirm the presence of bone loss.

There are newer tests currently being developed and used sparingly, such as a digital X-ray radiogrammetry (DXR) and an ultrasound test, but currently a DEXA test is currently the preferred method.

How is osteoporosis managed?

In a variety of ways. It usually depends on what the cause is.

Calcium and vitamin D are vital to healthy bones, so a diet containing a healthy amount of both will usually be advised. Getting plenty of exercise, particularly weight-bearing activities such as walking and strength training, is also important.

Osteoporosis treatment focuses on slowing down bone loss, so that breaks and fractures are not as likely. Calcium and vitamin D supplements can help to strengthen bones and, in addition to a healthy diet, might be recommended for people with mild or moderate bone loss (osteopenia) to help prevent progression to osteoporosis. 

A type of medicine called bisphosphonates can also help to slow the rate at which bone is broken down in the body. These are usually available as a tablet or as an injectable treatment. Examples of these treatments include Alendronate and Binosto which contain alendronic acid.

Women who are going through the menopause may be recommended an oestrogen treatment to help prevent bone loss. Similarly, men with low testosterone may be prescribed testosterone replacement therapy.

A doctor will consider your age, bone density, alcohol consumption, BMI and any other pre-existing conditions when deciding on a course of treatment.

Page last reviewed:  16/06/2020
Questions and Answers

How is osteoporosis treated?

Often the underlying cause of the condition, if there is one, may need to be addressed. The menopause, low testosterone, an underactive thyroid, gland disorders and other hormonal imbalances can all contribute towards osteoporosis. So you may be offered treatment for these to help lower the risk of further bone loss.

If you have already been found to have a fragility fracture, you will likely be started on a course of medication. Bisphosphonates are the most common type of medication used to treat osteoporosis. They help the bone-making cells to function better, and can help to reduce the chances of developing a second fracture. There are also various lifestyle measures that can be taken to help stem the development of the condition, such as weight-bearing exercise, not smoking and refraining from drinking to excess, as well as eating a healthy, balanced diet.

People who have or are at risk of osteoporosis may be recommended a calcium or vitamin D supplement (or both).

How long will it take for me to recover?

Osteoporosis is a long-term condition which requires management to prevent it from getting worse. If you’re at risk of developing osteoporosis, you’ll need to be monitored to check your bone density levels. People with osteoporosis will have scans on a regular basis to help ensure their treatment plan is working.

However, in some cases, it can be reversed with the right treatment.

How long fragility fractures associated with osteoporosis take to heal depends on the fracture itself; it can range from 6-12 weeks in less serious cases. But severe fractures and breaks may take significantly longer, or never completely heal.

Can I consult a doctor about osteoporosis online?

Yes. Our doctors are available to consult with online about osteoporosis. Through our secure video chat facility, they can advise you on lifestyle measures to help prevent osteoporosis, and management of the condition if you’ve already been diagnosed.

Page last reviewed:  16/06/2020

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