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Bone Health

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Basic statistics*

	Osteoporosis is widely spread and most of us know someone who suffers with it
	In the UK, every 3 minutes there is someone that suffers an osteoporosis related fracture
	An estimated 3 million people in the UK have osteoporosis
	Osteoporosis is more common in women than in men – 1 in 3 women and 1 in 12 men
	Currently in the UK there are approximately 75,000 hip fractures; 50,000 wrist fractures and 40,000 spinal fractures
	Osteoporosis related costs in the UK are currently estimated at £1.7 billion per year

**Data from the National Osteoporosis Society*

Osteoporosis Definition

Osteoporosis is often referred to as “brittle bone disease”, but the actual meaning can be accurately described as “porous bones” – bone that has large structural holes, which lead to a compromised bone strength and an increased risk for potential fragility.

Human skeleton has 206 bones. The skeleton supports the body and protects the internal organs. It also provides shape and acts as muscles anchor that allows the body to move. Skeleton is a live and living tissue that is constantly renewed. Female skeleton is usually smaller and lighter than male skeleton.

Bone is a live part of the body. It is constantly changing in a non-stop process of break down and renewal - called “bone turnover”. Bone can be best described as a honeycomb-like mesh structure that is made of protein collagen, calcium salts and other minerals. The void spaces within the mesh are filled with blood vessels and marrow and, together, these are encased in an outer hard and thick shell. When the void spaces within the honeycomb mesh become enlarged – the bone becomes fragile and prone to breaking – this is called “osteoporosis”. Osteoporosis usually affects the whole skeleton. However, the osteoporotic fractures mainly occur at the spine, wrist or at the hip. All fractures cause pain and misery, but it is the hip fracture that is the most devastating of all fractures. The risk of hip fracture can be additionally exacerbated by a low muscle mass. In thin frail people, the thin muscle lining around the hips does not provide sufficient protection from traumas, such as falling. Many elderly people permanently lose their quality of life, personal independence or even their life as a direct result of suffering a hip fracture.

Sadly, fractures of the hip are common injuries in older people, who have weakened/compromised bone strength. And, most commonly, hip fractures are sustained during a sideways fall that focuses the energy of impact on the trochanteric area of the proximal femur. Effects of falls in the elderly people can be gravely serious.

Hip Fracture Prevention Strategies include:

	Prevention and treatment of osteoporosis with bone building pharmacological interventions
	Primary falls prevention
	Protection of hip injury sites with external hip protectors

The fracture can happen in the area of the femoral neck or in the trochanteric area. The hip can be best described as a "ball and socket" joint. The socket is located in the pelvis and the ball is the head of the thigh bone. The thigh bone is called the femur. The area of the thigh bone at its upper end is called the greater trochanter. You can feel it moving, when you place your fingertips on the side of your hip, while slightly raising your knee. The neck of the femur is between the ball and the greater trochanter. Hip fractures occur in the area of the femoral neck or in the area just below the femoral neck called the trochanteric area.

Who is at risk of osteoporosis?

Osteoporosis affects people of any age and any gender. However, osteoporosis presents more commonly in women than in men and is more prevalent with advancing age. It is a “silent” disease, because many people do not realise that something is wrong until they break a bone in a low trauma accident. In addition to being an ageing woman, the most common risk factors include the following:

	Smoking
	Excessive alcohol
	Inactive lifestyle
	Lack of estrogens and early menopause
	Low levels of male hormone testosterone
	Amenorrhoea (missing periods for other reason than pregnancy)
	Long-term use of corticosteroids for conditions such as asthma or arthritis
	Family history of osteoporosis
	Malabsorbtion problems such as Celiac Disease, Crohn’s Disease
	Anorexia Nervosa

How can osteoporosis be identified?

Some people present with a kyphotic hump called Dowager’s Hump – an abnormally increased convexity in the curvature of the thoracic spine as viewed from the side, such thoracic kyphosis is due to vertebral collapse frequently seen in the elderly women. This occurs due to collapse/compression of several bones in the spine as a result of osteoporosis. There is a simultaneous loss of height and back pain.

However, taking visible signs aside, there are more accurate and reliable tests available. Currently, two methods of assessing the condition of bones directly are used – DXA scan (a special type of x-ray which looks at the hip and spine) and QUS (ultrasound which looks at the heel).

DXA is an accurate and reliable method of assessing bone density and can therefore diagnose osteoporosis. DXA is the favoured method as it provides very precise bone density measurements. However, it is usually performed in hospitals, where appointment waiting times can be very long.
QUS can accurately fairly predict fractures in older women, if appropriately carried out and interpreted by a medically qualified professional. Ultrasound is quick, portable and safe, as it does not use harmful x-rays. When combined with a review of lifestyle and medical history and interpreted by a skilled appropriately qualified clinician, QUS provides a powerful testing option that leads to a thorough understanding of bones. Being ‘Bone Aware’ can then help to take appropriate action to minimise future loss of bone and reduce risk of fractures. Ultrasound of the heel is supported by the Government’s Chief Medical Officer as a useful method of assessing fracture risk.

Can osteoporosis be prevented?

The height and the strength of the skeleton is to some extent predetermined by inherited genes. However, everyone can take simple measures to ensure that their bones remain as healthy and strong as possible for life. The recommendations include the following lifestyle actions:

Eat a healthy and balanced diet that is rich in calcium, minerals, vitamins and fibre acquired from different food stuffs sources (i.e. dairy products, leafy green vegetables, oily and bony fish).

Expose your skin to the sunlight for 20 minutes per day to replenish your vitamin D stores. Vitamin D is vital for healthy bones.

Stop smoking – smoking is toxic to bones and increases the risk of hip fracture in later life.

Exercise for 20 minutes at least three times per week – bones and muscles will deteriorate, if they are not used. The best and most effective exercises are weight – bearing activities that stretch and contract the muscles – a simple brisk walk with full shopping bags, climbing stairs, jogging or dancing can serve as examples of such exercises. For exercises especially designed with mature people in mind, please, refer to the "How to Prevent Falls" by Betty Perkins-Carpenter presented on a separate page on this website. Please, note that swimming is a non-weight bearing exercise and, as such, is very good for general health, but it is not going to stimulate the growth of new bone.

Reduce alcohol consumption as excessive alcohol damages bone turnover.

Eat 5 portions of fruit and vegetables a day - this will help your overall health and stamina!

Treat yourself to a glass of warm milk and a nice biscuit on retiring to bed - this may help you to sleep soundly, waking up strong and refreshed!

Can osteoporosis be treated?

There are a number of different treatments available for people with diagnosed osteoporosis. Your GP and your hospital specialist will consider your individual situation and prescribe the best treatment option for you.

Getting appropriate advice

If you are worried about osteoporosis or your bone health – consult your GP and he/she may refer you for further specialist investigations or prescribe an appropriate treatment.