Osteoporosis

Osteoporosis is a major health threat across the globe. An estimated 300,000 people in Ireland are affected by osteoporosis and approximately 200 million people worldwide are diagnosed with the condition. Worldwide, osteoporosis causes more than 8.9 million fractures a year, resulting in an osteoporotic fracture every 3 seconds.

Osteoporosis vs Osteopenia

Osteoporosis is a disease characterized by a decrease in bone density (mass and quality). It is a disorder in which bones become increasingly porous and brittle leading to increased risk of fracture. 

Osteopenia is a term that has been used to describe a decrease in bone mass. It is the early stage of osteoporosis. Having osteopenia places a person at risk of developing osteoporosis.

What are the signs and symptoms? 

Some signs that you may have a reduced bone mass include:

  • Fractures resulting from a fall/trip 
  • Loss of height 
  • Developing a ‘hump’ in the upper back (Dowager’s hump)
  • Sudden, severe episodes of back pain 
  • Unexplained broken bones

How is it diagnosed?

The most common test used is called a DXA scan. This test is completely pain free, and only takes 10-15 minutes. It will generally look at bone density in the spine, hip, and sometimes the forearm. The results are recorded as a ‘T-score’, which compares your results with the average peak bone mass of females and males between the ages of 20-40. Results are categorised as follows:

  • Mild Osteopenia T-score = -1 to -1.49
  • Moderate Osteopenia T-score = -1.5 to -1.9
  • Marked Osteopenia T-score = -2 to -2.49
  • Osteoporosis T-score = Greater than -2.5
  • Severe Osteoporosis T- score = -3 and higher.

Blood tests may also be carried out to identify if you have any other medical conditions that could contribute to osteoporosis. Biochemical marker tests can help estimate how fast you are losing or making bone.

Who is at risk?

While 90% of adult bone is laid down by the age of 17, bone continues to grow in strength up until the mid-thirties. After this, it is natural to lose a small amount of bone mass each year. This is accelerated in women after the menopause when the protective effect of oestrogen is lost.

Image result for peak bone mass diagram

There are a number of other factors that can increase your risk of developing osteoporosis:

  • Family history of bone disease
  • Being underweight
  • Long term use of steroids
  • Long periods of inactivity or immobilization 
  • Co-morbidities: hypothyroidism, type II diabetes, gastrointestinal disease, Cushing’s disease, renal failure, cancer (and cancer treatment), eating disorders, depression
  • Lifestyle & Diet: Alcohol (>3 drinks/day), tobacco use, calcium/magnesium deficiency, vitamin D deficiency, high-fat diet, excess sugar 

The Irish Osteoporosis Society have developed an online tool to assess your risk of osteoporosis. It can be found here: https://www.irishosteoporosis.ie/quiz/

What can I do to manage osteoporosis? 

Osteopenia and Osteoporosis may be managed through exercise, diet and medication where needed. A combination can help to maintain bone strength and minimise bone loss.

Exercise

A physiotherapist can prescribe individualised exercise programmes to maintain/improve bone health. An exercise programme consisting of weightbearing exercises, resistance training, and balance and postural exercises can help prevent osteoporosis worsening and reduce the risk of fractures. 

  • Weightbearing exercises, such as walking, hiking, dancing etc., can slow age-related decline in bone density and can influence factors that preserve bone strength.
  • Resistance/strength training, exercises performed using weights or resistance bands, has also been shown to improve bone density at the location of muscle attachment.
  • Postural exercises can prevent structural changes that may accompany osteoporosis such as thoracic kyphosis (rounding of the thoracic spine) which often causes reduction in height. These exercises should promote extension, e.g. chin tucks, scapular retractions, thoracic extensions, and hip extensions. Improving the posture can also improve balance and reduce the risk of falls
  • Balance exercises can also be performed to reduce the risk of falls, and thus reduce the risk of fractures. These exercises may be carried out statically, e.g. single leg stance, tightrope stance, or dynamically by adding movement, e.g. tightrope walk. Balance exercises can be modified to suit all abilities. 
  • Exercise classes such as Tai Chi, Yoga and Pilates are also beneficial as they incorporate different aspects of strength, balance and posture.

Diet

Calcium and Vitamin D are important in maintaining bone mass. It also important to avoid sources which may inhibit the absorption of these.

  • Include calcium in the diet i.e. milk, cheese, yoghurt almonds, broccoli, cauliflower. 
  • Vitamin D helps the body absorb calcium. Dietary sources of Vitamin D include eggs, oily fish (salmon, mackerel, sardines etc.), chicken or liver pate and some cereals
  • You should not have a high-protein diet. When the kidneys flush out excess protein, they also flush out calcium that you need.
  • Caffeine is also known to inhibit calcium absorption so you should limit your caffeine intake to 3 cups/day. 

Medical Management 

There are a number of medications that can be prescribed for managing osteoporosis. They are decided upon by your GP or consultant based on your presentation and medical history, and commonly include bisphosphonates, estrogen/hormone therapy, or parathyroid hormone. Calcium and Vitamin D supplements may also be recommended.

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