0 Osteoporosis
develops slowly over
many years and
there may be no
early warning signs0 Loss of height
and unusual
back pain (caused
by changes in the
spine) should
ring alarm bells
and prompt further
investigation.
However, the
first sign of
trouble is often a
fragility fracture0 According to
Nice, in a typical
year half a million
people are treated
in UK hospitals for
fragility fractures
— bones that have
broken because of
a slip, trip or fall
from standing height
— classically of
the wrist, upper
arm/shoulder,
spine and hip0 While it is
possible for a
perfectly healthy
person to break
a bone in such a fall,
in the over-50s it
often indicates
underlying
osteoporosis and
should never
be ignored0 Anyone taking
prolonged or
frequent courses
of steroids should
ask their doctor
about osteoporosis
and steps to prevent
it (we often
prescribe
alendronate and
calcium and
vitamin D
alongside steroids)0 For more
information on
all aspects of
osteoporosis and
bone health, visit
theros.org.uk. For
the latest guidance
on diagnosing
and treating
osteoporosis, search
“osteoporosis” at
cks.nice.org.ukTelltale signs
and symptoms
of osteoporosis
Dr Mark Porter
A new osteoporosis treatment is
good news, but awareness is key
towards the latter, encouraging new
bone deposition/strengthening. At
least this is what we hope will happen.
Although bisphosphonates can
improve bone density and protect
against fractures, they can have
significant side effects — from
indigestion (common) to serious
disease of the jawbone (rare). And,
paradoxically, taking them for too
long can increase the risk of fracture.
What constitutes too long is the
subject of debate, but taking a two to
three-year break after five years to
review the situation is common
practice in the UK. In older
people (over 75) some advocate
longer regimens with a break
after ten years. It is important
to ensure that anyone taking
bisphosphonates has an
adequate intake of calcium
(the main mineral in bone)
and enough vitamin D to
facilitate its absorption and
incorporation into the
skeleton. In most cases
this takes the form of
supplements, particularly
for vitamin D. Although
deemed good practice,
these supplements
remain controversial.
There is no doubt that
deficiencies of calcium
and vitamin D can
weaken bones but,
counterintuitive though
it may be, it’s not so clear
that boosting intake
always strengthens them.the earliest stages, where lower-dose
radiation (a Dexa scan) is required to
pick up more subtle changes.
The NHS uses risk calculators such
as QFracture to input factors
including age, lifestyle, height, weight
and family history to estimate an
individual’s risk of breaking a bone
because of osteoporosis. The results
can be used to decide who warrants
further tests and/or treatment. The
calculator is designed for use by health
professionals but there is nothing to
stop you having a go — just make sure
you click on the information tab for
more details on how it works.
Self-help measures such as stopping
smoking, cutting back on alcohol and
increasing weight-bearing exercise
are an important part of treatment.
Medication can help too. Hormone-
replacement therapy where
appropriate can reduce the fracture
risk, but it is bisphosphonates such as
weekly alendronate tablets that are the
mainstay of treatment for most people.
Like romosozumab, bisphosphonates
are thought to shift the balance of
osteoclast and osteoblast activityT
he National Institute
for Health and Care
Excellence (Nice) has
just approved the
first new osteoporosis
treatment for a
decade. Romosozumab
offers additional
protection against broken bones when
compared with conventional
treatments, and Nice estimates that at
least 20,000 people with the severest
form of the disease could benefit
from access to the drug on the NHS.
Any advance in the treatment of a
condition that affects at least three
million people in the UK is welcome,
but we could perhaps make a bigger
difference to more people if we made
the most of the therapies we already
have. Clues to osteoporosis are often
missed — by the NHS and the public
— and hundreds of thousands of
people could benefit from earlier
diagnosis and treatment with existing
drugs. Here’s what you need to know.
Your skeleton is constantly being
remodelled. Old bone is dissolved by
cells called osteoclasts, and new bone
is deposited by osteoblasts. It is a slow
process, but about 10 per cent of your
skeleton is replaced every year. Peak
bone mass (and strength) is reached
around the age of 35, after which our
bones become less dense with time,
a process that affects both sexes but
that accelerates after the menopause
in women.
All of us get “thinner” bones with
time, but for about one in three
women and one in five men over 50,
this process occurs to such a degree
that their bones fracture. Broken
wrists and hips are common after
simple trips and falls, but in the case
of the spine, vertebral fractures can
occur without significant trauma.
The longer you live the greater the
likelihood of developing the condition,
but there are myriad risk factors
ranging from general ill health and
immobility to smoking, drinking (three
units or more a day), the menopause
(particularly if early), low testosterone
levels, being underweight,
malabsorption due to bowel
conditions such as coeliac disease,
and having arthritis or a family
history of osteoporosis.
Medication can weaken bones,
particularly steroids, as well
as — to a much lesser
degree — commonly
used antacid drugs
such as omeprazole.
Whatever the
cause, the earlier
osteoporosis is
recognised the
better, and this
requires good
awareness of risk
factors as well as
early reporting and
recognition of
suspicious symptoms such
as loss of height or breaking
a bone after a fall from
standing height (see right).
Conventional x-rays can
detect osteoporosis but not in
Medication can
weaken bones
— particularly
steroids
6 Tuesday April 5 2022 | the times
health