Osteoporosis & Bone Health – what can we do to keep our bones healthy?
November 30, 2021
Osteoporosis is a debilitating condition that affects 150 million people world-wide and 3 million in the UK alone1. It’s characterised by changes to our bones and the cells which support them which leads to reduced bone density and strength2. This can often lead to an increased risk of fractures, especially the hip, forearm and vertebrae. A silent disease, many don’t have any symptoms until they develop a fracture and these can often lead to significant impairment to mobility and quality of life. Osteoporosis leads to an estimated £4.4 billion a year bill in NHS spending due to fragility fractures and the significant risk factor for increased chance of disability or death in certain population groups3. Below are some of the risk factors for development of the disease as well as ways to prevent.
The effects of osteoporosis are felt worldwide, though the continents with the highest rates are predominantly Europe and The Americas1. Women and men are affected roughly the same, though women have a significantly higher chance of developing a hip fracture. High risk population groups include the elderly, post-menopausal women, increase alcohol consumption, smokers, Vitamin D deficient individuals, those with chronic health problems and those with reduced mobility4. It is estimated that by 2040 over 300million people will be affected by osteoporosis.
What is osteoporosis?
Osteoporosis occurs for a multitude of reasons and is characterised by changes in the composition of the bone, making them more fragile and susceptible to fracture. There are a number of cells which contribute to our bone health; some of them help to build bone (osteoblasts) while some help to remove bone (osteoclasts). In osteoporosis, the rate at which bone is made compared to removed is reduced and the bone make up is modified or “remodelled” leading to a change in the structure and density5. This leads to an increased risk of traumatic fracture due to fragility. Osteopoenia is a condition seen before the development of osteoporosis and is a risk factor for progression to the disease6. It should be considered a warning sign and is reversible!
There are many risk factors for developing osteoporosis and the cumulative effect of multiple risk factors can lead to a significantly increased risk of developing the disease4. Most of these risk factors are preventable risk factors and include things such as:
• Excess or chronic alcohol consumption
• Vitamin D deficiency
• A history of smoking
• The use of hormone replacement therapy
• Malnutrition and obesity
• Long term steroid use
• Sedentary lifestyle and immobility
• High blood pressure and blood lipids leading to renal disease
• Chronic health conditions such as COPD, Type 2 diabetes
There are some other risk factors which unfortunately are not preventable such as:
• Increasing age
All of these should be taken into account when considering the risk of developing osteoporosis. A Fracture Risk Assessment Tool, also known as a FRAX score, is a tool used by physicians to calculate the risk of developing osteoporosis7. In those with a high FRAX score a bone scan or DEXA scan may be performed to asses the health of the bones and whether osteoporosis is present8. If present, bone protection treatment would be offered with a class of medication called bisphosphonates. A large study showed the benefits of bisphosphonates in reducing risk of fractures by 50%, particularly vertebral fractures9.
The most common complication of osteoporosis is fracture. Vertebral fractures or fracture of the neck of the femur (NOF) bone are a significant problem in patients leading to disability and death. In patients over the age of 75, it is estimated that 33% of people with a fractured NOF will die within a year10. Though advances in orthopaedic surgery in recent years it still remains a major cause of preventable long term illness. Following fractures other complications can occur such as chronic pain, blood clots in the lung or leg or reduced muscle mass and mobility.
Important considerations in winter
With all that being said, it still remains a very preventable and treatable condition if the necessary steps are taking to prevent development, recognise those at risk, investigate appropriately and treat when necessary. During winter, it is important to consider those at risk of developing the condition or high risk groups for fragility fractures. Some of the things people can do to reduce their risk of developing the condition as well as tips to reduce the risk of fractures in winter include:
Take Vitamin D supplements. Vitamin D deficiency is a recognised risk factor for the development of osteoporosis and 20-40% of the UK are thought to be Vitamin D deficient. Government advice is to consider supplementation, especially in the winter months, to prevent vitamin D deficiency11.
Increasing mobility and remaining active. Exercise helps to build bone strength and maintain it preventing osteoporosis. The two main types of exercise for this are high impact weight bearing exercises and muscle strengthening exercises12. Sports such as Tennis or gymnastics are examples of high impact weight bearing exercises whereas yoga or weightlifting are muscle strengthening.
Making diet and lifestyle changes. Doing this can significantly reduce your risk of developing osteoporosis. Some of the leading contributors to the disease are all preventable risk factors so things like reducing alcohol intake, stopping smoking and addressing weight issues will not only reduce your risk of osteoporosis but many other significant health problems. Even those who are lifelong smokers can see an improvement in their bone health if they stop smoking13.
Keeping to appointments for health checks during the winter. There is a huge importance for people with osteoporosis to see their GP, doctor or pharmacy to get regular blood tests and repeat prescriptions to prevent the chance of fracture. This isn’t always easy for some and especially so during the winter months. The use of home delivery services, online or telephone consultations and remote or closer phlebotomy services are ways to still keep up with health checks if getting out during the winter is problematic.
Plan journeys, sensible footwear and charity services. The rate of hip fractures is significantly higher in older population groups with the incidence of fracture 30% more in winter months than summer14. Simple interventions like sensible footwear and planning journeys before making them so not to rush can help to reduce the risk of a fall and fracture in those at risk. Other services or charities are also on hand to help with services such as lifts or shopping trips.
Consult a doctor if high risk. For those who are at high risk they should speak to their GP about whether they need investigations or bone protection medication as prevention is always the best treatment.