Osteoporosis

1.   What is the definition of osteoporosis?

It is a low bone mineral density with compromised bone strength and poor structure within the bones predisposing a person to an increased risk of fracture.

The structure of the bone changes making it fracture with minimal trauma.  Weak bones break easily.

Osteoporosis has occurred throughout history and can be seen in remains from Egypt from 1000 BC.

2. When are the bones the strongest?

Bone strength increases from birth to age 30. From the age of 45, both men and women start to lose a percentage of bone each year.

3.   Who does it affect?

Osteoporosis can occur in both men and women but more often in women and at a younger age.

This is because compared to men:

• Women never have the same peak bone density.

• Women never have the same muscle mass as men.

• There is an accelerated rate of bone loss after menopause, so women reach the fracture threshold sooner.

It is a problem as people age.  For example, there are currently 5 million osteoporotic fractures a year in the UK

4.   How is osteoporosis diagnosed?

We use a DEXA scan which looks at the thickness of the bone. This takes a measurement at the hip and lower back.

Sometimes the wrist is used in special circumstances.

It is not invasive and does not hurt.

Two readings are taken one called the T score which compares the result to that of a healthy person aged 30 and the Z score which compares the results to the results of a person of a similar age.

5.   How is osteoporosis diagnosed?

 Either through:

• A fracture not due to trauma (fall from a standing position)

• For men over 50 and women after menopause, we use a T score

• For men under 50 and women before menopause, we use a Z score

A T score of -2.5 was chosen as the point where osteoporosis is diagnosed. It identifies the thinnest 30% of bones in the population.

This level was chosen by a group of specialists in 1984. They chose this level because 30% of people get an osteoporotic fracture in their lifetime.

The doctors are trying to identify the people who will suffer a fracture in their lifetime.

6.    Is Osteopenia a useful term?

This is the term used when bones start to thin but the person is not in the bottom 30%. A better term is low bone density.

We monitor these patients over time and see how quickly they are losing bone mass:

Normal to   Osteopenia   to   Osteoporosis

7.   Who should be screened and when?

All women aged 65 should be screened.

Also, post-menopausal women if there is low weight, prior fractures, high-risk medications like steroids or diseases which accelerate bone loss like rheumatoid arthritis.

All men aged 70 should be screened.

Also, men should be screened earlier if there is a prior fracture or high-risk medications like steroids.

8.   How do we decide who to screen at an earlier age?

We use a FRAX score which asks lots of questions and gives a risk level.

This helps to tell us if someone is likely:

a.   To be fine.

b.   To need to start treatment.

c.   To need a DEXA scan to give extra information.

Once on treatment, FRAX is not reliable. It can only be used over 40 years.

9.   Once a patient has been screened with a DEXA scan, when should it be repeated?

This depends on the findings at your first scan. Scans should be at least a year apart.

Studies have shown the time it takes to develop osteoporosis depending on the results of your first scan.

Osteoporosis will develop in fewer than 10% of postmenopausal women during the following rescreening intervals.

• 15 years for a woman with normal bone density

• 5 years for a woman with moderate osteopenia

• 1 year of a woman with advanced osteopenia

Your doctor will tell you when you need your next scan.

10.   How do you treat osteoporosis?

•  HRT can be used in women especially between 50-59 if a woman has other symptoms of menopause, the quality of the bone is maintained.

•  Biphosphates such as Alendronic acid (which is a tablet taken either weekly or monthly) helps strengthen the bones. This can be taken for 5 years and then reassessed.

 o   NB. HRT leads to higher bone density and better quality bone than alendronate. However, when you stop HRT bone density decreases whereas alendronic acid therapy has ongoing benefits.

•  Denosumab is used for more severe cases or patients who are intolerant of biphosphates.

11. What else can I do to help my bone strength that is not medication?

 The following lifestyle changes can help:

• Exercising

• Taking Calcium and Vitamin D

• Stopping smoking

• Reducing alcohol intake

At Sloane Square Medical we offer screening for osteoporosis and work with specialists to ensure high levels of care.

If you are concerned about symptoms you may be experiencing, make an appointment to see one of our highly experienced GPs by visiting our appointments page or calling the practice on 020 7730 8835.