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Osteoporosis: Dispelling Myths, Empowering Bone Health

Updated: Nov 8, 2023

Osteoporosis. What do you know about this?

Most of us understand that it is a disease you may get due to old age.

You build bone when you are younger, so by the time you are 50, there is not much you can do.

Taking a daily calcium supplement can help to prevent it.

Weight-bearing exercise is an essential preventative action.


It is not that simple, and because there is quite a lot that I can warble on regarding this topic, this blog will be divided up into two parts – to try and ease the brain overload.



different bone structure from normal to osteoporosis


Some Facts
  • In the UK, 21.9% of women over 50 years were estimated to have osteoporosis.

  • 1 in 2 over 50 women will sustain an osteoporotic fracture.

  • In 2019, there were 1.444 fractures a day.

  • The average hospital stay is 20 days.

  • 53% of people are unable to live independently following a hip fracture.

The facts, to me, are scary. What I want to convey is that, while they may also seem scary to you, there is masses that we can do to reduce the probability of this grim process happening to us, regardless of age.


This blog will be information about bones and what can speed up osteoporosis. The following blog will be on preventative stuff.

 

Bone


Bone is a living tissue that undergoes a constant renewal process, with old bone replaced by new bone. There are two main types of cells; osteoblasts – which tell the body to build bone, and osteoclasts – which tell the body to break down bone and release the stored minerals into the bloodstream. When these two types of cells are coordinated, bones are healthy and robust. When they are uncoordinated – because of dysfunctions elsewhere in the body – bone is broken down faster than it is being built. This is osteoporosis.


It is the lack of coordination because of dysfunctions elsewhere that I would like you to remember. This is key and why it is possible to improve the situation.


Osteoporosis starts silently and is asymptomatic until a fracture occurs. Unfortunately, by the time a fracture happens, significant bone loss has already occurred. This lack of early warning signs makes it crucial for women to be proactive in protecting their bone health.


Until around your late 20’s we continue to make more bone than we break down. Our bones become denser and heavier. After this, until you get to around 50, it will decrease a tiny amount each year. Around the time of menopause, the loss increases significantly, primarily due to the drop in oestrogen.


Osteopenia is also a condition where you lose more bone than you make, just not as severe, and tends not to lead to fractures. It is relatively normal and occurs after 50 and more often, again because of the estrogen link, in women. It may progress to osteoporosis, but not always.

 

The exact cause of osteoporosis is not fully understood, but several factors contribute to its development.


Are you at risk?

  1. Age. As individuals get older, the balance between bone building and breaking down tips towards the breaking downside.

  2. Gender. Women generally have a lower peak bone mass than men. Plus, oestrogen plays a crucial role in maintaining bone health, and the decline in oestrogen after menopause can accelerate bone loss.

  3. Low body mass or previous anorexia.

  4. Alcohol intake of 3 units a day or more.

  5. Genetics. Therefore a history of parental hip fracture is important. Osteoporosis tends to run in families, but there is still much that you can do to prevent it.

  6. Age of menopause. The earlier the menopause, the greater the time for bone loss. A woman whose menopause happens before 45 has a fracture risk 1.5 – 3 times higher than one who experiences menopause around 50. This is why it is super important for those with POI or surgical menopause to get adequate professional support.

  7. Smoking. There are many ways in which smoking negatively affects bone health. Peak bone mass is lower, and it can impair the absorption of calcium. Bone loss is accelerated throughout the lifetime, but especially after menopause.

  8. Physical activity. Regular weight-bearing exercises that stress the bones, such as walking, jogging, or dancing, stimulate bone formation and help maintain or improve bone density. A sedentary lifestyle can contribute to bone loss and decreased bone mineral density.

  9. Medical Conditions. Such as rheumatoid arthritis, type 1 diabetes, hyperthyroidism, and gastrointestinal disorders.

  10. Medications. Several can have an effect, including steroids, SSRI anti-depressants, some anti-seizure medications, and proton pump inhibitors.

  11. Race. Caucasian women have the greatest risk.

  12. A history of over-exercise. Regular strenuous exercise combined with dietary restrictions impairs mineral absorption.

  13. Long term immobility.


How do I know if I have osteoporosis?


Bone Mineral Density testing (BMD) or a DXA scan is a diagnostic test used to measure the density and strength of your bones. It determines if you have osteoporosis or are at risk of developing it. The results are given as a T-score, which compares your bone density to that of a healthy young adult of the same gender. It is not a perfect test. It is normal to have a lower DXA score at 50 than 30. Any score needs to take into account other risk factors.


There is a general agreement that whole-population screening is not cost-effective, so these risk factors should help decide whether a DXA scan will be beneficial. A baseline DXA scan is advised if you are diagnosed with POI or have early menopause. This should be repeated every 2-3 years, depending on other factors. Once BMD is stable, this can be reduced.


I will say that bone health is not just about bone density. Bone quality is also important, which is why a DXA scan is simply a tool to help identify issues.


There is also a Fracture Risk Assessment Tool (FRAX), a free tool to help women 40 years + assess their risk of a major fracture.

 

It is important to remember that while these factors may seem daunting, many preventative measures can be taken to minimize the risk and promote bone health. This will be covered in the next part of this blog.


Lifestyle modifications, nutrition, exercise, and other strategies CAN help. Don't let the scary facts overwhelm you. There are many critical bone health factors that you can control. Empower yourself with knowledge and take control of your bone health.

Please do contact me, the link is below.




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