Osteoporosis

Understanding Osteoporosis and Osteopenia

• Osteoporosis is a condition where bones become thin and brittle, increasing the risk of fractures. This happens because bone density decreases, meaning bones lose minerals like calcium, which are crucial for strength.
• Osteopenia is a milder form of low bone density. While it isn’t as severe as osteoporosis, it can still increase the risk of fractures and may progress to osteoporosis over time.

Both conditions are more common with age and may not show symptoms until a fracture occurs. Risk factors include age, family history, certain medications, and lifestyle factors like smoking, alcohol intake, and physical inactivity.

Understanding a DEXA Scan

A DEXA scan (Dual-Energy X-ray Absorptiometry) is a quick and painless test that measures bone density. The scan calculates two scores, the T-score and Z-score, which are used to assess bone health and fracture risk.

T-score

The T-score compares your bone density to the average bone density of a healthy 30-year-old adult. Here's what the scores generally mean:

• Normal Bone Density: A T-score between +1 and -1
• Osteopenia (Low Bone Density): A T-score between -1 and -2.5
• Osteoporosis: A T-score of -2.5 or lower

This score helps identify if you have low bone density or osteoporosis and your risk for fractures. Lower scores indicate a greater loss of bone density.

Z-score

The Z-score compares your bone density to others of the same age, sex, and body size. It’s mainly used to assess if an unusual bone density loss may be due to other factors, especially in younger people. Here’s how to interpret it:

• Normal: A Z-score of -2.0 or above
• Below Expected Range: A Z-score of -2.0 or lower

If your Z-score is low, it may prompt further tests to understand the cause of bone loss.

What These Results Mean for You

1. Normal T-score: This suggests healthy bone density with a low risk of fractures. Regular exercise, a balanced diet, and lifestyle habits that support bone health can help maintain this.

2. Osteopenia T-score: You have mild bone density loss, meaning there is a slightly increased risk of fractures. A doctor may recommend lifestyle changes, calcium, and vitamin D supplements, or even medications to prevent further bone loss.

3. Osteoporosis T-score: This score indicates a higher risk of fractures. Treatment is likely recommended, which may include medications, supplements, and lifestyle adjustments to reduce fracture risk and help maintain bone density.

Preventing and Managing Bone Density Loss

• Diet: Adequate calcium and vitamin D intake are essential. Dairy, leafy greens, and fortified foods are good sources of calcium, while sunlight and certain foods help with vitamin D.
• Exercise: Weight-bearing exercises, like walking or resistance training, strengthen bones.
• Lifestyle: Limiting alcohol intake, quitting smoking, and managing medications can support bone health.

Treatment Options for Osteoporosis

The primary goals of osteoporosis treatment are to strengthen bones, reduce the risk of fractures, and improve quality of life. Treatment often includes a combination of lifestyle modifications, supplements, and medications, depending on individual needs and risk factors.

1. Lifestyle Adjustments

• Diet: A balanced diet rich in calcium and vitamin D is essential for bone health. Foods high in calcium include dairy products, leafy green vegetables, nuts, and fortified foods. Vitamin D is found in oily fish, eggs, and fortified foods, and it’s also produced in the skin when exposed to sunlight.

• Exercise: Weight-bearing and muscle-strengthening exercises, such as walking, running, and resistance training, can help improve bone density and overall bone strength.

• Avoiding Smoking and Excess Alcohol: Smoking and high alcohol intake can contribute to bone loss, so limiting these can reduce the risk of osteoporosis.

2. Vitamin D and Calcium Supplements

If you’re not getting enough calcium and vitamin D through your diet, your doctor may recommend supplements. These nutrients work together to support bone health.

• Calcium: Adults typically need around 700 mg of calcium daily in the UK. If your intake is low, supplements can help meet this requirement.

• Vitamin D: Vitamin D helps the body absorb calcium and is particularly important in the UK due to limited sunlight during the winter months. Doctors often recommend vitamin D supplements, especially for people over 65, pregnant women, and those who spend most of their time indoors.

3. Bisphosphonate Medications

Bisphosphonates are the most commonly prescribed medications for osteoporosis. They work by slowing down the rate at which bone is broken down, helping to maintain or improve bone density and reduce fracture risk.

• Alendronic Acid: One of the most widely prescribed bisphosphonates, usually taken as a weekly tablet. It’s typically taken on an empty stomach with water, followed by staying upright (sitting or standing) for at least 30 minutes to help absorption and prevent irritation of the oesophagus.

• Risks and Side Effects: Common side effects include digestive issues like nausea and heartburn. Rarely, bisphosphonates can lead to a condition called osteonecrosis of the jaw (ONJ), which affects jawbone healing. To reduce this risk, ensure good dental hygiene and notify your dentist if you are on bisphosphonates.

4. Other Medication Options

If bisphosphonates aren’t suitable, other medications may be recommended:

• Denosumab: Given as an injection every six months, denosumab is an option for people who cannot take or tolerate bisphosphonates. It works by reducing bone loss and increasing bone density.

• Selective Estrogen Receptor Modulators (SERMs): Medications like raloxifene mimic oestrogen’s protective effect on bones without some of the risks of hormone replacement therapy (HRT). SERMs can help prevent bone loss and reduce fracture risk in postmenopausal women.

• Hormone Replacement Therapy (HRT): For women with early menopause, HRT can help protect against bone loss by supplementing oestrogen levels. However, it’s typically considered only if other treatments are unsuitable due to certain risks, including increased chances of breast cancer and blood clots.

• Parathyroid Hormone Analogues: These medications, such as teriparatide, stimulate bone growth and are usually reserved for people with severe osteoporosis who have not responded to other treatments.

Summary of Treatment

• Lifestyle & Supplements: These are foundational steps that support bone health and reduce fracture risk.
• Medications (e.g., Bisphosphonates): Used when bone density is low enough to warrant extra protection, especially for people at high risk of fractures.
• Alternative Treatments: Options like denosumab or HRT may be considered for those who can’t take bisphosphonates.