What is Osteoporosis? Symptoms & Treatment

The word osteoporosis literally translates as "porous bones" – it describes a condition that causes bones to become fragile, brittle, less dense and more prone to fractures. Osteoporosis is a disease mainly associated with older people.

Healthy bone consists of two types of bone tissue; a strong inner mesh known as trabecular bone, its structure resembles a honeycomb in appearance. The outer shell is a thick protective layer known as the cortical bone. Bone tissue is made up of proteins such as collagen fibres, and bone minerals including calcium. Bones have multiple functions; they form the skeleton, providing the body with its overall structure, store minerals and work with muscles to provide movement and support, as well as protecting important internal organs. Bones also contain vital bone marrow, responsible for the production of blood cells.

Bone Regeneration

Bone tissue is constantly renewed and repaired throughout our lifecycle, by two different types of cells that work together to complete the cycle:

  • Osteoblasts – make new bone
  • Osteoclasts – break down and absorb old bone

Bone regeneration during childhood is a quick process, but it begins to slow down as we age; this explains why children generally recover from bone fractures more rapidly than adults. Bones reach their full length by the age of sixteen to eighteen years old, but they continue to increase in density up until the mid to late twenties. After around the age of thirty-five bones begin to lose density, this is a gradual and natural part of the ageing process, however in some cases it can lead to osteoporosis. A patient suffering from osteoporosis will have a significant decrease in the total amount of bone tissue; the cortical shell becomes thinner and more brittle, and the struts in the inner honeycomb like structure become thinner, weaker and more prone to breakage, leaving larger holes in the inside mesh – hence the description 'porous bone'- osteoporosis.

what is osteoporosis - bone example


Symptoms and Diagnosis

Most people suffering from osteoporosis don't know they have it until they suffer a fracture as a result of the condition, it is impossible to see or feel your bones losing density. Hip and wrist fractures are common injuries in patients suffering from osteoporosis. In some elderly people, a stooped posture can develop as a result of fractured vertebrae, the patient stoops forward as the spine can no longer fully support the weight of the body. In severe cases of osteoporosis, as much as a cough or a sneeze can cause ribs to fracture. Fractures can be extremely painful and debilitating, this is especially true for the elderly, where the recovery process takes a lot longer. Spinal fractures are among the most common causes of chronic pain caused by osteoporosis.

Investigation into osteoporosis will depend on a variety of factors based on the patient's clinical history such as; sex, age, the presence or absence of fractures. A clinical investigation for osteoporosis may typically include:

  • A bone densitometry DXA ( a painless scan that measures bone density)
  • Thyroid function tests
  • Blood cell counts
  • A general history and physical examination.

Possible Causes of Osteoporosis

Age

Older people are generally at a higher risk of developing osteoporosis. Although it is possible for younger people to develop the disease, it is rare.

Gender

Women have a higher risk of developing osteoporosis due to the hormonal changes following the menopause. They also have in general, smaller bones than men. The smaller the bones, the less overall tissue they have, making them more prone to fractures during the naturally occurring loss of bone density as we age.

Hormonal Imbalances

  • Oestrogen and testosterone

    Both of the sex hormones, oestrogen and testosterone are essential for maintaining healthy bone tissue. A drop in the level of these hormones can lead to an increased risk of the development of osteoporosis

  • Women - Oestrogen Production

    Women tend to be more at risk of developing osteoporosis because of the drastic hormonal change that occurs after the menopause, (this includes premature menopause) where the production of oestrogen rapidly decreases affecting bone density. A full hysterectomy will also affect the production of oestrogen in a similar way to the menopause.

    Absent periods for six months or more, caused by excessive weight loss or over exercising, can also make a woman more prone to weak bones.

  • Men – Testosterone Production

    It is often more difficult to identify an exact cause of the development of osteoporosis in men, it has however, been linked to low levels of testosterone production; this may be caused by hypogonadism, a condition where the body doesn't produce enough testosterone, as well as other causes such as excessive alcohol consumption.

  • Hyperthyroidism

    This is a relatively common hormonal condition, an over active thyroid gland produces too much of the thyroid hormone. Women are much more likely to develop hyperthyroidism than men.

  • Hyperparathyroidism

    An over or under active parathyroid gland can affect the production of the parathyroid hormone (PTH), this hormone controls levels of calcium, phosphorus and vitamin D within the bones.

  • Disorders of the adrenal gland

    Cushing's syndrome - high levels of cortisol are produced by the body; amongst others, weak and brittle bones are one of the side effects.

  • Disorders of the pituitary gland

Inflammatory Conditions

  • Crohn's disease
  • Chronic obstructive pulmonary disease
  • Rheumatoid arthritis

Genes

Many disorders are hereditary, a family history of osteoporosis increases the likelihood of the development of the disease.

Long Term Use of Certain Medications

Certain steroid medications, can cause thinning of the bones eventually resulting in osteoporosis. Other medications such as those used in the treatment of certain cancers for example, can also affect bone density.

Excessive Alcohol Consumption and Smoking

The consumption of large amounts of alcohol over time can affect the way in which the body absorbs calcium, as well as altering hormone balances.

Poor Diet and Vitamin D

Poor eating habits and vitamin D deficiency caused by a combination of a poor diet as well as a lack of exposure to sunlight can contribute to weak and brittle bones.

Low Body Weight

The development of osteoporosis and subsequent fractures is more likely to occur in those with a low body weight, this is due to the fact that there is less bone tissue overall. It also means that in the case of an accident such as a fall, fractures will occur more easily as there is less fat and muscle padding to cushion the impact.


Prevention of Osteoporosis

Looking after your body and engaging in a healthy routine is important in the prevention of osteoporosis. This is especially important in young people, where a healthy diet and regular exercise can maximise bone strength, setting them in better stead with stronger bones for when the ageing process begins to reduce bone mass.

Diet

A healthy diet is essential in maintaining a healthy body; a balanced calcium rich diet is vital in providing important vitamins and minerals that help maintain healthy bones. Calcium rich foods include; dairy products, oily fish such as herring or mackerel, dried fruits, leafy green vegetables, and wholegrain foods such as brown rice and pulses.

Vitamins

Vitamin D is particularly important in the maintenance of healthy bones and teeth, as it helps the body absorb calcium. The best source of vitamin D is the sun, short periods of exposure to the sun without a sunscreen can boost vitamin D levels sufficiently to last through the dark winter months when there is not enough sunlight. Vitamin D is found in some foods and is also available as a vitamin supplement for those that don't have enough exposure to the sun.

Exercise

Bones are living tissues and regular exercise is essential throughout our lives in order to build up and maintain bone strength. There are many different exercises that overload bones and muscles, building up their strength by encouraging cells to produce more bone; weight bearing resistance exercises and high impact exercises are some examples; supporting the weight of the body is an excellent way of strengthening bones and muscles. Strong bones are also not only less likely to fracture, but coupled with stronger muscles, will keep the skeleton more stable in older age making falls less likely. If bones are already fragile, then it is advisable to consult a health professional before starting any new type of physical activity to avoid more fractures. Regular exercise also strengthens muscles, helping to keep the body strong as well as providing extra padding for the bones during any falls.

Alcohol Consumption

Alcohol should not be consumed excessively, NHS guidelines state that no more than fourteen units off alcohol should be consumed per week.

Smoking

Smoking is extremely bad for overall health and has a multitude of serious and often fatal consequences. Osteoporosis is associated with smoking; heavy smokers often have lower bone density and a higher risk of fractures. Female smokers also have an increased risk of an early menopause.


Available Treatments

There are varying degrees of severity of osteoporosis; possible treatments and exercise programs will depend on a number of factors. The World Health Organisation has developed an algorithm to calculate a prediction of a patient's risk of fractures between the ages of forty and ninety. The algorithm takes into consideration many factors such as bone mineral density, gender, medical history, height, weight, alcohol consumption and if the patient is a smoker; it then calculates the probability of fractures during a ten year period. If you are suffering from osteoporosis, there are a range of treatments available, as well as preventative measures to stop further development of the disease.

Lifestyle Choices and Exercise

The aforementioned advice on healthy eating and exercise is essential in the prevention of further development of the disease as well as subsequent fractures, it will also help strengthen, improve balance and coordination. Regular physical activity, healthy eating and a healthy lifestyle can also help lift the mood and have an overall positive effect. A pain management specialist or GP can provide advice on a suitable exercise programme depending on the diagnosis.

Medication

Over the counter medications can provide some pain relief, other medication is available on prescription.

Physiotherapy

Physiotherapy can help patients suffering from fractures to strengthen their bones and prevent further thinning of the bone by practising specific exercises.

Pain Management

Some patients may have to endure chronic pain caused by bone fractures; spinal fractures can result in consequent back pain and postural problems. A pain management clinic can be highly beneficial in helping patients cope with chronic pain on a daily basis; it consists of a multidisciplinary team of pain management consultants, physiotherapists, psychologists and other health professionals that work together as a team to provide patients with a specifically tailored program of a combination of treatments, helping patients manage their symptoms and enabling them to maintain a quality of life whilst living with osteoporosis.

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Treatments

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