Unraveling osteoporosis: Insights, risks, and prevention strategies

In his latest online article, Dr Taher Mahmud gives us his insights into osteoporosis. He talks about what it is and why it affects older individuals, the risk factors, common signs and symptoms, prevention and when to see a doctor.

What is osteoporosis? How and why does it affect older individuals?

Osteoporosis is a condition that weakens bones, making them fragile and more prone to break. It develops slowly over several years and is often diagnosed only when a minor fall or sudden impact causes a bone fracture.

The disease arises when there is an excessive loss of bone tissue, insufficient production of new bone, or a combination of both. Bones are a living tissue and the body is constantly replacing old bone with new. However, with osteoporosis, the body’s ability to replace old bone tissue with new is hindered. This leads to an overall loss in bone density and strength.

As to why it affects older individuals more, this is because bone density peaks in your early twenties and generally begins to decline after the age of 35. From then on, you slowly start to lose bone mass. After menopause, women also experience a rapid decrease in bone density due to the drop in oestrogen levels, which is a hormone that helps protect against bone loss.

As you age, if you lose bone mass quicker than your body can replace it, then you are more likely to develop osteoporosis. Other factors like lack of vitamin D and calcium, lack of physical activity, and certain medications or medical conditions can also contribute to the development of osteoporosis. Therefore, it is important to maintain a healthy lifestyle and have regular check-ups to monitor bone health.

What are the risk factors associated with osteoporosis?

There are several risk factors associated with osteoporosis, and they can be categorised as modifiable and non-modifiable.

Non-modifiable risk factors include:

1. Age: The risk increases as you age because bones become thinner and non-modifiable risk factors:
2. Age: The risk of osteoporosis increases as you get older.
3. Gender: Women are more likely to develop osteoporosis than men.
4. Family history: If a parent or sibling has osteoporosis, you're at greater risk.
5. Small body frame: People with small body frames often have less bone mass to draw from as they age.

Modifiable risk factors:

1. Diet: A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density.
2. Physical activity: Lack of exercise or long-term bed rest can cause weak bones.
3. Tobacco use and excessive alcohol consumption: These can contribute to weak bones.
4. Certain medications: Long-term use of certain medications, like corticosteroids, can lead to osteoporosis.
5. Endocrine disorders: Conditions like hyperthyroidism or hyperparathyroidism can lead to osteoporosis. These are potentially modifiable if diagnosed and treated.
6. Menopause: Menopause itself isn't modifiable, but the associated increased risk of osteoporosis can be managed and potentially mitigated through medical interventions and lifestyle modifications such as hormone replacement therapy (HRT), diet, and exercise.

What are the common signs and symptoms of osteoporosis in older people?

Osteoporosis is frequently referred to as a "silent disease" since bone deterioration takes place without noticeable symptoms. Individuals might remain unaware of their osteoporosis status until their bones reach a state of fragility where a sudden strain, impact, or even a minor fall leads to a fracture or the collapse of a vertebra. However, once the disease has advanced, there can be signs and symptoms, which include:

1. Back pain: This can occur if a vertebra in the spine collapses due to loss of bone mass.
2. Loss of height over time: People with osteoporosis may become noticeably shorter due to compression fractures in the spine.
3. A stooped posture: This can occur due to weakening of the spine and may result in a hump-like curvature of the upper back (known as a "dowager's hump").
4. Fractures that occur more easily than expected: A minor fall or even mild stresses like bending over or coughing can result in a fracture, typically in the hip, wrist, or spine.

These symptoms can significantly impact an individual's quality of life and overall health. If you or someone you know is experiencing any of these symptoms, especially if you have risk factors for osteoporosis, it's important to consult a healthcare provider for an evaluation.

What can be done to help prevent osteoporosis and maintain bone health?

Preventing osteoporosis and maintaining bone health is crucial, especially as one ages. Here are some strategies to help safeguard your bones:

1. Dietary Calcium: Ensure you consume enough calcium. Good sources include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines, and tofu. If your diet falls short, consider taking calcium supplements.
2. Vitamin D: Vitamin D helps the body absorb calcium. You can get it from sunlight, foods (like oily fish, egg yolks, and fortified foods), and supplements.
3. Regular exercise: Weight-bearing exercises (like walking, jogging, and weight training) and resistance exercises help maintain bone density. Balance exercises can also reduce the risk of falls.
4. Avoid smoking and excessive alcohol: Both can decrease bone density. If you drink, do so in moderation.
5. Bone density test: Especially for post-menopausal women and men over 50, a bone density test can help assess your bone health and predict your risk of fracture.
6. Medications: Some medicines, when prescribed by a doctor, can help prevent bone loss and increase bone thickness.
7. Limit caffeine: Excessive caffeine consumption has been linked to decreased bone density, so moderation is key.
8. Limit sodium: High-sodium diets can cause the body to excrete calcium.
9. Limit retinol: High levels of retinol (a form of vitamin A) may weaken bones. Look for this in some multivitamin supplements.
10. Prevent falls: This is especially important for older adults. Ensure your living space is safe from hazards that might cause you to trip or slip. Consider balance exercises and possibly a hip protector.
11. Hormone Replacement Therapy (HRT): For some post-menopausal women, HRT can help maintain bone density. However, there are risks associated with HRT, so it's important to discuss with a doctor.
12. Limit long-term use of certain medications: Corticosteroids and some other medications can weaken bones.

Always consult with a doctor about potential risks. Regular check-ups and staying informed about your bone health are essential. Making small but consistent lifestyle changes can have a long-lasting impact on the health of your bones.

When should you see a doctor about symptoms of osteoporosis?

It's essential to see a doctor if you suspect you might have osteoporosis or if you're at risk. Here are some situations that warrant a medical consultation:

1. Fractures: If you experience a fracture from a minor fall or injury that didn't seem severe enough to cause a break, it could be a sign of weakened bones.
2. Back Pain: Chronic or sudden severe back pain can be a sign of a vertebral fracture or a collapsing spine, especially if associated with a decrease in height.
3. Height Loss: Losing height or noticing a stooped posture (like a "dowager's hump") is a sign of compression fractures in the spine and weakened bones.
4. Risk Factors: If you have multiple risk factors for osteoporosis (such as early menopause, long-term corticosteroid use, family history, or certain medical conditions), it's wise to discuss them with a doctor.
5. Age: Women over 50 and men over 70, or post-menopausal women with additional risk factors, should consider discussing bone health with their doctor even if they don't have symptoms.
6. Early Menopause or Surgical Menopause: Women who experienced menopause before age 45 or had their ovaries surgically removed (without hormone replacement therapy) before menopause.
7. Long-term Medication Use: If you're taking medications known to increase osteoporosis risk (like corticosteroids, some antiseizure drugs, or high-dose thyroid replacement drugs), regular bone health check-ups are advised.
8. Medical Conditions: Diseases that affect nutrient absorption (like celiac or Crohn's disease) or those that impact hormone levels can affect bone health. If you have such conditions, regular monitoring is important.

Being proactive about bone health can help prevent the debilitating effects of osteoporosis. If you're concerned about your bone health or have experienced any of the symptoms or situations mentioned, it's best to consult a doctor. They can provide guidance, recommend a bone density test if necessary, and discuss preventative or treatment options.

Dr Taher Mahmud is a highly esteemed consultant rheumatologist with more than 30 years of experience. You can book an appointment with Mr Madmud on his Top Doctors profile.