Osteoporosis: Expert advice for stronger bones

Osteoporosis is a condition that progressively weakens bones, increasing their fragility and susceptibility to fractures. Dr Tarun Solanki, renowned consultant physician in general and geriatric medicine, provides an expert insight.

What is osteoporosis?

Osteoporosis is a condition where bones become weakened due to a decrease in bone density and quality, making them more fragile and prone to fractures (even from minor falls).

In healthy bones, there is a balance between bone formation and resorption. In osteoporosis, however, this balance is disrupted, causing a decline in bone density. As a result, bones become more porous, resembling a sponge with larger holes and thinner walls. The internal structure of bones, normally dense and strong, becomes compromised, reducing bone strength and stability.

Often called a "silent disease," osteoporosis typically shows no obvious symptoms until a fracture occurs.

Who is most at risk of osteoporosis?

Osteoporosis often develops slowly over time and is more common in older adults, particularly postmenopausal women. However, the condition can affect anyone. Factors that contribute to osteoporosis include ageing, hormonal changes (particularly a decline in oestrogen in women), insufficient calcium and vitamin D, a sedentary lifestyle, smoking, and excessive alcohol intake.

How is osteoporosis diagnosed?

The primary diagnostic tool for osteoporosis is a bone density test (also known as a Dual-Energy X-ray Absorptiometry or a DEXA scan) that measures the density of bones, primarily in the hip and spine, to assess the risk of fractures. For patients at risk or diagnosed with osteoporosis, bone density tests are generally recommended every 1-2 years.

Along with the bone density test, a physician will review the patient's medical history and conduct a physical examination to assess overall health and identify potential risk factors for osteoporosis. Blood tests may also be ordered to check for underlying conditions contributing to bone loss and to assess vitamin D and calcium levels.

What treatments are available for osteoporosis?

Treatment for osteoporosis focuses on slowing bone loss, increasing bone density, and preventing fractures. The main treatment approaches are:

• Medications: Bisphosphonates are the most commonly prescribed medications for osteoporosis that work by slowing down the rate at which bone is broken down. The other option is Denosumab, a monoclonal antibody that slows bone resorption and is given via injection every six months.
• Calcium and vitamin D: A diet rich in calcium (dairy products, leafy greens) and vitamin D (fatty fish, fortified foods) supports bone health. If dietary intake is insufficient, supplements of calcium and vitamin D may be recommended.
• Exercise: Weight-bearing and resistance exercises help strengthen bones and improve balance, reducing the risk of falls.
• Fall prevention: Preventing falls is crucial to avoid fractures. This can involve implementing safety measures at home, such as installing grab bars and removing tripping hazards.

Oestrogen therapy can help maintain bone density in postmenopausal women. However, due to its associated risks, it’s usually considered only when the benefits outweigh the risks or if a woman has significant symptoms.

In cases of fractures, especially spinal fractures due to osteoporosis, surgical options like vertebroplasty or kyphoplasty may be considered to stabilise the spine and relieve pain.

If you would like to book an appointment with Dr Solanki, head on over to his Top Doctors profile today.