Your Bone Health

Dr Rizwan Rajak - Consultant Rheumatologist has written a piece explaining more on Osteoporosis, the symptoms and treatments available.

Brittle Bones (Osteoporosis)
Osteoporosis, also known as ‘brittle bones’, is a bone disorder characterized by low bone density and compromised bone strength which can lead to an increased risk of bones becoming fragile and breaking easily (fracturing), resulting in pain and disability. The condition is a significant health risk particularly in postmenopausal women and men over 60 years.

How does Osteoporosis present?
It is a ‘silent disease’ until complicated by fractures. The commonest sites for osteoporotic fractures are the wrist, hip or spine. 1 in 2 women and 1 in 5 men over 50 years old will fracture a bone as a result of poor bone health(*1).

What are the complications of Osteoporotic Fractures?
Once a fracture occurs the effect on one’s health (quality of life and survival) can be dramatic; 1 year after a hip fracture(*2):

• 20% of patients die
• 30% are left permanently disabled
• 40% are unable to mobilize independently
• 80% are unable to carry out at least one independent activity of daily living.

Once one fracture occurs the risk of further fractures is significantly increased. Spinal fractures are especially easily missed despite being the most common fracture type; when a patient develops one spinal fracture they are prone to a cascade of further spinal fractures within 1 – 2 years leading to a high risk of disability and mortality. Therefore, physicians should consider a preventative approach to reduction of fracture risk in the same way they do so for heart disease and strokes.

What causes Osteoporosis?
Osteoporosis is most commonly associated with being post-menopausal though there are a number of other risk factors that can also be associated such as early menopause, coeliac disease, inflammatory bowel disorders, rheumatoid Arthritis, alcohol excess, smoking, family history, use of steroids, use of breast cancer drugs (aromatase inhibitors), use of prostate cancer drugs (androgen inhibitors), low weight and more.

How is Osteoporosis assessed?
Evaluation of osteoporosis is mainly through an assessment of osteoporosis risk factors and bone density measurement. In my specialist service there are other techniques that can be used to monitor the disease (such as bone turnover markers).

What are the aims of treatment for Osteoporosis?
The aims of treatment are to prevent the first fragility fracture or future fractures if one has already occurred. We can achieve this by stabilizing and increasing bone mass through a combination of using the latest osteoporosis medicines, ensuring adequate calcium and vitamin D supplementation and discussing lifestyle improvements.

What the West Valley Hospital offers?
Dr Rajak's service at the CDH clinic provides a structured and evidenced based pathway of management to ensure that your individual risk of osteoporotic fractures is measured and assessed and a comprehensive holistic treatment plan (including treatment, supplementation advice, dietary and exercise advice and more) is provided. He can offer the whole spectrum of up-to-date osteoporosis treatments as well as providing the time to counsel you properly about the treatments.

2. Cooper C; Am J Med; 1997;103(2A):12S-17S


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