| Osteoporosis - are you at risk? |
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Genes, hormones and lifestsyle factors are all at work in predisposing us to this bone-thinning disease, says The National Osteoporosis Society
We are all potentially at risk of osteoporosis because of the bone loss that occurs as we get older, particularly as we are living longer. Women are more at risk of developing osteoporosis than men. They have smaller bones, which are less dense, and they also experience the menopause, which greatly accelerates bone loss for several years. At the menopause (normally around the age of 50) the ovaries stop producing the female hormone oestrogen, which is essential to bone health. It is this lack of oestrogen that causes the increase in bone loss. Younger women can similarly be at risk of osteoporosis if they have low circulating levels of oestrogen. Over-exercising and eating disorders such as anorexia nervosa can also upset the normal hormonal balance and lead to bone loss. Men generally have bigger, denser bones than women and do not undergo the rapid bone loss associated with the female menopause. Osteoporosis in men is often the result of another health problem. Low levels of the male hormone testosterone can lead to osteoporosis, due to a problem with the testes themselves or the pituitary gland, which controls hormone levels. There may be no obvious signs or symptoms but some men do find they need to shave less regularly, have a low sex drive and feel excessively tired. In nearly half of all men with osteoporosis the cause is unknown (called idiopathic osteoporosis) and further research is needed to establish why excessive bone loss occurs. Assessing the riskThere are many factors which can increase your risk of osteoporosis.For women A lack of oestrogen, caused by:
For men
For men and women
Warning signs and testsIf you have already broken a bone after a minor bump or fall, you may already have osteoporosis. Other warning signs include height loss and kyphosis (curvature of the spine). If you have one of these warning signs you may want to discuss your risk of osteoporosis with your doctor.Because you cannot see your bones getting thinner you will probably be quite unaware of any problems with your bone health. Osteoporosis is a silent disease and for most people the first sign that something is wrong can be when they break a bone, often in the wrist or spine after a minor incident, although not all fractures are due to osteoporosis. A normal x-ray of bone cannot reliably measure bone density but is useful to identify spinal fractures, explain back pain, height loss or kyphosis. A bone density scan, called a Duel Energy X-ray Absorptiometry (DXA) scan, is used to measure the density of bones and compare this to normal range. This test is currently the most accurate and reliable means of assessing the strength of your bones and your risk of fracture. It is a simple, painless procedure that uses very low doses of radiation. You will be asked to lie down on the machine for 10-15 minutes while an x-ray arm passes over you to take an image of your spine and hip. Some centres may have machines that measure the density of the wrist or heel. A bone density scan can diagnose osteoporosis, assess risk of fracture and monitor the effects of treatment. Bone density scans are only recommended for people who are at high risk of osteoporosis, so you should discuss your medical history with your doctor, who will decide whether to refer you to hospital for a scan. The doctor may use the results to help with decisions about treatment, or you may be asked to see a specialist consultant. In some areas of the UK, access to bone density scans is very limited, so your doctor may go ahead and prescribe treatment without a scan if a fracture has been identified by x-ray, or if the doctor decides there is sufficient risk of osteoporosis (such as an early menopause). Women who take hormone replacement therapy (HRT) at the menopause would probably not need a bone density scan. Genes determine the potential height and strength of the skeleton but lifestyle factors can influence the amount of bone laid down in the bone 'bank' during critical growth years and how much density is maintained in later life. During childhood, adolescence and early adulthood, when the skeleton is increasing in bone density, it is vitally important to try to maximise peak bone mass. Making the most of bone mass will put your skeleton in a better position to withstand the natural bone loss that occurs later. If you are in your mid-30s or older it is important to aim to maintain the strength of your bones. Take exerciseLike muscles and other parts of the body, bones suffer if they are not used. They need regular weight-bearing exercise, which puts force through the bone, stimulating growth and therefore strength. Good bone-building exercises include running, skipping, aerobics, tennis and weight training. Even a brisk walk can be of some benefit.Try to exercise at least three times a week for a minimum of 20 minutes but most importantly choose exercise that you enjoy and stick to a regular routine. If you haven't exercised for a while, start gently and check with your doctor if you have another health problem and are concerned about exercising. If you are a smoker - give up. Smoking has a toxic effect on bone in men and women. It can cause women to have an earlier menopause and may increase the risk of hip fracture in later life. Not smoking will benefit your bones and general health. Watch what you drink. Drinking too much alcohol is damaging to bone turnover. Limit your alcohol intake to a maximum of 3-4 units per day for men and 2-3 units for women. These limits are not targets to drink up to and having alcohol-free days is advisable. |
