Dr Peter Browne discusses osteoporosis in light of World Osteoporosis Day!
Osteoporosis, which is diagnosed with a DEXA (bone density) scan, is a very common condition affecting both men and women, usually in older life. The field of osteoporosis is about reducing the risk of fractures, especially hip fractures. A person who breaks a hip has a marked increase in mortality (likelihood of death) in the year after the fracture and some studies show that up to half of patients die within a year of a hip fracture. Patients who survive a hip fracture often have a very different quality of life with loss of independence. It is therefore a very worthwhile exercise to identify patients at high risk of fracture and institute appropriate measures to reduce that risk.
Osteoporosis is a ‘silent disease’ in that there are no symptoms except for fractures. Some people notice a curvature of the spine or loss of height. Both the quality and quantity of bone can be reduced in patients with osteoporosis. Of course, fractures can occur in anyone including during a collision on the football field. Low impact encounters such as a fall from body height (e.g. tripping over shoelaces) should generally not result in a broken bone however this is more likely in osteoporosis. In severe osteoporosis the bone quantity and quality is so low that the bones (usually in the low back) can collapse for no obvious reason. Worryingly, up to one third of patients with this type of fracture have no symptoms at all and are at increased risk of further fractures without knowing it. A stress fracture refers to a fracture where there is excess amount of use or load in the setting of normal bone. This is often seen in elite athletes (e.g. shin splints) and is different to osteoporosis.
During a consultation to discuss osteoporosis we try to discover the risk factors which increase the likelihood of getting a fracture such as previous steroid use, family history of osteoporosis, malabsorption or poor diet as well as smoking and medication use. Patients are then assessed for balance, strength and falls risk. Finally, the DEXA scan and relevant blood tests are reviewed and a comprehensive assessment of fracture risk can then be made.
DEXA scans are either normal, or show osteopenia (mild thinning of bones) or osteoporosis. Curiously, most fractures occur in patients with osteopenia because these people are typically more active and therefore more likely to fall. Patients with osteoporosis tend to be older, less mobile and therefore have fewer opportunities to fall.
Treatment of osteoporosis involves identifying risk factors which can be corrected such as poor vision and poor diet for example. Strength, balance and impact exercises combine to reduce the risk of falling as well as maintaining the strength and integrity of the bones. Calcium and vitamin D supplements are often recommended, especially where dietary intake of same is considered insufficient. Dairy and leafy greens are excellent sources of calcium in the diet. Sunshine and wild salmon are the best natural sources of vitamin D. A small number of patients will be recommended medication for osteoporosis and the choice of medicine depends on your age, gender, reasons for osteoporosis and severity of osteoporosis.
If you wish to be assessed for your bone health and fracture risk you can avail of the full range of services at Bon Secours Tralee including onsite DEXA scanning, blood tests and consultant review. An exercise specialist is also available to prescribe and supervise a special strengthening programme.
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