Osteoporosis & bone health

Throughout life, bone is constantly renewed: old bone is removed and new bone laid down in its place. Osteoporosis develops when this balance tips, so that bone is lost faster than it is replaced and the internal structure becomes thinner and more porous. Bone strength is built up to a peak in early adulthood and then declines gradually with age.

The fall in oestrogen after the menopause accelerates this loss, which is why women are affected more often, although men develop it too. Several things drive bone loss faster, including long-term steroid treatment, an overactive thyroid or parathyroid gland, early menopause, and conditions affecting how nutrients are absorbed. It frequently sits alongside other metabolic bone disease.

Several factors increase the risk of osteoporosis. You may be at higher risk if you:

• Are post-menopausal, or went through the menopause early
• Have a parent or sibling with osteoporosis or a hip fracture
• Have taken long courses of steroid medication
• Have a low body weight
• Smoke, or drink alcohol heavily
• Have previously broken a bone after a minor fall
• Have certain other medical conditions that affect bone

Bone-health assessment looks at your individual risk and, where appropriate, measures your bone density. This is done with a DEXA scan, a simple, quick and low-dose X-ray that measures how strong the bones are. The result is interpreted alongside your wider health and risk factors, rather than in isolation.

Dr Borukhson offers dedicated osteoporosis and bone-health assessment, including arranging a DEXA scan where the assessment suggests it would help and explaining what the results mean for you. Where useful, she can also arrange specialised blood and urine tests for bone turnover markers. These give a picture of how active the bone is, which helps to monitor bone health over time and, in particular, to judge how well bones are responding to treatment.

The aim is to strengthen the bones and reduce the chance of fracture. Depending on your assessment, this may involve lifestyle measures such as exercise, diet and addressing vitamin levels, medication to protect or build bone where it is needed, and follow-up scanning to monitor progress.

Where medication is needed, the usual first choice is a bisphosphonate, a medicine that slows bone loss, taken as a weekly tablet such as alendronic acid or given as a once-a-year infusion of zoledronic acid. Denosumab, an injection given every six months, is an alternative, and for a small number of people at high risk a bone-building treatment may be appropriate; adequate calcium and vitamin D support whichever treatment is used.

There are practical points with each: bisphosphonate tablets need to be taken in a particular way to work properly, and any dental problems are worth mentioning before treatment starts, while denosumab should not be delayed or stopped without a follow-on treatment, as bone loss can otherwise rebound. The right plan depends on your individual situation and is agreed with you.

A great deal can be done to protect your bones, and the same measures support general health.

• Stay active with a mix of weight-bearing activity and muscle-strengthening work; staying steady on your feet also lowers the chance of a fall. Our guide to exercise and staying active covers the general principles
• Eat well for bone, with enough calcium from food and attention to vitamin D, which is harder to obtain in UK winters
• Stop smoking and keep alcohol within sensible limits, as both weaken bone
• Reduce trip hazards at home and have eyesight checked

Osteoporosis is usually a long-term condition rather than something that resolves, but with treatment and these measures bone strength can be held steady or improved and the outlook is reassuring.

Because osteoporosis is silent, the warning sign is usually a fracture rather than a symptom you can feel.

Seek urgent medical attention if you have a fall and cannot bear weight, or have sudden severe back pain after even a minor strain, which can signal a spinal fracture. Sudden back pain with leg weakness, numbness around the back passage, or loss of bladder or bowel control needs emergency assessment without delay.

Arrange a routine review if you notice gradual height loss or a developing stoop, break a bone after a minor fall, or are starting a long course of steroids.

If you take denosumab, do not let an injection lapse without a follow-on plan, as bone loss can rebound quickly. Any new jaw pain or unhealed dental problem during treatment should be mentioned promptly.

Because osteoporosis is usually silent, the first sign is often a fracture that could have been prevented. Even then the opportunity is often missed: the Royal Osteoporosis Society reports that half of people who break a hip had an earlier fracture that could have flagged them as being at risk, and that only around half of NHS trusts in England and Wales have a fracture liaison service to pick this up. Identifying and addressing risk early, before a fracture happens, is the most effective approach. If any of the risk factors above apply to you, a bone-health assessment is worthwhile.

Do I need a DEXA scan?

Not necessarily; the starting point is your individual risk. Factors such as the menopause, a family history of osteoporosis or hip fracture, long courses of steroid medication, low body weight or a previous break after a minor fall all raise the question, and a DEXA scan is arranged where the assessment suggests it would genuinely help. The scan itself is simple and quick, using a low dose of X-rays.

What happens at a bone-health assessment?

The consultation reviews your risk factors, medical history and any previous fractures, and considers whether a DEXA scan is needed to measure bone density. Where useful, specialised blood and urine tests for bone turnover markers can also be arranged; these show how active the bone is and later help judge the response to treatment. The results are always interpreted in the context of your wider health, and what they mean for you is explained.

Is it too late to be assessed if I have already broken a bone?

No, quite the opposite. A bone that breaks after a minor fall is one of the clearest pointers to reduced bone strength, and many people who later have a serious fracture had an earlier one that could have flagged the risk. Assessment and treatment after a first fracture aim to strengthen the bones and make further breaks less likely.

How long does osteoporosis treatment last?

It is generally a longer-term plan rather than a short course, kept under review so the approach can change as your bones respond. One practical point with denosumab: the injections should not be delayed or stopped without a follow-on treatment in place, because the bone loss they have been holding back can otherwise return quickly. Your follow-up, including any repeat scanning, is agreed with you from the start.

How will I know whether treatment is working?

Because osteoporosis is usually silent, progress is tracked with tests rather than symptoms. Follow-up DEXA scanning monitors bone density over time, and bone turnover marker tests on blood and urine give a picture of how the bone is responding to treatment. Together these allow the plan to be confirmed or adjusted at review.