Osteoporosis is a disease that affects the bones.¹  It is often referred to as a 'silent disease' because there may be no signs or symptoms until a bone breaks.  Osteoporosis literally means 'bone that has many holes' which makes the bone weak and more likely to break.  This weakening process is increased in women after the menopause when their ovaries produce less oestrogen which helps to protect bones.

Osteoporosis affects the whole skeleton but fractures most commonly occur to the wrist, hip and spine. One in three women and one in five men over the age of 50 will be affected by osteoporosis.²  After the menopause, women who have had one fracture are at least twice as likely to suffer another.³

Vitamin D plays a vital role in bone health. Without vitamin D, calcium which is required for strong and healthy bones cannot be absorbed.² The major source of vitamin D is from sunlight on the skin, so when exposure to the sun is reduced you may need to find out other sources of vitamin D.² Unlike calcium, vitamin D is not readily available from diet. It is found naturally in only a small number of foods, including dark leafy vegetables, egg yolks, liver, oysters and oily fish.² However, most normal diets do not contain enough vitamin D, so it often needs to be supplemented.² A recent survey highlighted that 52% of European women with osteoporosis suffer from Vitamin D inadequacy.⁴

Everyone is at risk of developing osteoporosis as they grow older - age is one of the major risk factors for this silent disease. Osteoporosis affects both sexes but post-menopausal women are at greatest risk because bone loss is accelerated to varying degrees after the menopause due to reduced oestrogen which helps protect the bones.¹

There are a number of other risk factors for osteoporosis including:

• In women, if you were over 16 years before your first period, missed menstrual periods for more that 6 months and were not pregnant, had an early menopause or had a hysterectomy².
• In men, low levels of the male hormone testosterone (hypogonadism) which can cause loss of sex drive, loss of erections, depression and fatigue²
• Low body weight or history of an eating disorder such as anorexia or bulimia²
• Psychological stress²
• Long term use of corticosteroid tablet (such as asthma medication)
• Maternal history of a hip fracture²
• Malabsorption, inflammatory bowel disease (Coeliac disease, Crohn’s disease, ulcerative colitis and gastric surgery) ²
• Lack of exercise, long-term immobility or excessive exercise ²
• Heavy drinking ²
• Smoking²

If your doctor considers you may be at risk of osteoporosis, he/she may refer you for a DEXA scan.² A DEXA scan is the gold standard diagnostic test for osteoporosis and is a special X-ray that uses an extremely low dose of radiation to measure bone density.²

There are a number of different medicines available for the treatment of post-menopausal osteoporosis and treatment should be tailored to the individual. The main objective of medical treatment is to prevent further fractures.

Unless doctors are confident that post-menopausal women receiving osteoporosis treatment following a fracture have an adequate calcium intake and/or are vitamin D replete, calcium and/or vitamin D should be provided as part of their treatment.

Treatment options include: ²

For men & women:
Calcium
Vitamin D
Bisphosphonates

For women only:
Selective oestrogen receptor modulators (usually called SERMS)
HRT (Hormone Replacement Therapy)
Teriparatide
Strontium

 References

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