To avoid osteoporosis you should be eating healthily throughout your life, but especially from middle age,” says Dr Miriam Casey, consultant physician at St James’s Hospital.

“Bones are continually remodelling and repairing themselves, and calcium and protein intake is very important for this.”

Don't assume back pain is arthritis

Dr Casey says that often there are no symptoms of osteoporosis, but back pain can herald it.

“Don’t assume the back pain you’re having is arthritis. Sometimes people will get an acute back pain that settles down over time, then they mightn’t know any more until they break a wrist from a simple fall, for example. Generally speaking, you can have lost a lot of bone before you become aware there is a problem. That’s why osteoporosis is called the silent disease.

“Often when we x-ray people in our bone health clinic, we see that some of the vertebrae in the back have actually collapsed, so fractures have already taken place because of osteoporosis. In post-menopausal women, particularly, acute back pain should be considered as a possible osteoporotic fracture and not just assumed to be wear and tear,” says Dr Casey.

“Everybody needs to inform themselves about osteoporosis. Go online and look up the information about calcium-rich foods. While people of all ages can have osteoporosis, women who are post-menopausal are particularly prone to it because of lowered oestrogen [hormone] levels in their bodies. Higher oestrogen levels [in pre-menopausal females] prevent bone breakdown.”

Medication

Diet and lifestyle change (more weight-bearing exercise*) is important if one is diagnosed with osteopenia, a milder form of bone loss, or osteoporosis, Dr Casey says.

“However, medication, as well as lifestyle changes, will be needed if there is a diagnosis of severe osteoporosis. There are some very effective treatments available now, including a bone-growing agent that can reduce risk of breaking another bone in your back by 90%.”

While in the UK, a lot of Dr Casey’s research specialised in this area of treatment. Your GP should be your first line of help for old or young.

“If he or she feels that there is something out of the ordinary, or if bone density is not improving with the medication you’re already on, you should be referred to a specialist.”

Teenagers’ indoor sedentary lifestyle is also a concern for her as a doctor.

“You grow half your adult bones when you are a teenager – that’s why it is so important to take in adequate calcium during those years and take exercise outdoors as well.”

* Weight-bearing exercise like walking/dancing/skipping or playing tennis is essential for health. This is because the impact of your foot hitting the ground sends a vibration through your skeleton which stimulates bone formation.

Eating properly

Dr Miriam Casey is the principal bone health investigator for the bone health arm of a major cross-border study of 6,000 people. This €1.8m Tuda study (Trinity University and the Department of Agriculture) is exploring the link between nutritional intake, genetics and bone disease in one third of those who have osteoporosis.

“We are looking at the nutritional intake and eating habits of older people, particularly calcium intake and milk and dairy product consumption,” she says.

“We’re now analysing that data and should have some interesting results later this year.”

The normal daily calcium allowance to prevent this bone disease is 1,200mg/day, sourced from a variety of foods, mainly of dairy (low-fat if necessary) origin and green leafy vegetables, eg kale.

Hip fractures can be life-threatening

According to Dr Casey, hip fractures are one of the most life-threatening events for older people.

“In the UK, 22% of people in the 78 to 82+ age group – the group most likely to break their hip – die within a year. Generally, it is due to the decline in mobility afterwards and risk of pneumonias, heart attacks and blood clots, when people are immediately recovering from this stressful event. Also, further falls and fractures are more likely to occur in this first year.

“We know that one in 10 people who have a hip fracture will have a second hip fracture within five years.”

Osteoporosis has huge implications for our health service because of our ageing population, unless we take action now.

“In Ireland, by 2025 [from 2009], an increase of 88% in the number of hip fractures in Ireland is expected, for example.”

Men and osteoporosis

Men get osteoporosis too and it’s time to face up to that fact, says the Irish Osteoporosis Society (IOS). Increasing awareness of osteoporosis among men will be the theme of World Osteoporosis Day in October 2014.

“It’s not just an old woman’s disease and pride shouldn’t stop men talking about it or seeking treatment for it,” says Michele O’Brien, IOS chief executive.

“Men often don’t want to talk about it because they don’t want anyone thinking they have what’s perceived to be an ‘old woman’s disease’. One in four men, as well as one in two women over 50 will break bones because of it.”

Currently, an estimated 300,000 people in Ireland have osteoporosis, but only 15% are diagnosed. The IOS believes that not enough people in Ireland are scanned for osteoporosis, even when they have experienced multiple fractures from simple falls.

“We know of men who have had severe back pain and fractures, but were never referred for a DXA scan to see if they had osteoporosis. When they did have one it showed they had severe osteoporosis and several fractures already. They shouldn’t have had to suffer that kind of pain for years.”

Osteoporosis can be prevented in most cases, says Michele O’Brien, and is treatable in the majority of people.

“Early diagnosis is key, however, and a DXA/DEXA scan is the gold standard for diagnosis. It means Dual Energy X-ray Absorptiometry. It is painless, not claustrophic and takes about 15 minutes and scans the hips and spine. Men and women who have physically-demanding jobs, like those involved in farming and who suffer acute back pain, need to ensure they don’t have undiagnosed osteoporosis.”

Dr Miriam Casey is a senior consultant physician in the Bone Health Clinics at St James’s Hospital, Dublin. If you have any further queries about osteoporosis, see the charity’s website www.irishosteoporosis.ie or telephone its helpline on 1890-252-751.

Note: There may be a long waiting period (eg nine months) for DEXA scans in the public health service. A private DEXA scan costs about €100.

Reader's story

Anna Carroll (33) is from the northeast. She broke a bone in her arm from a simple fall off a low stool. Two more bones in her arm fractured as she was getting up. However, it was three years before she was diagnosed with osteoporosis after a further fracture, this time in an ankle. She subsequently fractured the other ankle, but thanks to medication – calcium tablets and osteoporosis medication – her bone density is now increasing.

“There was a history of osteoporosis on both my mum and dad’s side, but it was only diagnosed when they were in their 50s,” says Anna. “So I didn’t think when I broke my arm in three places that it was osteoporosis that I had. Looking back now though, it must have been for me to have broken that first bone so easily.”

Anna’s situation was further affected by a car accident in December 2011 which has left her in a wheelchair.

“My clavical bones and nine of my 12 thoracic spinal bones were fractured and dislocated in that, including my T6, which severed my spinal cord so I’m in a wheelchair since then.

“I’m lucky, though, that I have upper body and arm movement. While I don’t wrap myself in bubble wrap, I know I have to be careful to not knock myself against things.

“I don’t think there’s enough awareness about osteoporosis among younger people. Eating calcium-rich foods is really important too – dairy foods, or if they don’t agree with you, dark green vegetables like kale, broccoli and spinach. I eat a lot of them now.”