One in two women and one in five men over the age of 50 will develop a fracture due to osteoporosis, or brittle bone disease. Younger people can be affected as well.

Pain, disability, prolonged stays in hospital, reduced quality of life and less independence: the consequences of having osteoporosis aren’t pretty, but a DEXA (DXA) scan could mean the difference between a normal life and avoiding such suffering.

Osteoporosis is the disease that thins bones, leaving them fragile and liable to break easily.

It happens when bones lose calcium more quickly than the body can replace it.

Getting a DEXA (DXA) scan would be worthwhile if you’ve broken a bone – wrist, for example – in a relatively minor fall or accident, according to the Irish Osteoporosis Society (IOS), as this could be the first sign of osteoporosis.

Back pain could be a signal too. That’s because of vertebral crush fractures, where vertebrae may have become damaged. With severe osteoporosis, sometimes a cough or sneeze can be enough to cause a rib fracture or the partial collapse of one of the bones of the spine.

Many people undiagnosed

Many people don’t want to speak out about what is often referred to as an “old-woman’s disease”.

This reluctance means that only 15% of people with osteoporosis are diagnosed, according to CEO of the Irish Osteoporosis Society (IOS) Michele O’Brien.

The IOS wants to increase awareness about the disease among doctors and the public. “It is still possible for people with 10 fractures to be told it is just old age,” she says.

“By coming forward and getting rid of the stigma, they can help raise awareness for the 85% of people who are not diagnosed – and will more than likely lose their independence –when this condition is very treatable.”

The statistics make for sober reading. According to the IOS, 20% of people over the age of 60 who fracture a hip will die within six to 12 months, due to the secondary complications of osteoporosis.

“Half of people over 60 who fracture a hip, will no longer be able to dress, wash or walk unassisted, and only 30% will regain their independence.”

Risk factors for osteoporosis

But what puts you at risk of developing osteoporosis? Being a woman in No1. Hormones are important, and women can lose bone as a result of having less oestrogen after menopause.

Family history is another, with about 70% of bone density and fracture risk determined by genetics.

Smoking and alcohol use are both directly toxic to bone health.

Certain medications – like steroids and hormonal medication used to treat breast and prostate cancer – can increase the likelihood of the disease.

Conditions such as Crohn’s disease and rheumatoid arthritis increase your risk.

Not getting enough calcium and vitamin D in your diet, as well as too little exercise also have an effect.

Signs of osteoporosis

There are lots of signs and symptoms of undiagnosed osteoporosis that should not be ignored.

Anyone who breaks a bone from a trip and fall (from a standing height) or less even if it was on cement or ice, should be screened for osteoporosis. “It is a lot cheaper to have a DXA scan (€100) than wait to see if you break more bones,” says the IOS CEO.

Loss of height, between 2cm and 16cm is a red flag, especially if a person has back pain or their posture has changed.

A hump developing on your lower back should not be considered “normal ageing”. If it is from undiagnosed osteoporosis, the bones in the spine are collapsing. The hump develops because there is not enough bone in the spine to keep the person upright.

The good news is that, even if you have developed a hump, there are treatments to prevent it getting worse. “It is very rare that a person cannot be treated,” says the IOS.

Change in body shape or size is usually associated with loss of height. This can happen due to vertebrae collapsing, followed by the ribcage ending up resting on the pelvis, because the spine can no longer hold it upright. A pot belly can then occur, as there is no place for the stomach contents to go.

Medications

Two types of drugs to treat osteoporosis are available at present – those that stop the breakdown of bone (bisphosphonates), which come in tablet and injection form, and those that help build bone and reduce bone breakdown at the same time (anabolic agents).

One of these can be taken in tablet form (orally) and the other is a self-administered injection once a day for two years.

Preventing and treating osteoporosis

What if you are diagnosed with osteoporosis? What happens next?

Treatment for osteoporosis is based on treating and preventing fractures and using medication to strengthen bones.

The decision about whether you need treatment will be made after your doctor sees your DEXA scan results.

If medication is not required, your doctor may firstly give you advice about improving your diet, about stopping smoking and drinking alcohol, if you do so, and will advise you to increase the amount of weight-bearing exercise you do.

If medication is required he/she will discuss the options with you.

How stress can lead to osteoporosis

Stress due to any cause will often result in increased cortisol and prolactin levels in the blood, which can increase bone loss. High levels of cortisol are usually seen in people with Cushing’s syndrome, a person on steroids such as Prednisolone or an athlete who is overtraining.

walking to prevent osteoporosis

Walking does two things: it strengthens leg muscles, which are like scaffolding round the bone, and the impact when you put your foot to the ground helps stimulate the production of healthy bone.

Lifestyle advice in a nutshell

  • Don’t smoke.
  • Don’t drink more than recommended alcohol limits.
  • Eat a diet rich in calcium.
  • Take plenty of weight bearing exercise.
  • Osteopenia is the term used to describe having decreased bone density, but not enough to be classed as osteoporosis.

    *Dexa means dual energy x-ray absorptiometry. The scan is painless, and will not make you feel claustrophobic, takes about 15 minutes and scans the hips and spine. A private DEXA scan costs about €100 at most centres.

    >> Pete’s story

    Pete (55), from Cork, had severe back pain for many years – and several fractures. Osteoporosis wasn’t diagnosed until he came across the Irish Osteoporosis Society (IOS) on the internet, however, while trying to source a back brace.

    “A DXA scan that they advised me to have showed that I had severe osteoporosis in my spine and hips – and signs of fractures in my back. I was told osteoporosis is preventable and treatable in the majority of people, and I am now on medication.”

    Pete believes that if he had been sent for a DXA scan by his GP when he first complained of back pain, he wouldn’t have had to endure all the suffering and expense.

    >> Osteoporosis causes and prevention

    Causes of bone loss

  • Long-term use of steroids.
  • Eating disorders.
  • Stress.
  • Low calcium and vitamin D3 intake.
  • Menopause in women.
  • Testosterone deficiency in men.
  • Smoking.
  • Excess alcohol.
  • Malabsorption of nutrients due to coeliac disease or gluten intolerance.
  • Additonal risk factors for women

  • If your first period occurred after age 15.
  • Going through the menopause.
  • Early menopause (under 45).
  • Surgical menopause/ovaries removed/hysterectomy.
  • Depot Provera – contraceptive which affects bones.
  • Pre-menstrual tension.
  • Irregular periods or loss of periods for more than four months.
  • Additonal risk factors for men

  • Testosterone deficiency, known as hypogonadism.
  • PREVENING OSTEOPOROSIS

    Making sure you get enough calcium, vitamin D and protein in your diet is very important in preventing osteoporosis. Calcium-rich food sources include yoghurt; milk; cheese; bread; nuts; any oily fish (for example, sardines and tuna); some dark-green vegetables; some brands of orange juice; some breakfast cereals with calcium.

  • Vitamin D sources from food: yoghurt (for example, Calin+); fortified milks; oily fish; eggs; chicken livers; breakfast cereals.

  • Protein sources from food: yoghurt; milk; cheese; white meat of poultry and eggs.

  • SUPPLEMENTS: If you don’t get enough Calcium and vitamin D in your diet, you may need supplements like Calcichew D3 Forte; Osteofos D3; Kalcipos; Desunin.

    Information

    www.irishosteoporosis.ie Lo-call 1890 252 751

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    www.nhs.uk/conditions/ osteoporosis

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    www.arthritisireland.ie

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    www.hse.ie