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Osteoporosis Q&A

What causes osteoporosis?

Bone is alive and constantly changing throughout life. Old, worn out bone is broken down by cells called osteoclasts and replaced by bone building cells called osteoblasts, a process of renewal called bone turnover.

In childhood, osteoblasts work faster, enabling the skeleton to increase in size, density and strength. During this period of rapid bone growth, it takes the skeleton just two years to completely renew itself. In adults this process takes seven to ten years.

Bones stop growing in length between the ages of 16 and 18 years, but bone density continues to increase slowly until a person’s late 20s. At this point the balance between bone demolition and bone construction becomes stable.

After the age of around 35, bone loss increases very gradually as part of the natural ageing process. This can lead to osteoporosis and an increased risk of broken bones, especially in later life.

Women are particularly susceptible because bone loss becomes more rapid for several years following the menopause.

What are the consequences to health of osteoporosis?

Osteoporosis causes bones to break following a minor bump or a fall. These broken bones, commonly referred to as fragility fractures, are most common in the wrist, hip and spine, although other parts of the body can also be affected.

Compressed bones in the back (spinal fractures) can lead to loss of height and spinal curvature, while a broken hip often results in both loss of confidence and independence.

Having osteoporosis does not automatically mean that your bones will break; it means that you have a ‘greater risk of fracture’. Thin, fragile bones in themselves are not painful but the broken bones that can result can cause pain and lead to other problems.

However, effective drug treatments, physiotherapy and practical support can reduce the risk of further fractures and help speed recovery.

Is there a cure for osteoporosis?

Fragile bones are caused by a number of factors, including genetics.

With medical treatment, bone density can improve and the risk of fracture can be reduced. However, if you have been judged as a high risk of bone fracture, you will probably need to continue drug treatment.

Drug treatments help reduce the risk of breaking a bone and can decrease the risk of fracture by roughly half.

Lifestyle changes, such as increasing weight-bearing exercise, will help to build and strengthen bone. You should also eat a well-balanced, calcium-rich diet to provide all the nutrients your bones need and ensure you get enough vitamin D – either through supplements or through limited exposure to the sun.

Should my doctor prescribe me hormone replacement therapy if I have osteoporosis?

Hormone replacement therapy (HRT) used to be prescribed to prevent osteoporosis. However, due to the health risks associated with HRT, the Committee on Safety of Medicines (MHRA) advised in 2003 that it should only be used to treat osteoporosis when all other treatments have proved unsuccessful (1).

I have a low body mass index due to anorexia. Am I at risk of developing osteoporosis?

If you have been diagnosed with anorexia nervosa, it is likely that you will have a bone density significantly lower than average. If you have bulimia nervosa, you may also have lower bone density than normal (2 PDF).

Low bone density is osteoporosis. Some people with eating disorders, such as anorexia, are at a higher risk of bone fractures at a young age.

Loss of bone density due to anorexia nervosa probably may be caused by low levels of the hormone oestrogen, a lack of adequate nourishment and high levels of the steroid cortisol in the blood.

Oestrogen has a protective effect on bone density and low levels are indicated by the loss of menstrual periods (amenorrhoea), which is common in anorexia nervosa. Your doctor should discuss the associated health risks of anorexia nervosa with you.

Infolinks:

• National Osteoporosis Society (NOS)
• National Osteoporosis Foundation (NOF)
• National Institute of Health and Clinical Excellence Guidance on Osteoporosis (NICE)

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