Osteoporosis

What is Osteoporosis?

Osteoporosis is a condition that affects the bones. They lose substance or density, causing them to become weak and fragile and more likely to break (fracture).

What causes Osteoporosis?

In childhood, bones grow and repair very quickly, but this process slows as you get older. Bones stop growing in length between the ages of 16 and 18, but continue to increase in density until you are in your late 20s. From about the age of 35, you gradually lose bone density. This is a normal part of ageing, but for some people it can lead to osteoporosis and an increased risk of fractures.

Who is at risk of Osteoporosis?

Osteoporosis can affect men and women. It is more common in older people, but it can affect younger people too.

Women
Women are at greater risk of developing osteoporosis than men. This is because changes in hormone levels can affect bone density. The female hormone oestrogen is essential for healthy bones. After the menopause, the level of oestrogen in the body falls, and this can lead to a rapid decrease in bone density. Women are at an even greater risk of developing osteoporosis when:

• they have an early menopause (before the age of 45)
• they have a hysterectomy before the age of 45, particularly when the ovaries are also removed
• their periods are absent for a long time (more than six months) as a result of over-exercising or over-dieting

Men
For most men who develop osteoporosis, the cause is unknown. However, there is a link to the male hormone testosterone, which helps to keep the bones healthy. Men continue to produce this hormone into old age, but the risk of osteoporosis is increased in men with low levels of testosterone. In around half of men the exact cause of this is unknown, but known causes include:

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•  the use of certain medications such as oral glucocortoids
• alcohol misuse
• hypogonadism - a condition that causes abnormally low testosterone levels

Diseases of the hormone-producing glands
Many hormones in the body can affect the process of bone turnover. If you have a disease of the hormone-producing glands, you may be at higher risk of developing osteoporosis. Osteoporosis can be triggered by hormone-related diseases, including hyperthyroidism (overactive thyroid gland)

• disorders of the adrenal glands, such as Cushings syndrome
• reduced amounts of sex hormones (oestrogen and testosterone)
• disorders of the pituitary gland
• hyperparathyroidism (overactivity of the parathyroid glands)

Increased risk

Other things thought to increase the risk of osteoporosis and broken bones include:

• a family history of osteoporosis
• a parental history of hip fracture  
• a low body mass index (BMI of 19kg/m2 or less)
• long-term use of high-dose steroids / corticosteroids treatment (widely used for conditions such as arthritis and asthma), which can affect bone strength
• heavy drinking and smoking
• rheumatoids arthritis  
• mal-absorption problems, as experienced in Coeliacs disease and Crohns disease
• some drugs used in breast cancer and prostate cancer treatment which affect hormone levels
• long periods of inactivity, such as long-term bed rest

Symptoms of osteoporosis
Osteoporosis develops slowly over several years. It is likely there will be no warning signs or symptoms until a minor fall or sudden impact causes a bone fracture. Healthy bones should be able to withstand a fall from standing height, so a bone that breaks in these circumstances is known as a fragility fracture.

The most common injuries in people with osteoporosis are:

• wrist fractures
• Hip fractures
• fractures of the spinal bones (vertebrae)

A simple cough or a sneeze may cause the fracture of a rib or the partial collapse of one of the bones of the spine.

A fractured bone in an older person can be serious, depending on where it occurs, and can lead to long-term disability. For example, a hip fracture may lead to long-term problems with mobility.

One visible sign of osteoporosis is the characteristic stooping (bent forward) position that develops in older people. It happens when the bones in the spine are fractured, making it difficult to support the weight of the body.

Is osteoporosis painful?

Osteoporosis usually doesn't cause pain unless a bone is broken as a result of the condition. Although not always painful, spinal fractures are the most common cause of chronic pain associated with osteoporosis.

Also see:

Osteoporosis: Diagnosis and Treatment
Prevention of Osteoporosis

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