Osteoprosis Clinic

Osteoporosis causes bones to loss of microscopic struts, becoming thin and brittle and more prone to a break after a fall or a minor stress such as bending or cough.  These broken bones are referred to as fragility fractures.  Osteoporotic bones become fragile and if not treated, can progress painlessly until a bone breaks.

Osteoporosis affects men and women of all races.  But Caucasian and Asian women — especially those who are past menopause — are at highest risk.  Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones,

Osteoporosis is common

There are over 300,000 osteoporosis related fractures in the UK per year, yet many fractures can be prevented by treatment.

The bones in our skeleton are made of a thick outer shell and a strong inner mesh filled with collagen (protein), calcium salts and other minerals. The bone structure is lattice-like.

Osteoporosis occurs when the spokes of the lattice thin and break. Although osteoporosis usually affects the whole skeleton, the most common fractures are in the wrist, spine and hip.

Signs and symptoms

There typically are no symptoms in the early stages of bone loss. But once bones have been weakened by osteoporosis, you may have signs and symptoms that include:

• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone fracture that occurs much more easily than expected

Causes of Osteoporosis 

Your bones are in a constant state of renewal — new bone is made and old bone is broken down.  When young, your body makes new bone faster than it breaks down old bone and your bone mass increases.  Most people reach their peak bone mass by their early 30s.  As we age, bone mass is lost faster than it’s created. How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth.  The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.

Osteoporosis tests

The tests for an individual patient will depend on the clinical assessment and what has already been done.  We often do appropriate bloods and some times urine tests to determine appropriate treatment and response to treatment.

Bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral contained in your bones.  During this painless test, you lie on a padded table as a scanner passes over your body.  In most cases, only a few bones are checked usually in the hip, wrist and spine.

What is DEXA?

Bone density scanning is the most commonly used diagnostic technique for osteoporosis but other scans and tests may be used to help understand what is happening to your bones. Most of these tests or scans help to predict how likely it is you will break bones and some are specifically used to diagnose osteoporosis as it is currently defined.

Life style changes and drug treatments

These suggestions may help reduce your risk of developing osteoporosis or experiencing broken bones:

• Avoid smoking.  Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman’s body makes and by reducing the absorption of calcium in your intestine.
• Avoid excessive alcohol.  Consuming more than one alcoholic drink a day may decrease bone formation and reduce your body’s ability to absorb calcium. Being under the influence also can increase your risk of falling.
• Prevent falls.  Wear low-heeled shoes with nonslip soles and check your house for electrical cords, area rugs and slippery surfaces that might cause you to trip or fall. Keep rooms brightly lit, install grab bars just inside and outside your shower door, and make sure you can get in and out of your bed easily.

For both men and women, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:

• Alendronate (Fosamax)
• Risedronate (Actonel)
• Ibandronate (Boniva)
• Zoledronic acid (Aclasta, Zometa)

Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed oesophagus or oesophageal ulcers. These are less likely to occur if the medicine is taken properly. Injected forms of bisphosphonates don’t cause stomach upset. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill.

Long-term bisphosphonate therapy has been linked to a rare problem in which the middle of the thighbone cracks and might even break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition mostly occurring after a tooth extraction in which a section of jawbone dies and deteriorates. You should have a recent dental examination before starting bisphosphonates.

Hormone-related therapy

Oestrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman’s risk of blood clots, endometrial cancer, breast cancer and possibly heart disease.

Raloxifene (Evista) mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may also reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots.

In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help increase bone density, but osteoporosis medications are better studied in men with osteoporosis and are recommended instead of or in addition to testosterone.

Less common osteoporosis medications

If you can’t tolerate the more common treatments for osteoporosis — or if they don’t work well enough — your doctor might suggest trying:

• Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It is given by injection under the skin. After 18-24 months of treatment with teriparatide, another osteoporosis drug may be required to maintain the new bone growth.
• Denosumab (Prolia). Compared with bisphosphonates, denosumab produces similar or better bone density results while targeting a different step in the bone remodeling process. Denosumab is delivered via a injection under the skin every six months. The most common side effects are back and muscle pains.