Osteoporosis
Assessment and treatment aimed at reducing bone loss and fracture risk
What is osteoporosis?
Bone is living tissue that is continuously broken down and rebuilt. In osteoporosis the rebuilding falls behind, the internal structure of the bone thins, and it fractures under a force that would not normally break it.
Bone density falls sharply in the years after the menopause, and it falls with age in both sexes. Long-term steroids, an overactive thyroid, smoking, heavy alcohol use and a low body weight all add to it.
What you might notice
- A bone broken by a minor fall
- Losing height or stooping forward
How it is diagnosed
A DEXA scan measures bone density at the hip and the spine and reports it as a T score, with osteoporosis defined at minus two point five and below.
Density is only half of it. Your doctor combines it with your age, previous fractures, family history and steroid use to estimate the actual risk of a fracture, and checks calcium, vitamin D, kidney and thyroid function to rule out a treatable contributor.
Recovery
Treatment reduces fracture risk within the first year, and bone density changes slowly, so a repeat scan is usually left for two to three years.
Bisphosphonate tablets need to be taken on an empty stomach with a full glass of water while sitting or standing upright for half an hour, which is what prevents them irritating the gullet. Calcium and vitamin D are taken alongside, since the medicines work poorly without them.
If it is left untreated
The first sign is usually a fracture. Wrist and spine fractures come first, and a hip fracture is the one that changes a life: a substantial proportion of people never return to independent living after one.
Spinal fractures often happen without a fall and may be noticed only as height loss and a rounding of the upper back, with the pain put down to ordinary backache.
Questions about osteoporosis
Do I need a scan?
A scan is advised after the menopause with risk factors, after a fracture from a minor fall, on long-term steroids, or where height has been lost. Your doctor combines it with your other risk factors instead of reading it alone.
How long do I stay on treatment?
Bisphosphonates are usually given for three to five years and then reviewed, with a break considered in people whose risk has fallen. Other treatments are continued differently, and stopping some of them causes a rapid loss of what was gained.
Why the dental check before starting?
Because a rare jaw complication is associated with these medicines, and it is far likelier where there is existing dental infection or where a tooth is extracted during treatment. Dealing with dental work beforehand largely removes that risk.
Other endocrinology treatments
Diagnosis and long-term medical management of diabetes, including blood sugar, lifestyle and complication monitoring
Day CareAssessment and medical management of common thyroid conditions and hormone imbalances
Day CareTalk to a care coordinator about osteoporosis
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one