the key to reducing risk
Despite affecting one in three women and one in 12 men,
osteoporosis is still an unseen danger and can be
difficult to diagnose, but there are ways to minimise the
risks and treat the symptoms. VICKY SWAIN reports.
the medical world, prevention is usually better than
cure, and with osteoporosis the case is the same.
Hard to initially diagnose, it most commonly affects
women, but itís a myth that men are unaffected Ė
low testosterone levels can have the same damaging
effects as low oestrogen levels in women.
One of the most important starting points to help
combat the onset of osteoporosis in later life is a
calcium-rich diet during adolescence, which will
help to ensure healthy bones are formed at the
Approximately ten per cent of bone in the body is
replaced every year. When more bone is reabsorbed
back into the body than new bone is created it means
bones become thinner and are more liable to
fracture. Bone mass usually peaks by the age of 30.
Following that, the level gradually drops at the
rate of around one per cent every year, with a
higher drop for women during the first few years
after the menopause.
There are three types of primary osteoporosis Ė
Type I, which is postmenopausal and caused by a lack
of the female hormone oestrogen; Type II, which is
due to age; and Idiopathic, which affects younger
people and for which a cause has yet to be
Added to this there is secondary osteoporosis, which
can be the result of a number of factors Ė
hormonal, owing to an over-active thyroid;
underproduction of sex hormones or over-production
of natural steroids; digestive problems which limit
the absorption of nutrients in food; arthritis and
joint disease; cancer and malignant disease; and
some medications, including steroids.
most important message for doctors to pass on to
their patients is that itís better to prevent the
onset of osteoporosis before it becomes a problem
because of the difficulties in diagnosis
Although osteoporosis can affect anyone, certain
groups of people are naturally in a higher risk
category. These include females, older people, those
experiencing the menopause before the age of 45,
people with low sex hormone levels often due to
excessive weight loss or exercise, smokers and those
with a family history of the condition.
However, whatever the cause, preserving and
increasing bone density is the main aim of any
treatment for osteoporosis. Bones need a continuous
supply of calcium and vitamin D combined with
vitamin C and nutrients obtained from a healthy
There are also a number of medicines well suited to
the treatment of the condition including Hormone
Replacement Therapy (HRT); Calcitonin, administered
as a nasal spray or injection under the skin;
bisphosphonates; and selective oestrogen receptor
modulators, like raloxifene.
But there are drawbacks to each.
Bisphosphonates can be used to stop the progression
of osteoporosis and can even reverse the problem by
helping calcium to form on the bone. But they are
not easily absorbed into the body and need to be
taken with fluid and at regular intervals between
Calcitonin is a hormone, which can only be used for
a limited amount of time and has shown to be less
effective than other drugs.
HRT offers the greatest protection from
osteoporosis, but carries the added health risks of
breast cancer and deep vein thrombosis (DVT).
Raloxifene behaves in a similar way to HRT, but
itís less effective in preventing osteoporosis and
carries a higher risk of DVT.
In addition, for men, there is testosterone therapy,
which involves the replacement of low levels of
testosterone that will help maintain bone density.
There are other measures, which are also useful in
lessening the effects of osteoporosis.
Ensuring thereís sufficient calcium in the diet is
important either through the consumption of foods
like dairy products and nuts or through dietary
supplements. Vitamin D, the main source of which is
through exposure to sunlight, but also found in
milk, cereals and eggs, is also a vital part of a
diet that counteracts the likelihood of developing
In some countries fluoride has also been used to
combat the disease, but although evidence shows that
bone mass increases with its use, there has been no
evidence to suggest that it works in the long term
to prevent fractures.
The most important message for doctors to pass on to
their patients though, is that itís better to
prevent the onset of osteoporosis before it becomes
a problem because of the difficulties in diagnosing
While a normal x-ray canít reliably measure bone
density it can identify spinal fractures common in
sufferers. However, a dual energy x-ray
absorptiometry (DXA) scan can measure the density of
bones and compare this to a normal range. This test
is currently the most accurate and reliable means of
assessing the strength of bones and the risk of
Bone densitometry is also an essential tool in
osteoporosis management. Densitometry helps with
diagnosis, fracture risk assessment and monitoring
response to therapy. It can be used to categorise
patients as normal, osteopenic, or osteoporotic
following World Health Organisation (WHO)
The patientís T-score, a comparison to bone
density in a young adult, is the critical variable
in diagnosis. Usually, both femurs and the spine are
assessed, with the diagnosis made using the lowest
T-score and patient examination, in addition to the
T-score, is vital in diagnosing osteoporosis.
in Middle East have the latest detection
and more hospitals in the Middle East are
waking up to the need to detect and treat
osteoporosis. The Al-Zahra Hospital in Sharjah,
UAE, for example, offers two of the latest
state-of-the-art ways to gain the most
accurate and widely accepted methods of bone
DEXA BONE DENSITOMETRY
Dual Energy X-ray absorptiometry (DEXA) is
recognised to be the gold standard for bone
It is a fast, convenient and extremely precise
method to evaluate bone mass and monitor
response to therapy.
It measures bone density in the spine, hip and
the forearm Ė the sites commonly predisposed
The procedure, of course, causes no pain or
discomfort, and its radiation exposure is
clinically insignificant. The other advantage
is that no special preparation is required.
ULTRASOUND BONE DENSITOMETRY
Bone mass can also be measured using
ultrasonography Ė the same technique used
during pregnancy to monitor foetal
In this case the heel bone provides the ideal
site for a precise quantitative assessment of
bone health. The test is quick and simple, and
also avoids exposure to ionising radiation.
Fracture risk assessment Bone Mineral Density (BMD)
is the strongest tool to predict fracture risk,
increasing rapidly as BMD decreases.
Femur BMD is recognised as the strongest predictor
of femur fracture risk, which has the highest
morbidity, mortality and cost of all osteoporotic
fractures. A decrease of one standard deviation (SD)
in femur BMD corresponds to a threefold increase in
femur fracture risk. In comparison, a one SD
decrease in spine BMD corresponds to double the
increase in spine fracture risk.
Monitoring changes in BMD, patients often return for
bone density tests every one to three years,
depending on the expected rate of loss and their
clinical situation. BMD may increase over time as a
response to therapy, or it may decrease with disease
progression or poor response to therapy.
By ensuring precise measurements of the BMD are
taken, changes can be easily detected ensuring the
patient receives the best possible care throughout