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Osteoporosis - the silent disease

Siobhán Hallmark of the National Osteoporosis Society describes what causes the condition, risk factors, and how a healthy lifestyle can prevent or delay it. 

Osteoporosis, when bones become increasingly fragile, is often referred to as the silent disease because it normally remains undetected until a bone is broken.

Osteoporosis causes bones to break following a minor bump or 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 be affected.

Spinal fractures can lead to loss of height and spinal curvature, while a broken hip often results in reduced 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 are not painful but the broken bones that result cause pain and lead to other problems.  However, effective drug treatments, physiotherapy and practical support can reduce the risk of further fractures and speed recovery.

Our genes are key to deciding the potential size and strength of our skeleton but the way we live our life can also play a part in the amount of bone we invest in our 'bone bank' during our youth, and how much we retain in later life.

Healthy balanced eating

Whatever your age or sex, make sure that what you eat today will help to keep your skeleton strong for the future.

A good diet will provide the vitamins, minerals and energy you need to live life to the full, keep your bones healthy and reduce the risk of other chronic diseases.

Calcium gives strong teeth and bones strength and rigidity. Most people should be able to get enough calcium through healthy eating, without the need for additional supplements. 700mg daily is recommended although those with osteoporosis taking drug treatments might benefit from 1,000 to 1,200mg a day.

Vitamin D
Vitamin D is essential because it allows us to absorb calcium from our diet and deposit it in our bones. Sunlight is the best natural source of vitamin D so people in the UK should get out in the sun for ten minutes, once or twice a day a day, without sunscreen, which blocks the process of vitamin D production.

The human body is efficient at producing vitamin D so you should have produced enough long before you start to burn. If you are fair-skinned, have lots of moles and freckles or have a family history of skin cancer, you should be particularly careful in the sun to reduce your risk of skin cancer, and avoid the strong sunshine in the middle of the day

Who is at risk of developing osteoporosis?

Both sexes are at increased risk of breaking a bone because of osteoporosis if they:

  • have low body weight (women who are under weight or have developed an eating disorder);
  • drink excessive amounts of alcohol or smoke;
  • take high doses of corticosteroid tablets (taken for conditions such as asthma and arthritis);
  • have medical conditions which leave them immobile for a long time;
  • have a family history of osteoporosis;
  • have a medical condition which affect the absorption of foods, such as Crohn's disease and coeliac disease.

Men with low levels of the male hormone testosterone (hypogonadism) are at a higher risk of osteoporosis.

Women are at risk due to a lack of oestrogen caused by:

  • early menopause (before the age of 45);
  • early hysterectomy (before the age of 45), especially if both ovaries are removed;
  • missing periods for six months or more (excluding pregnancy) as a result of over-exercising or over-dieting.

What should I do if I think I'm at risk?

If you think you are at risk, discuss it with your GP.  He or she will assess your medical history, including whether you have broken any bones or lost height, and may send you for a Dual Energy X-ray Absorptiometry (DXA) scan to measure your bone density.

This is the most accurate and reliable way to find out the strength of bones and your risk of breaking a bone. It is a simple, painless procedure that uses low doses of radiation.

Assessing fracture risk

Many factors contribute to the risk of breaking or fracturing a bone. Some of these risk factors, such as the risk of falling, may be tackled by lifestyle changes.

Others relate to bone strength and may be improved by taking drug treatments. When doctors decide who needs drug treatment to reduce their risk of a fracture, they use a fracture risk assessment tool called FRAXTM.

Measurement of bone density may form part of this assessment but may not always be necessary.

Osteoporosis drug treatments

There are two types of cells at work in our bone. Demolition cells break down old bone; construction cells build new bone.

Some drugs work by slowing down the activity of the demolition cells while others stimulate the construction cells to build more bone. Some work on both sets of cells.

The National Osteoporosis Society

The National Osteoporosis Society is the only UK wide charity dedicated to improving the diagnosis, prevention and treatment of osteoporosis. It has a telephone helpline service staffed by a team of nurses who have specialist knowledge of osteoporosis and bone health.

It also has a network of over 100 Support Groups that provide help and information to local communities; organise exercise classes, hydrotherapy and social events; raise funds for local and national projects and lobby politicians and health care professionals.

Find out more by visiting the National Osteoporosis Society's website.

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