Worried about osteoporosis? This is the secret to stronger bones
An NHS-approved drug is the latest step forward in the development of an issue that affects over 3 million people in the UK
The National Institute for Health and Care Excellence (Nice) has just approved a new treatment for osteoporosis which should be available on the NHS within the next few months. Abaloparatide, which can be self-administered by injection, will be reserved for those who have not responded to, or cannot tolerate, existing medicines. Nice estimates that more than 14,000 people in England could benefit from its introduction.
Awareness of osteoporosis — both among healthcare professionals and the public — has been transformed during my career thanks to a combination of better diagnostics, new treatments and the efforts of campaigners such as the Royal Osteoporosis Society and its president, Queen Camilla. However, while much progress has been made there are still far too many people in the UK who are unaware of the risks, or who may already have osteoporosis and are missing out on existing therapies. Could you be one of them?
Bone is a complex structure mostly made of calcium and phosphorus salts deposited on to a protein (collagen) framework. It is a living tissue that is constantly being remodelled and renewed. As well as healing injuries, this remodelling allows it to respond to stresses and strains by getting stronger. The opposite occurs — bones get weaker — if loading is reduced when you do too little, take to your bed or get stuck in the International Space Station for months on end.
Bones also get lighter and less dense as we age. Most people reach peak bone mass between 25 and 30, after which it tends to decrease slowly until the age of 50, when it starts to drop more quickly, particularly in women. So we all end up with “thinner” bones over time, but for about one in three women and one in five men this process eventually occurs to such a degree that they develop fragility fractures — broken bones from relatively minor trauma. The most common examples are fractured wrists and hips caused by simple trips and falls. Vertebral fractures of the spine, leading to pain, loss of height and deformity (the dowager’s hump) are another common problem. These can even occur under the weight of one’s body, without any significant trauma.
Fragility fractures are often the first sign of trouble and should always prompt further investigation (see below). Such investigation is now routine in the NHS, or should be, but in 2017 Nice estimated that about a quarter of hip fractures in the UK (more than 20,000 a year) could have been prevented by a better follow-up with patients who had had other fragility fractures.
Some people are more at risk of developing osteoporosis than others and should be particularly vigilant. It is more common in those with a family history of the condition, as well as smokers, heavier drinkers (more than three units a day) and women who go through the menopause early, along with men with low testosterone levels (sex hormones protect bone density).
Other risk factors include general ill health and immobility, being underweight, having arthritis and/or nutrient malabsorption due to bowel problems like coeliac disease, low calcium intake and vitamin D deficiency. Certain medicines can cause it too, ranging from steroids (typically those taken over the longer term in tablet form) to antacid drugs such as omeprazole and lansoprazole, albeit to a much lesser degree.
Medicines like bisphosphonates, which promote new bone formation, may mitigate some of the risks in people taking steroids long term, while HRT can help in women who have had an early menopause (as can testosterone in men with low levels), but self-help is key in both prevention and treatment. A good diet and a healthy lifestyle, particularly weight-bearing exercise and lifting weights, is important, as is getting enough vitamin D and calcium (though evidence for the benefits of high-dose supplements is mixed).
You can read Nice’s statement on abaloparatide at nice.org.uk
Diagnosis and treatment
• GPs and hospitals typically use a combination of a risk calculator (like the Frax fracture risk assessment tool at frax.shef.ac.uk) and/or a special type of x-ray (a Dexa scan) to identify people with osteoporosis.
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