Questions And Answers

Milestones

What is osteoporosis?

After about the age of 30 all people, men and women, begin to lose some bone. Unless there are exceptional circumstances, like orbiting in the space station for several months, this is a slow process. So 30 year old women are the benchmark for peak bone mass against which older women are compared. When the bone mass in a mature woman is below a World Health Organization accepted level (T-score equal to, or less than, minus 2.5; see below) a doctor will diagnose osteoporosis and recommend intervention to maintain bone mass.

What is osteopenia?

If a woman is found to have a T-score of between minus 1 to minus 2.5 a diagnosis of low bone mass is determined and advice on lifestyle and diet, often with supplementation is offered and continual monitoring recommended.

How is bone mass measured?

The ‘gold standard’ uses a specialized machine that shines energy through your body (don’t worry as this is very small – less than you would experience on a flight across the Atlantic). The amount of energy that passes straight through you will depend on what it hits – hard tissue, like bone, stops the energy reaching a detector. So the more bone the less energy hits the detector. Fancy machines and skilled operators can then define how much bone you have and this is often fed back to you as a T-score (or if you ask a bone density).

What is a T-score?

Take a community of healthy adult women – ideally all aged 30 – and measure their individual bone densities. Then it’s time to do some mathematics! The average bone density for a given community (and there can be significant differences, for example African American ladies are generally blessed with a greater bone density than their Caucasian sisters) is set as the healthy marker for older women from a similar ethnic community. Some of these young women will have a bone density above the average and some below the average bone density and there is a way to determine the movement away from the average bone density for a community of young healthy 30 year old women – this is called standard deviation. Now forget the term standard deviation! And think T-score. If a community of mature women, let’s say all 60 years old, had their bone density measured and were found to have the same bone density as the average bone density of their 30 year old counterparts they would be said to have a T-score of 0. These mature women would be considered to have good bone density. If the same mature women had a bone density T-score of minus 1 to minus 2.5 below the average bone density of the 30 year old group they would be diagnosed with osteopenia and if they were at minus 2.5 or below they would have osteoporosis.

How do I know if I have osteoporosis?

Before the development of the instruments capable of accurately measuring bone density it used to be the case that a mature woman presenting at hospital with a fracture following a simple fall or a sudden increase in back pain would initiate a clinical investigation for osteoporosis. Doctors today want to prevent fractures as best as they can. Osteoporosis should be on the agenda of all general practitioners, but obviously your practitioner cannot tell as you walk through the door if you have osteoporosis. A detailed history looking for ‘indicators’ may help to question the possibility, such as your mother or an aunt suffering an osteoporotic fracture, early menopause, hysterectomy, previous long-term medications for asthma. Your doctor may be able to refer to a secondary healthcare provider for more detailed investigation, including laboratory tests and/or bone density scans.

Are there any symptoms?

If you have not got, or recently had, an obvious fracture, then, apart from things like bouts of back pain and a decrease in height, no is the answer.

Can I have low bone density, but my bones are of a high quality?

The quality –vs- quantity discussion goes on. Certainly there are a large number of women with low bone density, who have not been seen clinically for osteoporosis and who will not fracture. This may be a general indicator that the quality of bone that an individual has is as important as the amount of bone that we can retain as we age. The problem is that we a really good at measuring quantity and need to get much better at trying to define a reliable quality measure that can be readily used.

Can I prevent osteoporosis?

As pointed out above, we all start to lose bone after about 30 years of age. What we should all do is look to things that may slow down bone loss by making changes to our lifestyle and maintain as much bone as we can. A good balanced diet and regular exercise are two areas that we can all take an interest in so as to limit the effects of ageing on our bones. There are many self-help books available to help you make the choices that will benefit you and many countries have osteoporosis societies, which are charitable organizations looking to support people who may get osteoporosis and support those already with osteoporosis. Also, it is always a good idea to talk health issues through with your general practitioner.

What can I do if I have osteoporosis?

Talk with your healthcare provider and discuss medications available, find out if there are exercise classes designed for people who want to strengthen their bones. If you have children talk them into being more forward thinking about their bones now.

What do tests for Osteoporosis involve?

The “gold standard” is a DEXA scan, but an ultrasound scan of the heel bone can be done. There are some blood and urine tests available, but these are specialist tests run in specialist centres.

Does it hurt when you get tested?

The scanning machines are harmless. Blood sampling, if done, may cause minor discomfort.

At what age should I start thinking about getting tested?

If you have a hysterectomy or an early menopause you should be showing up on your general practitioners radar already. Some women may lose bone faster than others during the menopause, but for all women as they enter the menopause osteoporosis should be a subject on the discussion list with your general practitioner.

Does it affect both women and men in the same way?

Men are thought to have a greater peak bone mass than women at the age of about thirty. They also don’t go through menopause, but bone is very sensitive to all the sex hormones and if a man has low testosterone it will have an impact on his skeleton.

Who should my first call be to?

Osteoporosis is a silent menace that creeps up on people over years, so there is no need to panic. The internet contains huge amounts of information and the local charity for osteoporosis in your country will have lots of information to help you. If you want clinical advice speak with your general practitioner.

What field of medicine does Osteoporosis fall under?

By far the majority of people fall under the care of their general practitioner. There are increasing numbers of secondary referral centres with specialist orthopaedic physicians and if in the unfortunate position of having suffered an osteoporotic fracture you will be under the initial care of an orthopaedic physician.

Are there medical clinics set up for patients with Osteoporosis?

Yes and these are sometimes run through well women clinics or after secondary referral from general practitioners.

What are some of the most popular drugs being used to treat Osteoporosis today?

Calcium and vitamin D still have a place in treatment for osteoporosis, particularly in osteopenia. More potent treatments are available and the most widespread are the bisphosphonate class of drugs. Other drug options are available, including hormone replacement treatment, but all therapeutic approaches need to be discussed with your general practitioner.

Where can I read more about Osteoporosis?

See the Suggested Reading for both medical and educational literature on the subject of Osteoporosis.