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Osteoporosis
Written by Dr Dan Rutherford, GP
Low impact fractures
A person is also deemed to have osteoporosis if they have suffered a fracture too easily, ie a 'low impact' or 'osteoporotic' fracture.
A low trauma fracture is:
It is more difficult to categorise spinal fractures because they occur out of the blue and are not related to falls - sometimes they are not even accompanied by much pain.
However, the sudden onset of back pain should suggest there has been a collapsed vertebra, possibly due to osteoporosis.
Identifying people who have osteoporosis after they have suffered a fracture allows efforts at prevention to be concentrated on them. This can reduce the chance of them suffering another fracture later.
Causes of osteoporosis
Various factors are known to increase the rate at which bone loss occurs.
These can be divided into three groups: factors you can do nothing about, things you can change and causes related to other medical conditions or drug therapy.
Listed below are the main conditions that can lead to osteoporosis.
Changeable causes of increased bone loss
Medically related causes of increased bone loss
Diagnosing osteoporosis
Usually the same reference point in the skeleton is chosen, which allows better comparison between different people. The hip, forearm, heel bone or spine are all used, but exactly which varies according to local procedure.
As the name implies, a DEXA scan uses X-rays to determine the density of bone.
Ultrasound
X-rays
However, the same appearance will show if the exposure of the film is slightly too high. Conversely, if the film is slightly underexposed, the bones will look normally dense.
As much as 30 per cent of bone mass needs to be lost before it shows up on ordinary X-rays.
Who can have a DEXA scan?
The details of these criteria vary across the UK, but could look like the list below, in which the presence of any one factor would justify a DEXA scan.
a body mass index (BMI) less than 21
Thinness
People with a BMI of 21 or less have a higher rate of bone loss than those who are heavier, and obese people have lower rates of bone loss than those who are ideal weight.
It is not known if a thin person who deliberately puts on a lot of weight will reduce their subsequent fracture risk.
Obesity, of course, carries with it many other health hazards.
Alcohol
High levels of alcohol intake (over 50 units per week in men or 35 units in women) are associated with osteoporosis, as well as the other serious health risks that accompany alcoholism.
It is possible that lower levels of alcohol consumption than this could still damage bone, and be associated with problems such as raised blood pressure or diabetes.
Many experts therefore now recommend lower safe limits of alcohol consumption of 21 units weekly for men and 14 units weekly for women.
Prevention and treatment
The best test to diagnose osteoporosis is a scan to determine the density of the bones.
Ultrasound of the heel bone is another common technique for determining bone density. It uses cheaper equipment, but it is not yet clear if it is as accurate or reliable as DEXA scanning.
Ordinary X-rays are not reliable as a tool for diagnosing osteoporosis. It can be possible to suspect from a standard X-ray that the person has less bone mass than normal, because the bone outline on the film might appear fainter.
There are not enough DEXA scanners in the UK to make the test freely available, so some form of vetting procedure is used to ensure that those most at need are being scanned.
People who are unusually thin are more likely to develop osteoporosis, and the way to define 'thinness' is to measure your body mass index (BMI).
Historically, the recommended maximum consumption of alcohol per week has been 21 units for women and 28 units for men.
There are some general measures that people can take to prevent and treat osteoporosis including changing their diet and modifying their lifestyle and attitude to exercise as well as taking supplements or treatment prescribed by a doctor.
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