As with all parts of the human body, looking after your bone health is vital. Not only do bones provide support and structure, but they also protect our organs, anchor our muscles and help regulate our calcium levels. Bones are constantly broken down and replaced. At times, the creation of new bone doesn't keep up with the removal of old bone, leading to reduced bone density and a condition called Osteoporosis.
Osteoporosis can lead to an increased risk of fractures (broken bones) after relatively minor trips or falls from a standing height. These are so-called fragility fractures. Although osteoporosis is extremely common, it has no symptoms, and so the diagnosis is often missed until a bone breaks. The most common sites for fragility fracture are the hip, spine, wrist and ribs. The risks of osteoporosis and fragility fracture increase with age and as the UK population is ageing, the rates of fragility fracture are also predicted to rise significantly unless the problem is addressed more effectively.
In the UK 1 in 2 women and 1 in 5 men over 50 will have at least 1 fragility fracture in their lifetime. This equates to over half a million fractures at an estimated cost of £4.4 billion annually. Fractures are not simply painful broken bones that will heal and lead to a full recovery. A fragility fracture can cause a significant risk of death and disability. After a hip fracture more than 1 in 4 people will die within a year of the fracture and more than half will never return to independent living. Furthermore, after having one fracture the risk of another increases significantly.
One way of trying to tackle the epidemic of fragility fractures may be better education to raise awareness of osteoporosis as a silent condition and the known risk factors for fracture so that people who may be at risk can ask their GP for advice and assessment. Early diagnosis and taking action as soon as possible can prevent broken bones.
At UK charity Arthritis Action's Annual General Meeting and Conference held last week in London, I gave a talk on the critical role that self-management plays in improving bone health. Self-management strategies including tackling lifestyle factors can help maximise bone density and strength and reduce the risk of fracture, even in people who have already broken a bone.
Osteoporotic fractures are more common in smokers, in those who regularly drink more than 3 units of alcohol daily, after an early menopause, with certain drugs, especially steroid tablets, and drugs used to treat breast and prostate cancer. Osteoporosis is more common in people who are inactive, and both weight-bearing exercise and resistance exercises with weights may help to maintain bone density and reduce the risk of fractures. Exercises such as Tai Chi or weight training can also improve balance and reduce the risk of falling and therefore fractures, especially in elderly people.
Keeping to a healthy weight and having a balanced diet rich in Vitamin D and calcium, as well as having adequate amounts of dietary protein can also help keep bones as strong as possible. Good sources of dietary calcium include milk (skimmed milk has the same amount of calcium as full fat milk), yoghurt and cheese. Vitamin D is naturally made by the action of sunlight on the skin and in the UK during the spring and summer, most adults should get enough sunlight naturally. In autumn and winter, Public Heath England recommend that all adults should consider having a supplement of 10 micrograms of Vitamin D daily and people with dark skin, those who cover their skin or live in residential care should have a supplement all year-round.
Although osteoporosis is easy to diagnose using a simple type of x-ray scan called bone densitometry (DXA) and although there are extremely effective treatments for osteoporosis and simple tools for determining who is at risk of fragility fracture, osteoporosis is still often a hidden disease with many people at risk remaining undiagnosed, or not receiving treatment which could dramatically reduce their risk of fracture.
If you are worried about your bone health or osteoporosis or have already broken a bone please speak to your GP as you should be properly assessed.
As part of their holistic self-management approach, Arthritis Action have produced a Staying Active factsheet which suggests a number of exercises that are suitable for people with osteoporosis to help maintain bone density.
Wendy is a Consultant Rheumatologist at North Hampshire Hospitals NHS Foundation Trust and UK Charity Arthritis Action's Medical Advisor.