Osteoporosis  is a chronic metabolic bone disease, which progresses slowly. Osteoporosis is thinning of the bone making the bones more fragile and prone to breaking.  There are usually no symptoms until a fracture occurs. This may be one of the reasons why osteoporosis is under treated. Fractures as a result of osteoporosis can have a serious effect on the mobility, general health and has psycho-social consequences.

How do people with osteoporosis present?

Most people may not have an obvious fracture. they may complain of bony pain or muscle spasm. People can have fractures of long bones, hip and spine. Vertebral fractures are common and usually are detected late. Vertebral fractures can lead to a decrease in height and also cause spinal deformity. Osteoporosis can manifest as just back pain, more so after bending or lifting.

Who is at risk of osteoporosis?

The following groups of people are more likely to have osteoporosis and have higher risk of sustaining a fracture:

• Women, more so menopausal women
• Smoker
• Excessive alcohol intake
• Elderly
• reduced intake of calcium and vitamin D
• reduced physical activity and immobility
• Family history of osteoporosis
• Very low body weight

What are the causes for osteoporosis?

Any condition which interferes with bone metabolism is likely to lead to low bone mineral density and osteoporosis. Some of the causes of osteoporosis are listed below:

• Hyperparathyroidism
• Amenorrhoea (Absence of menstrual periods) and strenuous exercise
• Men with low testosterone
• Coeliac disease
• Malabsorption syndrome
• Crohn’s disease
• Steroids
• Cushing’s disease

How is osteoporosis diagnosed?

DEXA scan is done to assess Bone mineral Density, that is the quality of bone.

The World Health Organisation definition of osteoporosis, which is accepted in current UK guidance, relies on BMD (Bone Mineral Density) checked by a DEXA scan. A T-score of −2.5 SD or more is diagnostic of osteoporosis.  However, there are some people who are at increased risk of fracture even at a low BMD.

In addition, several blood tests are done to find out the underlying reason for osteoporosis.

Sometimes, fractures may be due to other sinister causes including cancers and multiple myeloma.

How is osteoporosis treated?

Treatment in the first instance involves a change in life style. This includes increasing physical activity and undertaking gradual weight bearing exercise. It is recommended that a balanced diet should be taken with adequate calcium containing food. Smoking should be stopped and alcohol consumption should be reduced.

Medications usually involve calcium and vitamin D supplements and bisphosphonates. In some people these medications may not help and hence other alternative and newer medications should be tried.

People with osteoporosis should have a regular review by an endocrinologist.

Dr Chinnadorai Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. As a private endocrinologist he  has private endocrine, diabetes and weight loss clinics in Harley Street, London, Chennai (India), Claremont Hospital, Sheffield, Nuffield Hospital, Leeds and Simplyweight, Bradford.

He has face to face consultations with people from Barnsley, Rotherham, Chesterfield, Doncaster, Wakefield, Huddersfield, Bradford, Harrogate, Leeds, Sheffield, London and Chennai (India). He also offers video consultations.