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Healthy bones have a thick outer shell mostly made up of calcium salts and a strong inner mesh. The inner mesh is made up of a protein called collagen, calcium salts, and other minerals. The inner mesh has a hollow down its middle where the blood vessels and bone marrow can be found. Vitamin D is vital for healthy bones as it controls how much calcium gets into our bodies and how much of that gets into our bones. So two factors are vital for growing and maintaining healthy bones: 1/ an adequate supply of calcium in our diet and 2/ adequate levels of vitamin D in our bodies.

Osteoporosis means ‘porous bones' and occurs when calcium and minerals in the bone mesh are lost so the mesh size becomes bigger, making it spongy and weak. This results in loss of bone density and when this happens bones become fragile. Osteoporosis can affect the whole skeleton but is most important when it affects the bones in the wrist, spine and hip making them fragile and more likely to collapse or break or fracture.
Changes in bone density happen very slowly and cannot be felt. They result in osteoporosis which is often termed a `silent disease' because it causes no symptoms or pain unless or until you take a knock or fall and break a bone (fragility fracture). For many people the first sign that they have osteoporosis is when they break a bone after a minor bump or fall. Some sorts of fractures are typical of osteoporosis including wrist fractures (especially for middle aged and older women), spinal
fractures (which can cause bad back pain) and hip fractures (which often result from falls in older people). Spinal fractures can eventually lead to a curvature of the spine (widow’s hump) and loss of height. They can also happen painlessly and the resulting change in a person's shape or height is sometimes the first they know about having osteoporosis.
Bone is alive and constantly changing. Bone strength and bone density is built up throughout childhood and during our early adult years. It then remains fairly stable through our thirties, but in middle age as we start to get older we all lose bone density at a very gradual rate. Some people, however, have various 'risk factors' (listed below) that can cause their rate of loss of bone density loss to be abnormally fast leading to osteoporosis.

For women
• A lack of oestrogen, caused by the menopause
• Hysterectomy as a young woman (if both ovaries were removed)
• Missing periods for six months or more
For men
• Low levels of the male hormone testosterone
For men and women
• Long term use of corticosteroid tablets (for various medical reasons)
• Person’s mother has had a fragility fracture
• Previous fragility fracture (ie. a broken bone after a minor bump or fall)
• Low body weight
• An over active thyroid gland
• Intestinal conditions that cause malabsorption (colitis)
• Smoking
• Long term immobility
• Anorexia

The aim of all treatments for osteoporosis is to prevent fractures resulting from falls. So a logical place to start is by taking medicines that help with balance and bone strength. Recent research has shown that Vitamin D is needed, not only for healthy bones, but also for strong muscles and good balance. But vitamin D can’t help bones to stay healthy if there is too little calcium in a person’s diet. So it is usual to prescribe calcium along with vitamin D. Once doctors are satisfied that a person with osteoporosis is getting enough calcium and vitamin D they may decide to give treatments which slow down or reverse the rate at which bones become fragile with age. There are a variety of different treatments which can be used to reverse the loss of bone density seen in osteoporosis. The decision of which treatment to use is determined by a person's medical history and personal preference.

The main treatments used in addition to calcium and vitamin D tablets are: 1/ Bisphosphonates, especially alendronate (but also risedronate, ibandronic acid and cyclical etidronate): these drugs reverse the loss of calcium and minerals from bones, 2/ a calcium substitute that stimulates bone formation called strontium renelate, 3/ a substance which has some of the bone protecting properties of oestrogen called raloxifene. All of these drugs have recognised side effects but your doctor will pick the one which is most likely to agree with you. Less commonly used treatments include testosterone (hormone replacement for men), calcitonin (based on a natural thyroid hormone involved in controlling bone metabolism), calcitriol (an active form of vitamin D) and teriparatide (which encourages repair and production of new bone).
When to consult your doctor
If you think that you may be at risk of developing osteoporosis or are having problems with your current osteoporosis medications, speak to your GP who will discuss the matter with you further. If you are considered to be at risk of osteoporosis your doctor may refer you to have a bone density scan (often called a DXA scan after the type of scanning machine used). This scan measures bone density and can be used to confirm the diagnosis of osteoporosis.
Take the 2-minute test

If you answer yes to any ofthese questions you could beat risk of osteoporosis.

? Have any of your close family been diagnosed with osteoporosis?

? Did you go through the menopause early (before 45)?

? Before the menopause, did your periods ever stop for prolonged periods of time (e.g. 6 months or more) other than because of pregnancy?

? Have you lost more than 1 1/2 inches (4cm) in height?

? Do you often drink more than the recommended alcohol limits?

? Do you smoke more than 20 cigarettes a day?

? Do you frequently suffer with diarrhoea?

? Have you ever taken corticosteroids for more than 3 months?

Useful Tips
  • Eat a well-balanced diet, incorporating minerals and vitamins

  • Make sure that your diet is rich in calcium

  • Try to get out in the sun as often as possible (sunlight makes vitamin D in your skin)

  • Give up smoking

  • Cut down on alcohol

  • Get plenty of exercise

Sponsored by Shire Pharmaceuticals Ltd

Date of preparation April 2009; UK/CORP/09/0019