Professor David M Reid
MBChB, MD, FRCP Edin, FRCP Lon Emeritus Professor at the University of Aberdeen.
Osteoporosis is one of those disorders which some think is simply an invention of the pharmaceutical industry.
Osteoporosis is not a manufactured disorder but the definition of the problem is based on bone density measurements assessed by Dual Energy X-ray (DXA) scan. Bone density is a strong risk factor for excess fracture risk, just as high blood pressure is a risk factor for future stroke and high cholesterol is a risk for future heart attacks.
How common Are Fractures?
At least one in 3 women and 1 in 5 men over the age of 50 will sustain a fracture that could be related to osteoporosis . The commonest sites are the wrist (Colles fracture), the shoulder, the vertebra (back bone) and the hip but really almost any bone fracture can be related to osteoporosis perhaps with the exception of the skull, fingers and toes.
How Can Risk Of Fractures Be Assessed?
Calculating an individual’s future risk of fracture is based on a combination of clinical risk factors most usefully with an additional DXA scan.
There are two different online clinical risk factor calculators which work out an individual’s 10-year risk of major osteoporotic fracture and hip fracture alone and both have been “approved” in NICE Clinical Guidance 146.
Q Fracture has the advantage of including many clinical risk factors but the disadvantage of not linking to arguably the strongest risk factor, bone mineral density (BMD).
FRAX has far fewer risk factors but crucially includes BMD of the hip when available. It also has the arguable advantage of linking directly to the National Osteoporosis Guideline Group (NOGG) recommendations of thresholds for BMD measurement and treatment.
Who Should Be Assessed For Osteoporosis and Fracture Risk?
Really anyone in middle age and beyond can be at risk but individuals who are at increased risk of fractures and will benefit from a risk assessment include those with:
|-A Family History of osteoporosis or fractures||-Women with an early menopause|
|–Men and women with a previous fracture||-High Alcohol Intake|
|-Overactive Thyroid or Parathyroid glands||-Smokers|
|-Eating Disorders especially anorexia nervosa||-Chronic liver or kidney disease|
|-Limited mobility due to neurological disease||-Frequent fallers|
|-Overactive Thyroid or Parathyroid glands||-Chronic Steroid (glucocorticoid) user|
|-Coeliac Disease or poor absorption of food||-Rheumatoid arthritis, ankylosing spondylitis|
In addition loss of height, developing a bent back in mid to older age, or a sudden onset of acute mid or lower back pain could be a sign of a vertebral fracture, which can occur almost silently. These “silent” fractures can often be detected nowadays by the use of a lateral DXA scan, which is taken from the side.
How Can Fractures Be Reduced?
Active weight bearing exercise, good healthy nutrition and access to adequate reserves of vitamin D derived from sunlight, the diet or a supplement is very important for maintaining good bone health. Gauging the right level of sunlight exposure for good bone health without excess risk of skin cancer is problematic but recent advice has been published by NICE.
It would be ideal if improving lifestyle factors alone could reduce fractures but in those with significant increased risk of fracture or those diagnosed with osteoporosis by DXA scan drug therapy will usually be advised. The level of risk at which treatment is advised is based on risk factor calculators and/or a DXA scan result is advised by NOGG and in Scotland by a guidelines from the Scottish Integrated Guideline Network (SIGN).
Methods of Identification of risk of osteoporosis and fracture followed by treatment to support Health Ageing have improved dramatically over the last 30 years. There are still some controversies and subtleties however. The National Osteoporosis Society is an excellent source of evidence based and up to the minute further information.
Professor David Reid is a consultant rheumatologist and has been involved in providing specialist osteoporosis for 30 years.
To book a DXA scan at London Imaging Centre or find out more about the service and our new DXA Lifestyle scan call 020 7467 8800.