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Osteoporosis and fracture risk

What is osteoporosis?

Osteoporosis is a progressive, systemic (affecting the whole body) skeletal disease that affects bones, making them fragile and more likely to break (osteoporosis means “porous bone”). It is a chronic, lifelong condition and affects over two million people in the UK; more than double the number of people affected by dementia.

Osteoporosis usually occurs in later life and affects both sexes, but women are at greater risk, particularly after the menopause, when levels of the hormone estrogen are no longer adequate to provide protection. As bones weaken, there is an increased risk of sudden and unexpected fractures, and in particular, fragility fractures, a term for fractures that occur following a fall from standing height, or after minimal trauma.

Bones are living tissues made of a hard, dense outer layer and an inner core of soft, spongy material. Under normal circumstances, bones go through a process of remodelling and repair, as old, damaged bone is replaced by new, healthy bone.

Osteoporosis affects this remodelling process, causing “holes” to appear in the spongy tissue, which, as time goes on become larger and more numerous, resulting in weakening of the internal bone structure and increased fracture risk. Osteoporotic fractures can occur anywhere in the skeleton, but they most commonly occur at the wrist, hip, spine and upper arm.

Multiple fractures occurring together in the spine may result in an increase in spinal curvature, known as a kyphosis, often described as a ‘Dowager’s hump’, which results in poor posture, back pain and reduced height.

Research shows that osteoporosis may have a significant effect on quality of life. In a study by Opinion Health in 500 women over age 55 with postmenopausal osteoporosis:

  • 77% said osteoporosis had an impact on their life
  • 43% said it had an impact on day-to-day tasks, such as housework and gardening
  • 36% said their quality of life was adversely affected, and
  • 65% said they suffered pain to some degree

Osteoporosis generally causes no symptoms, so women are usually totally unaware of it until they experience a fracture, often following a fairly minor fall or injury. It is estimated that one-third of women with osteoporosis are undiagnosed.

Osteoporosis Stages

Why is osteoporosis risk increased after menopause?

Estrogen is necessary for the maintenance of healthy bones, and as levels fall following menopause, normal bone remodelling is impaired, and many women experience a rapid fall in bone density. This is particularly important for women experiencing early menopause or premature ovarian insufficiency (POI) for whom prolonged estrogen deficiency significantly increases the risk of osteoporosis and other medical conditions such as cardiovascular disease.

Other risk factors for osteoporosis

  • taking high-dose corticosteroids for more than 3 months
  • medical conditions such as inflammatory and hormone-related disorders or malabsorption problems
  • a family history of osteoporosis; particularly a history of a hip fracture in a parent
  • excessive alcohol intake
  • long-term use of certain medicines that affect bone strength or hormone levels, such as anti-estrogen preparations that many women take after breast cancer
  • eating disorders such as anorexia or bulimia
  • low body mass index (BMI)
  • lack of exercise
  • smoking

Predicting fracture risk

Fracture risk can be predicted using tools such as FRAX, which estimate the risk of a fracture occurring in the next 10-years based on the presence or absence of many of the risk factors listed above. A high FRAX score warrants further investigation to assess the presence of osteoporosis, followed by implementation of appropriate prevention and/or treatment measures.

What are the symptoms of osteoporosis?

As stated above, osteoporosis doesn’t usually cause symptoms, so most people are unaware of it until they have a fracture or the diagnosis is made on a DEXA scan (see below). 

The most common fracture sites in people with osteoporosis are the wrist, hip and spine, however, breaks can also happen in other bones, such as the arm or pelvis. Sometimes, even a cough or sneeze can cause a broken rib or the partial collapse of one of the spinal vertebrae. Although osteoporosis is not usually painful until a bone is broken, vertebral fractures (broken bones in the spine) are a common cause of long-term pain.

How can osteoporosis be prevented?

To keep bones healthy and prevent osteoporosis, it’s important to::

Bone strengthening treatments may also be  prescribed for some people to prevent a fracture.

How is osteoporosis diagnosed?

Osteoporosis is usually diagnosed by measuring bone density at the spine and/or hip with a DEXA (dual energy X-ray absorptiometry) scan. Bone density gives an indication of the strength of bone and therefore can be used to predict the risk of a fracture, as well as to monitor responses to osteoporosis treatments.

DEXA scans can also detect osteopenia, the stage before osteoporosis, which uncorrected may progress to osteoporosis. Osteopenia does not itself  increase fracture risk.

How is osteoporosis treated?

Treatments for osteoporosis slow the rate of bone breakdown or increase the rate of development of new bone, and some do both.

  • Estrogen as hormone replacement therapy (HRT), usually in the form of a tablet, patch gel, or spray, is the most effective treatment for menopausal osteoporosis. HRT replaces the estrogen no longer being produced by the ovaries and slows the rate of bone breakdown as well as increasing new bone development. Estrogen may be used to prevent and treat osteoporosis in perimenopausal and early post-menopausal women.
  • Bisphosphonates taken as a tablet, liquid or injection, slow  the rate of breakdown of bone.
  • Selective estrogen receptor modulators (SERMS) mimic the effect of estrogen and help to maintain bone density and reduce fracture risk. They are taken as a daily tablets.
  • Parathyroid hormone treatments, like estrogen, stimulate cells to create new bone. These are usually only used in people with severe osteoporosis and are given by injection.
  • Biologics are made from proteins or other substances produced by the body and are usually recommended where other treatments can’t be used or for people who have severe osteoporosis. They work by slowing bone breakdown and increasing new bone development and are given by injection.

Most people receiving treatment for osteoporosis will often also be prescribed calcium and vitamin D supplements.

How NewWoman Health can help

At NewWomen Health we have a commitment to educating, advising, treating and supporting women approaching, during, and following menopause. Our wide range of medical and lifestyle interventions helps women to manage or minimise their menopause symptoms and improve their quality (and potential longevity) of life in an aspirational and uplifting way.

If you’re concerned about osteoporosis or any symptoms you have been experiencing, we can help with our personalised medical consultations with menopause specialists. Take the next step in learning about osteoporosis and ensuring your long-term health and quality of life by booking a consultation with us today.

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You are not alone. As a local example, in Manchester over 46% of council employees are female and over 40 years old. In a CIPD survey (2019) over 30% of women said they were unable to work because of menopausal symptoms.

Only 25% said they could tell their manager the real reason for their absence. The Council account for nearly 7% of all employment in Manchester. They implemented a new Menopause policy in March 2022. CIPD survey | Manchester Council Menopause Policy | CIPD Manchester

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