20/10/2023
Approximately ½ of women and 1/5 of men will sustain at least one fragility fracture in their lifetime1. ‘What is a fragility fracture?’ you may ask…
You may be thinking that the phrase “low trauma” suggests that there’s not a lot of pain involved but this couldn’t be farther from to the truth. Causing severe pain, a reduction in quality of life and even disability, fragility fractures deserve significantly more awareness as it’s your bones providing structure to your body and protecting your organs. Here’s a few questions to get you thinking about the impacts fragility fractures cause throughout the UK:
a) £549,000
How many people sustain fragility fractures in the UK?
A) 590,0001
B) 812,0001
C) 1,100,0001
C) £5.4 billion
How much did fragility fractures cost the NHS in 2019?
A) £2.1 billion
B) £3.4 billion
C) £5.4 billion
C) the hips, spine & limbs.
Where are fragility fractures most common?
A) neck, wrist & skull.
B) knuckles, fingers & toes.
C) hips, spine & limbs.
As Autumn gets into full swing and we quickly approach the gloomy nights of winter, the reduction in your exposure to sunlight means you’re getting less vitamin D. This vitamin, along with calcium, is crucial to healthy bones. The theme for World Osteoporosis Day 2023 is ‘Build Better Bones,’ giving us an opportunity to investigate this common condition, the mechanisms behind it, and what you can do to reduce the risk of fractures and maintain healthy bones.
What is Osteoporosis?
Osteo (bone) – por (passage) – osis (condition)
Osteoporosis is a combination of Greek words, as described above. However, the accepted translation is ‘porous bones.’ It’s a metabolic bone condition characterised by weak, fragile bones and an increased risk of fracture.
To understand osteoporosis, you’ll first need to understand a few key terms. First up are modelling and remodelling. Modelling is the formation or resorption of bone occurring independently at distinct sites which changes the dimensions and shape of the bone during growth2. Remodelling is different – a finely orchestrated process involving the resorption of bone tissue followed by the formation of new bone at a specific location2. This intricate mechanism plays a vital role in preserving the structural integrity of the skeleton by continuously renewing old or compromised bone. Next are the cells involved in these processes: osteoclasts are responsible for bone resorption and osteoblasts, for bone formation2. Finally, there are osteocytes. Osteocytes are the most abundant cell type found in bone. These enigmatic bone cells have, until recently, been considered bystanders in bone metabolism. New insights, however, have shown an important role in bone and mineral maintenance and a role as drivers of bone remodelling2.
Osteoporosis Causes and Risk
Osteoporosis causes are multifactorial including a complex relationship between genetic and lifestyle factors which can affect your bone density. These include endocrine mechanisms such as oestrogen deficiency, secondary hyperparathyroidism, and vitamin D deficiency2. Osteoporosis is categorised as primary or secondary.
You’re at increased risk of primary osteoporosis as you get older and develop age-related sex hormone deficiencies, which can cause a loss of bone density. As we age, the remodeling process is altered so that more bone is resorbed than is formed, causing a reduction in bone density. The decrease in oestrogen levels seen in post-menopausal women can contribute to loss of bone density and increase osteoporosis risk3.
Secondary osteoporosis is the loss of bone density associated with a range of other conditions or medications. Many diseases commonly affect our metabolic balances some of which, like calcium and vitamin D, can cause a loss of bone density and increased risk of osteoporosis. For example, Cushing’s disease causes an increase in cortisol production, which can lead to accelerated loss of bone density. Treatment for rheumatoid arthritis commonly takes the form of long-term glucocorticoid therapy which can result in similar losses of bone density3.
In men, glucocorticoid therapy is a common cause of osteoporosis symptoms. Other causes associated with osteoporosis, particularly in men, are excessive alcohol use and hypogonadism3. In women, calcium disorders, such as hypercalciuria (excess calcium in the urine), and hyperparathyroidism (excess production of parathyroid hormone, which regulates calcium levels) contribute to 78% of secondary causes. Other common risk factors include vitamin D deficiency, 3, white or Asian ethnicity, thyroid problems, eating disorders, gastrointestinal surgery, and family history of osteoporosis4.
Osteoporosis Diagnosis
Until recently, the gold standard for osteoporosis was the determination of bone mineral density through dual-energy x-ray absorptiometry (DEXA). However, this is now used to supplement FRAX (Fracture Risk Assessment Tool)5. FRAX is a tool used to assess the risk of fractures in individuals, particularly those with osteoporosis or at risk of developing it. Developed by the World Health Organization (WHO) Collaborating Centre for Metabolic Bone Diseases at the University of Sheffield, UK, it considers various risk factors such as age, sex, body mass index (BMI), previous fractures, parental history of hip fracture, smoking, alcohol intake, and the presence of certain medical conditions5. With this information, FRAX calculates a person’s 10-year probability of a major osteoporotic fracture (hip, spine, forearm, or shoulder) and the 10-year probability of a hip fracture combining their personal risk, with region-specific fracture rates to provide the most accurate assessment possible5.
Osteoporosis Treatment
If you receive an osteoporosis diagnosis, there are several treatment options available. Your doctor may prescribe bisphosphonates. This is a class of drugs which work by slowing osteoclast functions and therefore, bone resorption6.
For post-menopausal women, selective oestrogen receptor modulators (SERMs) are another option. SERMs function similarly to oestrogen and help support bone density and reduce the risk of fracture6.
Parathyroid hormone (PTH) is commonly implemented in osteoporosis due to its role in calcium regulation. PTH treatments can be used to help stimulate osteoblasts6. The primary distinction among these treatment approaches lies in their capacity to increase bone density, as opposed to the alternative method, which merely reduces the rate of bone degradation. Nevertheless, these treatments are exclusively reserved for scenarios where bone density is exceptionally low and conventional treatments have proven ineffective6.
Ensuring an adequate intake of both calcium & vitamin D contributes to maintaining strong & healthy bones6.
Calcium
Calcium plays a crucial role in bone health, serving as the primary mineral in bones. A balanced diet should include sufficient calcium to maintain healthy bones.
For those dealing with osteoporosis, additional calcium, often in the form of supplements, may be necessary. You should consult your healthcare professional for guidance on calcium supplementation6.
Vitamin D
Vitamin D is vital for calcium absorption. Between late March and September, sunlight provides adequate vitamin D. However, given the challenge of obtaining enough from food alone, many people consider daily vitamin D supplementation during the autumn and winter months. NICE guidance states that all adults should consider taking a supplement containing 400IU of vitamin D particularly during autumn and winter and that those over 65 years old should consider this all year round7.
Other Factors
Exercise has a significant impact on bone mineral density and osteoporosis. A combination of weight-bearing and resistance exercises, such as walking, jogging, and weightlifting, stimulate bone remodelling and increase bone mineral density. These activities create stress on bones, prompting them to become denser and stronger over time3. Incorporating exercise into one’s routine, coupled with a balanced diet, is an effective strategy for building and preserving bone health, reducing the risk of osteoporosis, and improving overall quality of life3.
Other factors which can impact your risk of osteoporosis have been alluded to throughout this article, such as excessive alcohol intake and smoking, but obesity also contributes to the development of osteoporosis3.
How Randox Health Help
As we observe Osteoporosis Day, it’s crucial to emphasize the significance of bone health in our lives. Prevention and proactive care are paramount, and Randox Health stands at the forefront of promoting overall well-being. Our signature packages, thoughtfully designed to encompass all aspects of health, including bone health, reflect our commitment to your holistic well-being. By choosing these packages, you’re taking a step towards ensuring a future where healthy, resilient bones are a cornerstone of your active, vibrant life. So, get in touch today to find out how you can understand your health to the fullest.
With 1 test, measure 350 health data points relating to your full body health including genetic, stress, neurological & tumour associated markers with a private GP consultation to discuss your results.
Expanding on our Signature Prestige service, The Signature Platinum package includes full repeat testing after 6 months allowing you to effectively evaluate the progress of your health journey to the fullest and identify further areas for improvement.
Our most comprehensive, personalised health programme available.
Signature Platinum + integrates state-of-the-art genetic screening into Platinum’s expansive test menu, covering 174 genes associated with increased risk of inherited cardiac conditions & 94 genes associated with mutations that increase your risk of hereditary cancers.
- Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022;17(1):58. doi:10.1007/s11657-022-01061-5
- Föger-Samwald U, Dovjak P, Azizi-Semrad U, Kerschan-Schindl K, Pietschmann P. Osteoporosis: Pathophysiology and therapeutic options. EXCLI J. 2020;19:1017-1037. doi:10.17179/excli2020-2591
- Tu KN, Lie JD, Wan CKV, et al. Osteoporosis: A Review of Treatment Options. P T. 2018;43(2):92-104.
- Mayo Clinic. Osteoporosis . Diseases & Conditions. Published September 7, 2023. Accessed October 5, 2023. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968
- Kanis JA, Johansson H, Harvey NC, McCloskey E V. A brief history of FRAX. Arch Osteoporos. 2018;13(1):118. doi:10.1007/s11657-018-0510-0
- NHS. Treatment . Osteoporosis . Published October 13, 2022. Accessed October 5, 2023. https://www.nhs.uk/conditions/osteoporosis/treatment/
- National Institute for Health and Care Excellence. Scenario: Prevention of vitamin D deficiency. Vitamin D deficiency in adults. Published January 2022. Accessed October 18, 2023. https://cks.nice.org.uk/topics/vitamin-d-deficiency-in-adults/management/prevention/