Throughout our lives our bones continue to grow, be broken down and renewed. Osteoporosis has been dubbed ‘the silent killer’ as it has no symptoms until you break a bone, and this can be more likely at menopause.

What is it?

Osteoporosis means “porous bones” and bones are strongest at about age 30, then begin to lose density.

Overall, 61% of osteoporotic fractures occur in women and in the UK 1 in 2 women and 1 in 5 men will suffer a fracture after the age of 50. Almost 3 million people in the UK are estimated to have osteoporosis, with more than 300,000 fractures every year due to osteoporosis.

Our bones are constantly being rebuilt throughout our lifetime. Bones are made up of collagen, a protein that provides the basic framework, and calcium phosphate, a mineral that hardens the bone.

As we age, we lose more bone than we replace. The greatest change in a woman’s bone density comes in the five to seven years after menopause.

Symptoms 

Worryingly few people know they have it until they break a bone, because there is no warning and no obvious symptom. So you might not even realise you have osteoporosis until you have a fracture or an obvious change in posture.

In fact, you could have significant bone loss without even knowing it. Back pain, caused by changes in the vertebrae, may be the first sign that something is wrong.

Osteoporosis is the underlying cause of 1.5 million fractures every year. Spinal compression fractures are the most common — tiny fractures that can cause the vertebrae to collapse and alter the shape of the spine.

Hip fractures can cause lasting mobility problems and even increase the risk of death, which is where the ‘silent killer’ tag has come from. Wrist, pelvic, and other fractures are also common in people with osteoporosis.

Who is at risk?

Bone loss is a natural part of aging, but not everyone will lose enough bone density to develop osteoporosis. However, the older you are, the greater your chance of having osteoporosis.

Women’s bones are generally thinner than men’s and bone density has a rapid decline for a time after menopause, so it’s not surprising that there are fewer men with osteoporosis than women.

Women who are thin and have a small frame are more likely to develop osteoporosis. Heredity plays a role, and so does ethnicity.

Some conditions, such as type 1 diabetes, rheumatoid arthritis, inflammatory bowel disease, and hormonal disorders are also linked to bone loss.

How to reduce the risk?

You cannot change your family vulnerability to osteoporosis but there are a number of ways to reduce the risk.

Lifestyle factors such as smoking, lack of weight bearing exercise, excess drinking and a diet low in calcium and vitamin D place you at greater risk for bone loss and a risk of fractures.

Some drugs too can b e a problem such as corticosteroids and anti-inflammatory drugs used to treat asthma and other conditions may increase your risk of bone loss.

Eating disorders (anorexia nervosa or bulimia) can also take a toll on bone health and can put younger women at risk later in life.

Weight-bearing exercise can help you build bone and maintain it. That includes walking, jogging, tennis, and other activities where you move the full weight of your body.

Using small weights in many different activities helps bones. Women who walk just a mile a day have four to seven more years of bone reserve, researchers have found.

Dietary help:

Some foods are better than others at helping build and protect bones. Eating calcium-rich foods can help protect your bones no matter what your age as can fish such as salmon, tuna, and herring.

These also contain vitamin D, which helps us absorb calcium, and leafy green vegetables also provide magnesium, which helps maintain good bone quality.

Osteoporosis can also benefit from a specific bone supplement which has ingredients such as calcium, magnesium, boron and vitamin D as well as other helpful ingredients.

What you want to avoid or minimise are foods that leach calcium from your body, and a major culprit here is salt. Common food items such as canned soups and processed meat are often high in salt, so check the labels.

Caffeine can decrease your body’s absorption of calcium too, but the effect is minimal unless you drink more than three cups of coffee a day. Heavy alcohol use can also lead to bone loss.

What about testing?

Your doctor may recommend a bone mineral density test such as a DXA scan if:

• You’re over 50 and have broken a bone
• You are a woman over 65, or a man over 70
• You are in menopause or past menopause and have risk factors

DXA (dual X-ray absorptiometry) uses low-dose X-rays to measure bone density in the hip and spine. The test takes less than 15 minutes, but you could also have a private ultrasound scan.

This is less invasive and is a service offered by Dame Dr Shirley Bond for osteoporosis screening, results interpretation and advice. You will find more information here:

http://www.harleyplacescreening.co.uk

Conventional treatment

If you are diagnosed with osteoporosis, you may be prescribed a biophosphonate: Actonel, Boniva, Fosamax, or Reclast. However there are known there are health risks associated with these drugs – particularly digestive problems oesophageal ulceration and it also increases the risk of arterial fibrillation.

Injectable bisphosphonates, given one to four times a year, can cause brief flu-like symptoms. Bisphosphonates may increase risk of jaw bone destruction and atypical femur fractures.

The bioidentical alternative for osteoporosis is progesterone as this is the hormone that helps build bone throughout life. However, If you wish to take progesterone for osteoporosis then it cannot be taken alongside Fosamax.

HRT has been given for osteoporosis as we need oestrogen to clear away old bone, and progesterone for new bone but due to concerns about the risk of cancer, blood clots, heart disease, and stroke this is less common.

Also HRT does not contain progesterone, but a synthetic progestin which does not have the same benefits as the bioidentical hormone..

 The bioidentical alternative

Over two decades ago, Dr. John Lee first published his startling conclusions about conventional hormone replacement therapy (HRT): that synthetic hormones don’t work as predicted and, worse, they pose a health threat to women.

His findings touched off a storm of controversy. But years later, research has proved him right as bioidentical progesterone supplementation can be considered an integral part of the treatment plan for osteoporosis.

Among one-hundred patients treated in a clinical setting, progesterone was shown to increase BMD and decrease the chances of fractures in postmenopausal women with osteoporosis.. Although Dr. Lee died in October 2003, his work lives on and offers women a non-drug alternative to help with hormonal issues as well as osteoporosis.