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OSTEOPOROSIS and OSTEOPENIA
What is it?
Osteoporosis is the medical term for bones that are demineralising (predominantly losing calcium but also losing other minerals) and are therefore at increased risk of fracture. A lower than expected bone density with no statistical increased risk of fracture is termed osteopenia.
Bone is an active tissue and older bone is constantly being broken down and replaced with new. Osteoporosis occurs when the creation of new bone does not keep up with the removal of old bone. It is not only to do with how much and the type of calcium imbibed, but more to do with nutrition and the many different minerals and nutrients needed and particularly the amount of protein eaten and the form of the calcium imbibed.
This is a common problem affecting up to one in ten women after the age of 60 and one in three after the age of 70. It can affect men too but at about 1/10th the rate.
Three million people have osteoporosis in the UK. This results in 230,000 fractures each year. There are 10 million osteoporotics in the USA
Problems associated with Osteoporosis
Many factors increase risk of osteoporotic fractures. These include:
- Genetics and heredity – a parent who has had a fracture
- Being small or too thin.
- Being Caucasian or Asian as opposed to African descent
- Obesity, smoking and taking above 20 units of alcohol per week
- Diseases such as diabetes and rheumatoid arthritis
- Deficiency in vitamin D, calcium and other minerals
- Low levels of thyroid and the sex hormones.
- Previous trauma
- Lack of balance and neurological disease
- Sight issues leading to increased risk of falls
- Certain medications such as steroid use (not inhaled as used in asthma)
What it can lead to
- Hip and spinal, wrist and other fractures
The average life expectancy after a hip fracture is under six years for both men and women although men fare slightly worse. The range is from 1.5 years to about 11 years so a fracture can markedly reduce longevity.
- Shortened life
This is due in no small part to the decrease in exercise, which itself is partly due to fear of falling.
Up to 45 percent of post-menopausal women have low bone density.
Over the age of 50 there is a 5–8-fold increased risk for all-cause mortality during the first three months after hip fracture and mortality persists over time for both women and men. Hip fractures in women leap up from 250 per 100,000 women at the age of 70 to 2,500 per 100,000 women at the age of 85.
The lifetime risk of a fracture of the hip, spine or forearm is 40 percent in Caucasian women and 30 percent in Caucasian men. African-Americans have fewer fractures than many other races.
- Depression from isolation contributes to osteoporosis if people are fearful of venturing outside.
- Not being exposed to the sun leads to vitamin D deficiency and this is a major factor as bone absorption of calcium is dependent on vitamin D levels.
What symptoms osteoporosis causes:
- None ! It is not a painful condition although you will know if you have a fracture by pain and immobility.
Diagnosis is often made, unfortunately, after a fall leads to a fracture and plain x-rays indicate that the bone is thin. Regular X-rays are not the way to quantitatively assess bone density. This is done by using a specialised low-dose x-ray known as the DXA (previously known as a DEXA Scan) or Quantitative Ultrasound (qUS)
Scanning machines vary from centre to centre and even within the same centre the same machine may show a marked variation on the same patient. We also know that exercise increases bone density and so having a DEXA scan performed after, say, a 2-3 mile walk could lead to variability and influence accuracy.
Tests available in Functional medicine
- The most easily available is the urine test known as DPD Urinalysis.
This compound increases in the urine when bone is being broken down (increased turn over) more quickly than it is able to be built up. There is strong evidence that this sort of testing especially if combined with DXA scanning can predict risk of fracture even in pre-menopausal women.
- There are now investigations from simple saliva or cheek cell swab analysis known as Genomic tests that can indicate who might be at genetic risk of osteoporosis and what dietetic, environmental and life-style changes might benefit each individual.
- Metal toxicity testing. In those with osteopenia/osteoporosis urine or stool testing for lead and other metals is important as this is proven as a major cause of bone loss.