Many people quite rightly see osteopaths as clinicians who know a LOT about bones. That is because we do!
When you ask someone what might make them more likely to have osteoporosis, lots of discussion about calcium comes up. It is a common misunderstanding that osteoporosis is caused by ‘low calcium’ in bones. Though dietary factors play a part, there are a handful of risk factors that are far more important to consider. When I ask you about your health history, medication and activity levels I am trying to get an indication of your bone health.
What is osteoporosis?
Osteoporosis is a pathological metabolic bone disease which causes a weakening of bone and an increase in the risk of fractures in older age. Bone is shaped and affected by the stresses that are put through it. Bone breaks down and reforms according to these stresses – this happens with everyone and is a totally normal metabolic process.
There are two key bone types – an outer cortical bone, and an inner cancellous bone. The outer bone is often where things like calcium is stored and provide the supportive and protective functions of bone. The inner bone is almost exclusively metabolic – is it softer and holds our bone marrow.
When someone has osteoporosis, the reformation of bone is not efficient and more bone is resorbed than is created to replace it. So the bone naturally breaks down but is reformed with thinner and weaker bone. This process happens faster in the more metabolic cancellous bone. The hip, wrist and spine have more of this cancellous bone and also rely more heavily upon supportive bone being healthy – and this is why osteoporotic fractures are more common in these areas.
There are three key types of osteoporosis:
Type 1 osteoporosis is causd by reduced oestrogen production (post-menopausal)
Type 2 osteoporosis is naturally occurring after age 75 as bone formation slows and no longer matches bone resorption (Women to men ratio is 2:1)
Type 3 osteoporosis is a ‘secondary’ type – after the use of certain medications or certain medical conditions or treatments.
What are the risk factors for osteoporosis?
Here are the strongest risk factors for the development of osteoporosis:
- Age: half of the population will have osteoporosis by age 75
- Gender: women are four times more likely to get osteoporosis due to the fall in oestrogen after menopause
- Race: Caucasians are more at risk
- Low body weight: those who are lighter (BMI <19) are more likely to have a fracture – this is in part due to less ‘padding’ but also lighter people have less ‘bone reformation’ stress put through their bones
- Previous fracture: those with a previous fracture are more likely to develop future fractures
- Smoking: if you smoke, you are more at risk for osteoporosis
- Alcohol: if you drink, you are more at risk for osteoporosis
- Medications: oral glucocortigoids for over three months increases your risk
- Longstanding disease: malnutrition, rheumatoid arthritis, Cushing’s disease, cancer, diabetes, hyperthyroidism (untreated) and a range of other conditions are also associated as are conditions which result in prolonged bed rest
What can I do?
Reduce smoking and alcohol (or stop entirely) and engage in weight bearing exercise in order to stimulate the regrowth of strong bone.
How at risk am I?
If I am concerned you may be at risk for osteoporosis, I will fill out an evidence based FRAX survey questionnaire for you and mail your GP so that you may be referred for a bone mineral density test if indicated. If you are worried, ask at your next appointment or speak to your GP.
If I suspect you may have a fragility fracture, I will immediately refer you for imaging and evaluation.