Dr Ajesh Maharaj
Rheumatologist
Westville - Durban

MB.BS.IMS.BHU(Varanasi);
H.Dip.Int.Med(SA);
FCP(SA) Cert in Rheumatology(SA)

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Osteoporosis

About this article

normal-bone

Fig 1
(a) Normal bone

affected-by-osteoporosis

Fig1(b)
Bone affected by osteoporosis

This article has been produced for anyone interested in finding out more about osteoporosis. You may have the con-dition yourself, or you may be a friend or relative of someone with osteo-porosis. Whatever reason you have for reading this, we hope you will find it useful. We want to explain as much as we can about osteoporosis – what causes it, how it can be prevented, and how it can be treated.

Unfortunately we cannot hope to answer all your questions, because every-one is different and this article is no substitute for individual consultation with a doctor.

What is osteoporosis?

The word ‘osteoporosis’ means, literally, ‘porous bone’. It is a condition where you gradually lose bone material so that your bones become more fragile. As a result, they are more likely to break even after a simple fall. Osteoporosis is common in South Africa.

How does it affect bones?

Bone is made of fibres of a material called collagen filled in with minerals – mainly calcium salts – rather like reinforced concrete. The bones of the skeleton have a thick outer shell or ‘cortex’, inside which there is ‘trabecular’ bone which is formed in a meshwork, as shown in Figure 1(a). Osteoporosis causes bone to be lost, leaving gaps in the bone material, as shown in Figure 1(b).

What causes osteoporosis?

total-bone-mass-in-men-and-women

Our bones grow during childhood and adolescence and are at their strongest in the late 20s. As middle age approaches the bones very gradually begin to become weaker. This weakening or thinning of the bones continues as we get older.

The process speeds up in women in the 10 years after the menopause. This is because the ovaries stop producing the female sex hormone oestrogen – and oestrogen is one of the substances that helps keep bones strong. Men suffer less from osteoporosis, because their bones are stronger in the first place and they do not go through the menopause.


Who is at risk?

All of us are at risk of developing osteoporosis as we get older, which is why elderly people are more likely to break bones when they fall. But there are some people who are more at risk of osteoporosis than others. These are some of the factors that can make a difference:

Can you prevent osteoporosis?

There is a great deal which can be done at different stages in your life to guard against the condition.

How can osteoporosis be detected?

There are no obvious, physical signs of osteoporosis, because no one can see the bones getting ‘thinner’. Osteoporosis can go unnoticed for years without causing any symptoms. Quite often the first indication that someone has a problem is when s/he breaks a bone in what would normally have been a minor accident. Relatively minor fractures of the spinal bones can cause you to become round-shouldered and to lose height. These minor fractures may be painless but can cause back pain in some people. If a doctor suspects osteoporosis, s/he can order a scan to test the strength or density of the bones. This scan is now available at some hospitals throughout the country. The results will tell how much risk there is of the bones fracturing. You will need to lie on a couch, fully clothed, for about 15 minutes while your bones are x-rayed. The dose of x-rays is tiny – about the same as spending a day out in the sun. The technique is called dual energy x-ray absorptiometry (DEXA).

What are the consequences?

People with osteoporosis are more likely to break a bone even after a relatively minor accident. Fractures are most likely to the hip, spine or wrist. Hip and wrist fractures are usually sudden and the result of a fall. People who have previously had a fracture after a minor fall are at greater risk of further fractures.

Spinal problems occur if the bones in the spine (vertebrae) become weak and crush together. If several vertebrae are crushed, the spine will start to curve. This may cause back pain and loss of height and because there is then less space under the ribs, some people may have difficulty breathing. People who have this type of spinal problem also have an increased risk of fractures.

How can osteoporosis be treated?

Apart from the preventive measures already described there are other treatments available if you have osteoporosis. These may slow down the loss of bone or reduce the risk of fractures.

Finally...

Leading an active healthy life and maintaining a diet with sufficient calcium is the best way of preventing osteoporosis. If you have the condition already, there are a number of treatments which can be effective, as described above.

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