What is Osteoporosis?

Reviewed by Dr Ray SH Ng

Osteoporosis occurs when bone mass decreases and becomes less dense than average. Generally, after the age of 30, the rate of bone metabolism gradually exceeds the rate of production, so our bones begin to weaken bit by bit.

Osteoporosis is a chronic disease that increases fracture risk due to decreased bone density and is more common in post-menopausal women. Osteoporosis has no obvious symptoms in the early stages making it more important to recognise the common symptoms when they do come along. 

Does osteoporosis come with old age?

Osteoporosis is more common in older age but this does not mean younger people cannot get it. Although the medical community does not fully understand the causes of osteoporosis, many known factors are known to contribute.

What are the common causes of osteoporosis?

As you age, losing bone is completely normal. However, it is not uncommon for some people to lose bone quicker than others.

Unfortunately, women are at a higher risk of losing bone quickly as it can be accelerated in the early stages of menopause. Osteoporosis is even more likely if menopause comes early, or if they have had to have ovaries removed for other reasons. This does not mean that osteoporosis only happens to women though. It can also affect men, younger women and children.

Other factors that increase the risk of osteoporosis include:

• Heavy drinking and smoking
• Eating disorders such as anorexia or bulimia
• Having a low body mass index (BMI)
• Not exercising regularly
• Long-term insufficient intake of calcium and lack of vitamin D
• Family history of osteoporosis
  • Hip fractures in the family are a good sign if nobody has been officially diagnosed with osteoporosis
• Regular use of some medicines over a long period of time can affect bone strength or hormone levels. For example
  • Anti-oestrogen tablets used after breast cancer 
  • Long term oral steroid medication
• Other healthcare conditions that increase risk of osteoporosis include:
  • Inflammatory conditions
  • Hormone-related conditions
  • Malabsorption problems

Is there an initial self-assessment for osteoporosis?

If you want to preliminarily assess whether you have osteoporosis, you can refer to online programmes such as FRAX or Q-Fracture to understand your own osteoporosis risk.

For a more scientific approach, you may choose to get a bone density scan (DEXA scan) to measure your bone strength. It's quick, painless and results are compared to that of a healthy young adult. It is worth speaking to your doctor first to see if this is required. 

Preventing, treating, and living with osteoporosis

How do I prevent osteoporosis?

Those at risk of getting osteoporosis can take steps to ensure they remain healthy. This can include:

• Taking regular exercise 
• Healthy eating, particularly of foods with high calcium and vitamin D levels
• Daily supplements can help, but for optimum effects consult your doctor first
• If you are a smoker or heavy drinker you should quit smoking immediately and monitor your alcohol intake

Treating for osteoporosis

Treatment for osteoporosis is largely down to nursing broken bones back to health and ensuring you minimise your chances of breaking a bone. Doctors can prescribe medications that strengthen your bones but will only do so if appropriate for you. It is also important to strengthen the joints and muscles to protect your bones as best as possible. This can be done through exercise. It is best to do that through consultation with a physiotherapist. A women’s health physiotherapist will be acutely aware of the issues women face as a result of menopause accelerating bone loss.

Living with Osteoporosis

When diagnosed with osteoporosis, it is important to put yourself in positions where you reduce your chances of falling. Regular sight and hearing tests would be a good place to start. Ensuring your senses are as good as they can be will mean your reactions can be faster. Lastly, maintaining good muscle strength will reduce the risk of falls and protect against fractures.

Osteomalacia vs Osteoporosis: What’s the difference?

Osteoporosis and osteomalacia are two bone conditions that reduce bone mass but differ in their mechanisms. Osteoporosis involves a decrease in bone mass with a normal ratio of bone mineral to matrix, leading to brittle bones prone to fractures. It results from low peak bone mass, increased bone resorption, and impaired bone formation. Osteomalacia, caused by severe vitamin D deficiency or abnormal metabolism, features a low ratio of bone mineral to matrix due to impaired mineralisation, leading to bone softening. While osteoporosis is more common, both conditions can coexist​​.

Embracing Bone Health: A Conclusive Overview

Understanding and managing osteoporosis involves recognising its potential onset at any age, though it's more prevalent in older adults and post-menopausal women. Key preventive measures include maintaining a healthy lifestyle with regular exercise and a diet rich in calcium and vitamin D. For those diagnosed, treatment focuses on bone strengthening and minimising fall risks, underscoring the importance of a proactive approach towards bone health. Moreover, distinguishing it from osteomalacia clarifies the unique challenges and treatments for those facing bone density issues, highlighting the nuanced care required for bone health.