What is osteoporosis?
Osteoporosis is common in the UK and affects nearly three million people. It is called the silent disease, as worryingly, most people don’t know they have it until they break a bone.
There are more than 300000 fractures a year in the UK; patients often come to see me after they’ve had a fracture, or they may be worried because someone else in their family has had a fracture. Another reason patients may visit me is if that they’ve had an early menopause.
Most patients are women over the age of 50, but patients with some chronic diseases like inflammatory bowel disease or rheumatoid arthritis may also visit me. People who have been on certain medications, such as steroids for severe asthma or polymyalgia rheumatica, might come for advice about their bones, because steroids can reduce bone density and lead to fracture.
There are two types of fractures: peripheral fractures – for example, fractures of ankle, wrists or hips. Some people can also fracture their spine. Spinal fractures can occur spontaneously and asymptomatically. They can lead to height loss and curvature of the spine.
Patients visit me for further evaluation or if they’re worried about osteoporosis. Often, they are referred by their GP or by an orthopaedic surgeon, if they’ve had a fracture.
We will take a medical history and examine you to make sure there is not a secondary cause for osteoporosis. We may also go through your drug history, and we’d then usually arrange a bone density scan, or a DEXA scan. This is a non-invasive scan that involves you lying on a bed while an arm like scanner passes over you – it takes about 10 minutes. The scan is open, and you are not closed in. It can be done on the same day as the clinic appointment. We can then calculate your fracture risk, which will help us decide if you require treatment or diet and lifestyle advice.
Following your initial appointment and DEXA scan, we can decide on what kind of treatment you need.
There are now several different oral therapies: an intravenous once yearly therapy, and a local subcutaneous injection, which is given once every six months. All the treatments are very effective. They reduce the risk of spinal fracture by up to 74% and reduce the risk of hip fracture by up to 40% over the following few years, so they’re worth trying.
Once you have decided which treatment you wish to take, your GP can continue treating you with it for the next few years, if you decide on an oral treatment. If you decide to have an IV treatment, you will return once yearly for a 30-minute infusion for the next three years. This will protect your bones for up to six years in total (three years of treatment for six years of protection).
If you decide to have the six-monthly injection treatment, we will usually arrange the first injection and your GP could prescribe further treatments in the majority of cases after that. To make sure your bone density is improving, the option to have a repeat scan in two years’ time is available.