So osteoporosis is a condition of the bones where they become a little thin and in the
end of the day somewhat porous, which is where the name comes from.
The bones are lost in all of us - the density in the bones lost as we get older,
but when it gets down to a critical volume, that is defined as osteoporosis
and there is a wordy technical definition for that level of bone density.
The bone density is measured by a DEXA scan.
A fragility fracture is a break in the bone which occurs most commonly in people who have osteoporosis
and it is technically defined as those fractures which occur after a fall from a less than standing height.
This means that anybody who has a simple trip and falls to the ground, stretches
their arm out and it breaks, that can be considered to be a fragility fracture.
So the combination of osteoporosis and a small trip may be enough to induce a fracture
and that's what we are trying to define
when we talk about the combination between osteoporosis and fragility fractures.
So for most of us, we don't need to worry too much about preventing fractures
because our bones are in good health, but if we have a tendency towards osteoporosis or thin bones,
then we just have to be a little bit more careful.
That means on the basis of not suddenly putting yourself in a position
where you're likely to cause your bones to be injured.
And a silly example might be, you would not go bungee-jumping if you had osteoporosis.
You would not jump over hurdles or walls when you were walking.
You would just be very a bit more careful than is normally the case.
You would want to try and avoid situations where you're more prone to have a fall,
such as when the pavements are icy, you're just a little more careful,
you may want to use a walking stick just to give you some support while getting around.
You make sure that your footwear is good and that your laces are fully tied up
and you don't trip over your laces.
You want to be certain that your eyesight is in good order
so that you can see clearly where you're going
and you want to perhaps avoid situations where you're in a crowd
and might be pushed unintentionally by others.
So there are ways in which you can avoid falls.
First thing is, if you're a little older and you're taking some drugs or medication
for blood pressure for example, or for your heart,
it's important to be sure that these are all being tested and you do still need them,
because some drugs do make us more prone to falls as we get older.
The second thing is that we can make sure that the environment that we live in is safe
and does not have, for example, loose wires or cables or loose carpets in the home
which we'll easily trip over.
Thirdly, we can be sure when out and about that we have had recent eye tests
and that our eye function is corrected as best as it can be with our glasses.
Poor eye function, for example, if you have cataracts, makes you very much more prone to falls.
If you have arthritis for example, then falls are more common
and sometimes then you need to use a stick.
Particularly, if you've got arthritis of your lower legs.
If you avoid situations where there's a big crowd when you might get pushed - for exmaple the football match -
then you can perhaps avoid the falls
as a consequence of being in that circumstance.
So if you already have osteoporosis, then it is important to maintain good nutrition.
In terms of preventing it, you probably can't prevent loss of bone entirely by diet alone.
In terms of nutrition, the important elements in the diet are of course calcium intake.
Calcium comes from a wide variety of sources, but is particularly present in daily products
including milk and cheese.
And in passing, it's important to note that if you have to take so-called milk supplements
or milk alternatives such as soya milk or almond milk,
these are almost always supplemented with calcium.
However, calcium is not the most important element in essence
in keeping a good amount of calcium in your bones.
The most important element is ensuring that you have adequate amounts of vitamin D in your system.
And you get vitamin D from meat and some other products such as margarine,
but importantly, you get vitamin D from sunshine and sunlight
and it's important to get a little bit of sunlight and sun exposure
to keep your vitamin D level satisfactory.
So, there are only a small number of medications
which are approved by the regulatory authorities to treat osteoporosis.
One for ladies just past the menopause is hormone replacement therapy,
and that has become less common over the last decade,
but it's becoming a little bit more common again to use it in ladies first past the menopause;
that is in their 50s.
And then the most common type of drug is a drug called bisphosphonate
often taken by mouth once a week on an empty stomach.
The commonest of that is Alendronic acid or Fosamax.
The same sort of drug can be given by an injection into a vein once a year
for three years and it's called zoledronic acid,
and then there's another class of drug which is injected under the skin
and has the same sort of effects as the bisphosphonates:
reducing fractures and improving bone density.
And that's called Denosumab or Prolia.
Then for those who have the most severe osteoporosis with multiple fractures,
bone building drugs can be used and the most common of these and the only
one available at the moment is a drug called teriparatide.
But a new drug may well be coming onto the market early in 2019,
which will be a considerable advance in this regard.
In living with osteoporosis, it really depends on whether you already have had a fragility
fracture or whether you're trying to avoid having one.
If you don't have a fragility fracture,
then weight bearing exercise, stressing the bones with walking, gentle jogging
and some exercises for your spine, will be a help in reducing the rate of bone loss.
For people who already have osteoporosis and perhaps have had fractures or breaks in the bones
in their spine and have become shorter and perhaps a little more bent as they grow older,
this happens particularly in older ladies,
then it's very important to do some exercises for the spine
and these are called back extension exercises.
These can be taught by a physiotherapist,
or at times you can find exercises to follow on YouTube and follow them through,
and then of course there's the importance of the nutritional elements and keeping a good healthy diet,
but importantly within that, you want to be sure that they vitamin D levels are fine
and that you're getting enough vitamin D and enough calcium in your diet.