Osteoporosis – an impending disaster

Osteoporosis is a silent killer. Although osteoporosis shows no symptoms, there are serious outcomes (such as fractures).

One in two women and one in five men will experience a fragility fracture (a fracture as the result of a fall from standing height or less) in their lifetime. Hip fractures are expected to increase around 300% over the next four decades due to our ageing society. Hip fracture is associated with around 20% first year mortality and around 50% of those affected lose independence. If you fall into any of the groups below, you may need fracture risk assessment:

• All women aged 65 years and over, and all men aged 75 years and over
• All women aged 50–64 years and all men aged 50–74 years who have any of the following risk factors:
  • A previous osteoporotic fragility fracture
  • Current use or frequent recent use of oral corticosteroids
  • History of falls
  • Low body mass index (less than 18.5 kg/m2)
  • Alcohol intake of more than 14 units per week
    
    A secondary cause of osteoporosis, including:
  • Hypogonadism in either sex, including untreated premature menopause (menopause before 40 years of age), treatment with aromatase inhibitors (such as exemastane) or gonadotrophin-releasing hormone agonists (such as goserelin)
  • Endocrine conditions, including diabetes mellitus, Cushing's disease, hyperthyroidism, hyperparathyroidism and hyperprolactinaemia
  • Conditions associated with malabsorption including inflammatory bowel disease, coeliac disease, and chronic pancreatitis
  • Rheumatoid arthritis and other inflammatory arthropathies
  • Haematological conditions such as multiple myeloma and haemoglobinopathies
  • Chronic obstructive pulmonary disease
  • Chronic liver failure
  • Chronic kidney disease

People younger than 50 years of age with any of the following risk factors:

• Current or frequent use of oral corticosteroids
• Untreated premature menopause
• A previous fragility fracture

People younger than 40 years of age with any of the following risk factors:

• Current or recent use of high-dose oral corticosteroids equivalent to, or more than, 7.5 mg prednisolone daily for three months or more
• Previous fragility fracture of the spine, hip, forearm, or proximal humerus
• History of multiple fragility fractures

People taking the following medication, especially in the presence of other risk factors:

• Selective serotonin reuptake inhibitors, such as fluoxetine
• Antiepileptic medication — particularly enzyme-inducing drugs, such as carbamazepine
• Aromatase inhibitors, such as exemastane
• Gonadotropin-releasing hormone agonists, such as goserelin
• Proton pump inhibitors eg lansoprazole
• Thiazolidinediones, such as pioglitazone

This article has been written for you by Consultant Rheumatologist, Dr Nisar. If you’re worried about your joints, book in to see Dr Nisar today by calling 01582 788 412.