health articles Osteoporosis
Osteoporosis is a common condition that causes pain, fractures and deformity. Although osteoporosis is common, it is frequently a silent disease. Many people have no symptoms until the bone-thinning causes a fracture.
The experienced GPs at Virtually Healthcare can help prevent osteoporosis, identify the disease at an early stage, and help you protect your bones and your future health.
What is osteoporosis?
Osteoporosis is a common condition in which there is bone-thinning, loss of bone density, and reduced bone strength. Osteoporosis can cause fractures, disability and infirmity, especially in the elderly. It is linked to around 9 million fractures across the world every year[1].
Throughout our lives, our bodies break down our bone cells, replacing them with healthy new tissue. As we get older, our bodies don’t build as much new bone, which means the bone mass progressively declines. The bones gradually become weaker and likely to fracture.
Virtually Healthcare provides expert support, investigation and treatment for anyone who is worried about osteoporosis.
[1] https://www.nice.org.uk/guidance/cg146/chapter/Introduction
Osteoporosis care at Virtually Healthcare
Virtually Healthcare is an innovative GP practice, providing expert care in the comfort, safety and privacy of your home. The Virtually Healthcare service is designed to fit with modern lives. Consultations are easy to access, discreet and convenient, with virtual appointments available seven days a week.
The highly skilled team includes more than 40 clinicians working together to investigate and treat disease and help you optimise your health and wellbeing. As well as experienced GPs and nurses, the team includes physiotherapists, a dietitian and social prescriber to connect you to local groups to offer a comprehensive primary care service to manage and prevent a deterioration of your osteoporosis.
During the pandemic, many patients are finding it more challenging to access healthcare. Virtually Healthcare provides quick access video or telephone appointments, with consultations available the same day if you contact us before 3 pm. Our clinicians can provide professional assessment and advice, arrange investigations, prescribe treatment or arrange for a face-to-face review.
At Virtually Healthcare, our focus is on you. Our clinicians take a holistic approach to osteoporosis care. They can provide self-help advice, arrange tests whenever indicated, and advise about treatment. The doctors will work with you to improve your wellbeing and protect your bone health.
Assessment for fracture risk
The GPs at Virtually Healthcare may offer you an assessment of your risk of bone fracture to help decide if preventive treatment might be helpful for you. They follow the NICE guidelines to ensure you get the best evidence-based care.
You may be offered an assessment if you are a woman aged 65 years or older or a managed 75 years or older. If you are younger, you may be offered an assessment if:
- You have had a fragility fracture.
- You are taking steroid tablets or injections or have used them frequently.
- You have a history of falls.
- You have a family history of hip fracture.
- You have a condition that can cause osteoporosis
- You are underweight.
- You smoke or drink more than 14 units of alcohol a week[1].
The doctor will complete an online questionnaire, Fracture Risk Assessment Tool (FRAX), which calculates your fracture risk over the next ten years. They will input your age, sex, height and weight, any health conditions or medications, and how much you smoke and drink. If they believe you are at risk of osteoporosis, they may refer you for a DEXA scan, which provides a statistical measure of your heel bone density compared to a group of young, healthy women[2]. If your bone density is lower (osteopenia) or you have osteoporosis, they will recommend lifestyle modifications and prescribe treatment.
[1] https://www.nice.org.uk/guidance/cg146/ifp/chapter/Who-should-be-assessed-for-fracture-risk
Who is at risk of osteoporosis?
Anyone can develop osteoporosis, but women are four times more likely to develop the condition. Women are at increased risk of osteoporosis after the menopause. Our hormones have an impact on the levels of bone turnover and bone strength. The female hormone oestrogen acts to protect the bones. Hormone levels drop after the menopause, causing bone density to fall. Women with low oestrogen levels are at particular risk of osteoporosis and fractures:
- Women after the menopause (especially if the last period was before 45 years.)
- Women with early ovarian removal.
- Women with eating disorders causing missed periods.
- People with low body weight.
- People on medications including steroids, anti-epilepsy drugs and certain breast and prostate cancer treatments.
- People with immobility.
- People who smoke or drink alcohol.
- People with a family history of osteoporosis or hip fracture.
- People with certain medical conditions, including rheumatoid arthritis, thyroid and parathyroid disease and bowel diseases such as Crohn’s or coeliac[1].
[1] https://theros.org.uk/information-and-support/osteoporosis/causes/
What are the symptoms and signs of osteoporosis?
Osteoporosis is often a silent disease, gradually developing over the years. Most people with osteoporosis do not notice any symptoms until they fall and suffer a fracture. However, research shows that some things could indicate that you have osteoporosis or are at risk of developing the condition. Keep an eye out for these so that you can get help at an early stage.
Fractures: Anyone can develop a fracture because of a significant accident or sporting injury. Osteoporosis fractures are known as ‘fragility fractures’ because they happen at low impact in weakened bones. The broken bone is sustained from falling from standing height[1]. The bones typically affected include the hips, wrists and vertebrae. If you’ve suffered a fracture by tripping or falling, that may be a fragility fracture. Get in touch with one of our doctors for expert advice.
[1] https://www.nice.org.uk/guidance/cg146/chapter/Introduction
Osteoporosis treatment
The GPs at Virtually Healthcare can give advice and prescribe effective treatment for your osteoporosis to help reduce your fracture risk. If appropriate, they can refer you to a specialist hospital team for assessment and treatment. The NICE guidelines state:
‘A combination of lifestyle changes and drug treatment aims to prevent fragility fractures in patients with osteoporosis.[1]’
Self-help advice- See our Hot Topics section for ways in which you can protect against osteoporosis.
Bisphosphonates are medications that prevent the body from breaking down and resorbing bone. As a result, the bone density can rise, reducing fracture risk by around 50%.
If you cannot tolerate these oral medications, intravenous bisphosphonates or Denosumab, an innovative antibody that slows down bone breakdown, may be used as an alternative. The selective oestrogen receptor modulator, raloxifene, can also be effective.
[1] https://bnf.nice.org.uk/treatment-summary/osteoporosis.html
Hot topics in osteoporosis Can you protect yourself against osteoporosis?
There are lots of things that you can do to strengthen your bones and protect against fractures:
Exercise: Try and stay active throughout your life. Women reach their peak bone mass in their twenties. Performing weight-bearing exercise when you’re young builds your bone mass so that there’s a greater reserve. Weight-bearing activities like walking, jogging or dancing are most beneficial. Exercise later on in life will improve strength, fitness and stability so that you’re less likely to fall and fracture.
Lifestyle: Smoking and alcohol can increase the risk of osteoporosis. So try and drop the bad habits or stick within the national recommend units of 14 a week.
Vitamin D: Vitamin D has an essential role in building strong and healthy bones, teeth and muscles. It works to help the body regulate the use of calcium. The body manufactures vitamin D in sunlight; however, it can be difficult to get enough, especially in the winter. Public health advice is that you consider taking a daily supplement of 10 micrograms (400 units) of vitamin D; supplements are vital for the housebound, elderly, disabled and anyone with dark skin[1]. Research shows that daily Vitamin D supplementation can decrease bone loss and increase bone marrow density.
[1] https://theros.org.uk/information-and-support/looking-after-your-bones/vitamin-d/
Should I take HRT for osteoporosis?
Women are more vulnerable to osteoporosis after the menopause. The hormone oestrogen protects bones; when levels fall after the menopause, bone density drops. Women whose periods stopped before the age of 45, who had early ovarian removal, or who missed periods because of eating disorders are particularly at risk of osteoporosis.
Hormone replacement therapy can protect against osteoporosis, but this benefit needs to be balanced against the risks. HRT can increase the risk of cardiovascular disease and some cancers in older postmenopausal women and women on long-term HRT therapy. In general, HRT is used for younger postmenopausal women with menopausal symptoms who are at high risk of fractures[1].
[1] https://bnf.nice.org.uk/treatment-summary/osteoporosis.html
Types of consultations we offer
We offer written, telephone and video consultations with a range of male and female clinicians from GPs, nurse practitioners, and primary care specialists such as physiotherapy.
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