APPENDIX 9
Osteoporosis
Osteoporosis is defined as a progressive systemic skeletal disease characterised by
low bone mass and deterioration of bone tissue, with a consequent increase in bone
fragility and susceptibility to fracture

In the UK, one in two women and one in five men over the age of 50 will
break a bone mainly because of poor bone health.

Osteoporosis costs the NHS and government £2.3 billion a year – that’s £6
million a day.

There are about 230,000 osteoporotic fractures every year.

1,150 people are dying every month in the UK as a result of hip fractures
Approaches to the prevention and treatment of osteoporosis include measures to
reduce fracture risk in the general population include increasing the level of physical
activity undertaken, reducing the prevalence of smoking, and increasing dietary
calcium intake. Epidemiological studies have shown, with varying degrees of
certainty, that these risk factors are associated with osteoporosis
Up to 20% of symptomatic vertebral fractures and 30% of hip fractures occur in men
The two major risk factors are being female and elderly. In addition, there are a
number of other well established risk factors listed below:
• Early menopause (age <45)
• Hypogonadism
• Physical inactivity
• Thin body type
• Major gynaecological surgery e.g. hysterectomy
• Amenorrhea
• Anorexia
• Heredity
• Rheumatological conditions e.g. rheumatoid arthritis, ankylosing spondylitis
• Lifestyle factors: Smoking, alcohol; high caffeine intake
• Insufficient dietary calcium and Vitamin D.
Secondary osteoporosis accounts for 20% of cases in women and 40% of cases in
men and may occur as a result of:
• Endocrine disorders - including thyrotoxicosis, primary hyperparathyroidism,
Cushing’s syndrome`
• Gastro-intestinal disorders (malabsorption, partial gastrectomy, liver disease)
• Malignancy (multiple myeloma, metastastic carcinoma)
• Certain drugs (corticosteroids, heparin).
Interventions and Screening
Bone Mineral Density (BMD)
Measurements of BMD are widely recognised as being effective at identifying
patients who are at a higher than average risk of fracture
Exercise
Physical activity can delay the progression of osteoporosis by slowing the rate at
which bone mineral density is reduced from the late 20’s onwards
Nutrition
A balanced diet provides all the vitamins and minerals required to develop and
maintain strong bones. The recommended daily intake (RDI) for calcium in adults is
700 mg although more may be required for people with osteoporosis
Fractures
Adults who sustain a fracture are over 50 % more likely to have another one of a
different type
Alcohol and Smoking
An alcohol intake of more than 2 units per day increases the risk of an osteoporotic
Fracture, a history of smoking also increases risk
Bone density is most commonly measured by dual energy x-ray absorptiometry
(DXA) scan
Reference;
NICE TA160 Alendronate, etidronate, risedronate, raloxifene and strontium ranelate
for the primary prevention of osteoporotic fragility fractures in postmenopausal
women.