Osteoporosis

Bones heal in most cases, but depending on which bones are fractured, there may be longer-term issues and symptoms to deal with. For example, if a person breaks their hip, they are likely to need surgery to repair it and perhaps even a hip replacement.

If a person has osteoporosis of the spine, their spine may change shape and become more curved at the base of the neck. They may become a little shorter over time and have a stooping posture; this occurs due to vertebral crush fractures and usually causes pain of varying degrees.

For more information about osteoporosis symptoms and signs, visit the NHS website. The NHS also provides advice on how to tell if you have broken a bone. If you have any concerns that you are at risk of osteoporosis, or if you think you have a fracture, visit your GP or urgent care centre.

Diagnosis of osteoporosis

It can take some time before osteoporosis is diagnosed.This is because there are no easy to spot osteoporosis symptoms. If you attend hospital due to having a fracture, you may be tested for osteoporosis if your doctor thinks you are high risk, you fracture ‘easily’ or through a very minor injury, or if you have had fractures before. If your doctor thinks you may have osteoporosis, they will suggest you undergo some tests that will confirm a diagnosis.

You are likely to require a scan to check the density of your bones. For example, a DEXA (dual energy x-ray absorptiometry) scan. If you have a lower than normal bone density, you are likely to have osteoporosis or be at risk of it developing, which is called osteopenia. The tests conducted will compare your bone density level with data on what is considered a healthy bone density, of someone similar to you. If you undergo such a test, you will be given a score. If this is below -2.5, you are likely to be diagnosed with osteoporosis.

You may also undergo a FRAX or Q-Fracture risk assessment to predict your risk of having a fracture in the future.

You may also need to undergo blood tests to explore whether other conditions are causing your low bone density or fractures.

If you think you may have or be at risk of developing osteoporosis, speak to your GP.

For more information on how a diagnosis of osteoporosis is made, visit the National Osteoporosis Society website.

There are many types of medication for osteoporosis you may be prescribed, which are designed to help slow down the degeneration of old bone, stimulate the building of new bone or a combination of these. Here are the most common ones:

• Bisphosphonates

• Teriparatide and parathyroid hormone

• Raloxifene

• Calcitonin

• Denosumab

You are also likely to be recommended to take calcium and vitamin D supplements, which support bone development and strength.

Can osteoporosis be reversed? In a word, yes. It may take a little time to find a medication for osteoporosis that is suitable for you, as some do have side effects. After a lengthy period of taking medication, your doctor may ask that you have a break because the drugs you are taking have a long-lasting effect and your bone density has improved. Some people find that by changing their lifestyle through implementing exercises for osteoporosis and eating an osteoporosis diet, they are able to improve their bone strength to such a level that they are no longer considered to have the condition.

Traditionally, women going through the menopause were prescribed hormone replacement therapy (HRT) to help prevent or treat osteoporosis. Whilst still widely used, there are many alternative medications available now which have fewer potential risk factors compared to HRT, which is thought to increase a woman’s risk of developing breast cancer and other conditions. If you are living with postmenopausal osteoporosis, visit the NHS website for more information on HRT.

Research is continuing into further osteoporosis treatment and in understanding how bones are regenerated. The National Osteoporosis Society supports and invests in research projects..

To find out more about osteoporosis treatment, visit the Arthritis Research UK website

There are ways you can reduce your risk of having a fall, and the NHS provides lots of tips on making your home safer and avoiding falls.

Obviously, there is no way to completely avoid falling or injuring yourself, as accidents will always happen, but it may help you to feel that you are doing everything you can to reduce your risk. The National Osteoporosis Society provides a wealth of practical information about how to stay steady and feel more confident.

It is important to remember that some people are able to increase their bone strength through changing their eating and exercise habits.

Living with osteoporosis pain

Osteoporosis causes some people to live with pain, due to current or old fractures, but this can often be managed with medication pain relief. You may be prescribed some of these medications, depending upon the severity of your pain:

• Paracetamol

• Ibuprofen

• Naproxen

• Codeine

• Tramadol

• Co-codamol

• Buprenorphine (BuTrans) Transdermal Skin Patch

The healing process for people with osteoporosis is not hindered by the condition, so most fractures will heal in 6 to 12 weeks, depending on where the fracture is and how severe. If you have experienced a fracture that is affecting your ability to get around or to carry out daily tasks, there are services available to help you, for example, physiotherapy and occupational therapy.

If you are experiencing continuing pain after a fracture has healed, there are ways to help manage your pain, for example:

• TENS machine

• Acupuncture

• Hydrotherapy

• Massage therapy

• The Alexander Technique

• Osteopathy

• Chiropractic

• Reflexology

• Mindfulness/Meditation

The NHS provides information on how to live with pain including advice about relaxation techniques. The NHS also recommends using the Pain Toolkit information booklet, which is designed to help with managing pain and thinking differently about it.

At NRS Healthcare, we are experts in daily living aids, which are products designed to help you get back on your feet, regain your independence or stay mobile. There are many daily living aids available that may help you if you have a fracture caused by osteoporosis, or a permanent disability as a result of the condition.

Here, we suggest some osteoporosis products that may help with a variety of daily living tasks if you are living with fractures or pain caused by fractures, or if you want to help prevent falls around the home.

Making the bathroom safer –

Grab rail, Shower seats, Bath mats

Getting in and out of the bath–

Bath lift, Bath step

Getting around–

Walking sticks, Rollators, Crutches, Wheelchairs

Sitting down onto and standing up from the toilet–

Raised toilet seats, Drop down rails, Toilet frames

Getting in and out of bed–

Bed rails, Mattress elevators

Carrying food, drinks, household objects safely–

Household trolleys

Preparing meals and drinks with one hand/arm–

Tin openers, Chopping, cutting and peeling aids, Kettle tippers

If you are unsure what osteoporosis products may help you, contact our Occupational Therapist Product Advice team:

Telephone: 0345 121 8111

Email: productadvice@nrshealthcare.co.uk

Most people with osteoporosis are able to work, but you may wish to discuss your condition with your employer. You may need to take sick leave from time to time, for example, if you experience a fracture or if you are experiencing pain. You may need to have appointments with your GP or healthcare team to discuss medication or test your bone density. You should discuss with your employer any issues that may affect your health, for example, you may need to adjust some of your tasks at work to avoid potential injury or falls. Advicenow provides information on your rights if you are unsure what your employer should be doing to support you.

The National Osteoporosis Society also provides advice about osteoporosis and employment.

Exercise for osteoporosis

It is important for everybody to exercise regularly. Our bodies need exercise to operate effectively and prevent ill health. It is essential to exercise for osteoporosis prevention and as part of your osteoporosis treatment plan.

If you have been given a diagnosis of osteoporosis, you may feel apprehensive about beginning an exercise regime in case you injure yourself. The benefits of exercise will usually far outweigh the risks.

Your GP may be able to refer you to a physiotherapy service, where a professional physiotherapist can instruct you on the best osteoporosis exercises to undertake. You are likely to be given weight bearing exercises for osteoporosis, such as resistance exercise (lifting weights or your own body weight) that strengthens your muscles and bones.

Your physiotherapist will be able to advise if there are osteoporosis exercises to avoid. For example, if you are at high risk of fractures, you may be advised against high impact weight-bearing exercised, such as aerobics or jogging.

Some research suggests that yoga and Pilates are really good exercises to prevent osteoporosis because they improve flexibility and strength.

Visit the NHS website to read a real-life story about how exercise and eating healthily can improve osteoporosis.

Diet for osteoporosis

It is important for everybody to eat a healthy, balanced diet, and especially important if you have a long-term health condition. You should ensure you have a balanced diet that contains all the food groups to give your body the nutrition it needs. An osteoporosis diet should include a variety of foods from the main food groups, i.e. fruit and vegetables, carbohydrates, protein and dairy. If you need advice on eating a balanced diet, The Eatwell Guide developed by Public Health England is available to download for free.

It is especially important to include at least the recommended daily allowance of calcium in a diet for osteoporosis. The recommended amount for an adult is 700mg per day. Calcium is essential for creating strong bones. Calcium can be found in seeds, dairy (such as cheese and yoghurt), nuts, lentils, leafy greens, and oily fish (salmon).

You may be advised to follow an osteoporosis diet plan that restricts certain foods and drinks that may have an adverse effect on the absorption of calcium, for example, salt, alcohol and caffeine. Research has also suggested that in an osteoporosis diet, coke or fizzy soda drinks containing phosphorous may contribute to people not absorbing enough calcium.

There are a large number of other vitamins and minerals that contribute to healthy bones, such as magnesium, zinc and vitamin B. Some people choose to take osteoporosis supplements to ensure they are getting enough vitamins and minerals. The best way to do this though, is to eat a wide variety of healthy foods; this is important in preventing osteoporosis developing. For more information on vitamins and minerals that are essential to bone health, visit the National Osteoporosis Society website.

We recommend talking to your GP or specialist before undertaking any osteoporosis diets.

The National Osteoporosis Society provides a helpline run by specialist nurses:

Call: 0808 800 0035 Email: nurses@nos.org.uk

They also have local osteoporosis support groups and an online forum.

Other osteoporosis support groups:

Osteoporosis Support Group World Wide Facebook group

Osteoporosis – NewLifeOutlook Facebook group

Away with Pain forum

AGE UK – information on healthcare conditions and advice about finances, healthcare and much more

Arthritis Research UK – provides information on a variety of musculoskeletal conditions

Menopause Matters – useful information on experiencing the menopause and menopausal osteoporosis

National Osteoporosis Society - the leading UK charity for Osteoporosis providing information, support and research

NHS – the essential guide to medical conditions, their diagnosis and symptoms

Pain Support – provides resources and support for people living with chronic pain

Acupuncture

– the process of inserting needles into the skin and/or muscles to stimulate nerves

Alcoholism

– a disorder that means a person is dependent on alcohol or misuses it to the point where it affects their health

Bisphosphonates

– a drug that slows the thinning of bones in the body, prescribed for people with osteoporosis of some types of cancer

Bone density

– the strength of your bones

Buprenorphine (BuTrans) Transdermal Skin Patch

– administers opioids to relieve chronic pain

Calcitonin

– a naturally produced hormone that slows the depletion of bone

Chiropractic

– a professional method of relieving pain and restoring spinal and muscular function using spinal manipulations

Co-codamol

– a medication that contains paracetamol and codeine phosphate

Coeliac disease

– a disorder of the immune system where the body reacts to gluten in wheat, rye and barley

Codeine

– an opioid pain relief medication

Denosumab

– an injection drug treatment for osteoporosis that reduces the risk of broken bones

DEXA (dual energy x-ray absorptiometry)

– a scan to test bone density, similar to an X-ray

Eating disorder

– the serious illness which may take many forms, but which usually means a person changes their eating habits drastically in order to change their body image, to a point where it damages their body and health

FRAX

– a diagnostic tool that helps assess the risk of bone fractures, providing a probability score for a ten year period.

Hormone replacement therapy (HRT)

– treats women who are experiencing adverse effects of menopause, by replacing hormones that are declining, mainly oestrogen

Hydrotherapy

– specialist exercises carried out in water to produce a therapeutic effect

Hysterectomy

– a surgical procedure in women that removes the womb and cervix, and sometimes the fallopian tubes and ovaries

Ibuprofen

– a non-steroidal drug that reduces the hormones released when there are inflammation and pain in the body

Massage therapy

– used to treat stress, discomfort and pain around the body, which focuses on physically manipulating soft tissue such as muscles

Menopause

– the decline of oestrogen that happens to women around 45 years of age, bringing the end of periods and many other symptoms

Mindfulness

– the practice of living in the moment and accepting thoughts and sensations, rather than fighting against them – often uses meditative techniques

Naproxen

– a drug used to treat inflammation of the muscles and joints

Non-steroidal anti-inflammatory drugs (NSAIDs)

– a pain relieving medication that helps reduce inflammation and is often used for people with arthritis or musculoskeletal aches and pains.

Occupational therapy

– the practice of assisting people to achieve their full potential and overcome difficulties, by looking at practical solutions, equipment and techniques.

Osteoblasts

– cells in the body that make new bone

Osteoclasts

– cells in the body that work to remove old bone

Osteopathy

– the practice of manipulating body tissue to help the body work smoothly

Paracetamol

– a pain relieving medication that reduces fever and mild pain

Parathyroid hormone

– a naturally occurring hormone in the body, which controls the amount of calcium found in the bloodstream, and which can be given as a synthetic treatment to reduce the risk of osteoporosis developing.

Phosphorous

– a mineral in the body which works with calcium to build bones

Physiotherapy

– the practice of restoring movement, function and reducing discomfort or pain due to ill health, disability or injury, often through manual therapy such as massage, exercise and advice

Q-Fracture

– an assessment tool based on algorithms, which asks questions about lifestyle and health to ascertain the likelihood of a person developing osteoporosis or experiencing a bone fracture

Raloxifene

– a drug treatment that provides the same effects as oestrogen in the body

Reflexology

– a complementary therapy that massages and manipulates the soles of the feet, with the belief that there are pressure points on the feet that correspond with parts of the body

Steroids

– drugs that are prescribed for a variety of health reasons and which affect how the body metabolises key vitamins and minerals, leading to possible bone loss

TENS machine

– Transcutaneous Electrical Nerve Stimulation carried out by a small device with electrodes that attach to the skin, which delivers electrical impulses to areas of the body that are painful, to reduce pain signals and relax muscles

Teriparatide

– a medication that helps treat osteoporosis by simulating the hormone in the body that regulates calcium

The Alexander Technique

– helps change long-standing habits such as poor posture, to naturally align the body and reduce discomfort

Tramadol

– pain relief drug in the narcotic or opioid family

Trabecular

– the spongy bone at the ends of long bones, which is easiest to fracture

Vertebral crush fractures

– a collapsed bone in the spine