Osteoporosis is a worldwide problem, though mostly documented in countries with advanced healthcare systems, and affects many millions of people across all countries. Women have a higher lifetime risk of a fracture due to osteoporosis with about thirty to forty percent chance in their life, whilst men have a much smaller but still significant risk of 13%. Osteoporosis is a condition which occurs slowly and quietly with the sufferer mostly not aware there is anything amiss until it is too late and they have a problem. The assessment of risk and the preventative treatment of this condition are vital and very active areas in research and treatment.

With 1.5 million fractures in the United States alone, osteoporosis is a common diagnosis and 50% of women over 50 years old suffer from this condition, rising to almost 90% of women aged seventy-five years. Osteoporosis causes fractures and this is the main clinical problem, with significant disability and pain from spinal fractures and a 5-20 percent chance of dying after a hip fracture due to the complications. Apart from the personal costs osteoporosis is also costly to health services dealing with high levels of fractures in post-menopausal women.

The greatest risk factor for getting osteoporosis is passing through the menopause, when the bone-protecting hormones stop being produced or are greatly reduced. The bone density of the person can then drop steeply unless they are diagnosed and treated. Other risk factors include being female, age, having a family history of osteoporosis, a hormone deficiency, having low calcium levels, drinking excessive alcohol and smoking cigarettes. If there is the menopause plus a number of risk factors, the woman is 65 years old or older or the person has had a fracture without significant trauma then they should be investigated for low bone density.

The signs and symptoms of osteoporosis are not that many. With an acute vertebral fracture on lifting or bending then the pain is extremely severe and long lasting, an indication that something significant has occurred. Back pain is common and there may be an increased thoracic kyphosis (upper back curve), an increased cervico-thoracic curve (dowagers hump) and a noticeable loss of height. Any fracture without significant trauma is suspicious and should be investigated. If the patients bones look thin on x-ray and there are compression fractures in the thoracic spine, the diagnosis may be clear, but a bone density scan (DEXA) can indicate the degree of osteoporosis and monitor change.

Osteoporosis prevention encompasses lifestyle change, eating a diet rich in vitamin D and calcium, avoiding smoking and excessive alcohol and engaging in weight bearing exercise. HRT (hormone replacement therapy) is used to prevent this condition in women who are past the menopause. Drugs include bisphosphonates, HRT, selective oestrogen receptor modulators and calcium and vitamin D supplements. The development of new bone rather than stopping the loss might be achievable with an anabolic drug. When we are young we lay the groundwork for our bone mass so should be encouraged to eat well and engage in weightbearing exercises to ensure a good bone density.

A recent development in the treatment of hyper acute spinal fractures with their very severe and disabling pain is vertebroplasty. In this procedure a radiologist introduces a needle under x-ray control into the front of the body of the vertebra which has collapsed and then injects a cement material which mechanically bolsters the area, with great relief of pain. Falls are particularly dangerous due to the high risk of fracture and exercise can improve balance, stability, co-ordination and muscle strength to reduce the risk. As this may be a long term condition it may be necessary to provide both practical and psychological help to enable patients to cope best with their condition.

Exercise and bone mass are closely linked and physiotherapists work in osteoporosis classes and clinics to educate people of all ages in the benefits of movement. Children and young people are encouraged to have plenty of exercise so their bone mass builds to a good level. Exercise can slow down the bone loss process and impact exercises which jar the bones are more beneficial than cycling or swimming. Anybody of any age can start a suitable exercise programme and make a difference, guided by a skilled physiotherapist.