Osteoporosis Treatment in Manchester

Osteoporosis is a medical condition that weakens bones, making them brittle and more likely to break. It can take years to slowly develop and is commonly only discovered after a bone breaks due to a fall or other unexpected impact. 

If you have osteoporosis you are at risk of fractures (broken bones) when performing everyday tasks like standing or walking. The hips, wrist, pelvis, upper arm and spinal bones are the most often impacted bones. Fractures of the spine, pelvis and hip can be particularly debilitating due to chronic pain.  Fractures of the hands, feet., ankles, skull, clavicle and tibia/fibula are regarded less indicative of osteoporosis.

At various times throughout our lifetimes, the ratio of bone production to bone resorption fluctuates. Examples of this include:

• When a person is young and growing, new bone forms quite quickly. Consequently, our bones might enlarge and become more robust (denser). By your mid-to late-20s, bone density peaks.
• The production of new bone occurs at roughly the same rate as the decomposition of existing bone. The adult skeleton undergoes a complete renewal process over a period of 7-10 years.
• After age 40, bone starts to break down more quickly than it is rebuilt, which causes your bones to gradually lose density.

Osteoporosis develops when your bone density decreases. Your body reabsorbs more bone tissue and produces less to replace it. Osteoporosis causes your bones to deteriorate and become porous, which raises the risk of fractures. 

As we age, we all experience some bone loss at varying rates.  Osteoporosis is only referred to when the bones become brittle in nature. A bone damaged by osteoporosis has greater pores in the honeycomb structure and a lower overall density, which increases the risk of fracture.   

The following risk factors should prompt an assessment for osteoporosis: 

• A history of fragility fracture (incurred from low trauma usually a fall from standing height).
• Family history of osteoporosis (particularly hip fracture).
• Certain medications such as oral steroids, anti-epileptic medications, and drugs used to treat breast cancer e.g. anastrazole.
• An early menopause (before age 45 years).
• A lack of calcium in your diet.
• Very low body weight particularly when associated with disturbed menstrual cycle.
• Gastrointestinal disorders such as malabsorption or coeliac disease.
• An Xray that suggests low bone density.

If you have any of these risk factors then you should either discuss with your GP or consider making an appointment at the Alexandra Hospital to see a Rheumatologist who specialises in Osteoporosis.

Osteoporosis is a silent disorder much like high blood pressure and develops gradually often without you knowing you have the condition. Most commonly patients become aware that they may osteoporosis and bone fragility when they have a fracture following a relatively small incident, such as a fall. Severely osteoporotic bones can break with as little as a cough or sneeze. 

If you have osteoporosis you could frequently break your wrists, hips, or spinal vertebrae. A spinal vertebral break may cause a stoop, abnormalities in posture, or a curvature of the spine. A drop in height or a change in how well clothing fits are other potential osteoporosis symptoms. 

It is therefore important to try identify if you are at risk of osteoporosis before you have your first fracture.

If you have had a fragility fracture or have any of the risk factors listed above, then you should consider being investigated for underlying osteoporosis.

At your initial consultation will see a Consultant Rheumatologist, preferably who has a specialist interest in osteoporosis.

Your consultant will start by taking a detailed medical history and perform a short physical examination to look for osteoporosis. In order to look for disorders that could lead to bone loss, they might also perform blood and urine tests. A doctor will also take into account any risk factors and family history.

Your doctor will likely recommend a bone densitometry or DEXA (dual energy x-ray absorptiometry) scan, also known as a bone density test or bone mineral density scan, if they suspect you have osteoporosis or are at risk of developing it.  This will be undertaken at DHL Dexa scanning Seroivce in Altrincham.  The DEXA scan is quick and safe and provides a very accurate assessment of your bone density at the spine and hip.

You lie on a comfortable surface during this painless examination as a scanner moves over your body. Typically, only a few bones - usually the hip and spine - are examined. This painless test can take from 10 to 30 minutes.

Why is bone density checked?

Doctors use bone density testing to:

• Identify decreases in bone density before you break a bone
• Determine your risk of broken bones (fractures)
• Confirm a diagnosis of osteoporosis
• Monitor osteoporosis treatment

Your bones are denser the higher their bone mineral composition. Bones tend to be stronger and less prone to break the denser they are.

DEXA test results

Doctors give the results of the test as a DEXA T score or a Z score.

You can compare your bone mineral density to that of a healthy young adult and someone your own age and sex. The difference is measured as a T score, which is a standard deviation(SD) calculation.

Standard deviation is a measure of variability based on an average or expected value. A T score of:

• -1.0 or above is normal or shows good bone strength
• -1.1 to -2.5 suggests mild bone loss (osteopenia), defined as decreased bone mineral density compared with peak bone mass
• -2.5 or below indicates osteoporosis

The Z score compares the bone mass with that of other people of a similar build and age.

Your doctor will typically repeat the test every 2-3 years as this allows them to compare results.

Osteoporosis treatment typically involves using medications to strengthen your bones, and we also focus on treating and preventing fractures.

Although the findings of your bone density scan are used to get an osteoporosis diagnosis, your consultant will take other factors into account when deciding if you need treatment, and if so which treatment is best for you. For example:

• Your age
• Your sex
• Your risk of breaking a bone
• Your previous injury history 

Even if you have osteoporosis and have already broken a bone, you should still seek treatment to lower your chance of doing so again in the future. 

If the results of your testing indicate that you have osteoporosis, your consultant will work with you to develop an osteoporosis treatment plan. In addition to prescribing drugs, your doctor may advise lifestyle modifications. Among these lifestyle adjustments are getting enough exercise and increasing your calcium and vitamin D intake. 

Osteoporosis cannot be totally cured, but effective osteoporosis treatment can help safeguard and strengthen your bones. Some of these therapies can encourage the growth of new bone while others can assist decrease the loss of bone in your body. Your specific situation will determine your treatment, your consultant will discuss the best options for you.

The likelihood that you will break a bone during the next 10 years is estimated using data from tests like the bone density test. If your risk is low, treatment may not involve medication and may instead concentrate on reducing fall and bone loss risk factors.

However, a variety of medications are used to treat osteoporosis (and sometimes osteopenia). Your doctor will go over the possible osteoporosis treatments with you and ensure that the medications are appropriate for you.

Bisphosphonates

Bisphosphonates are the most common and widely prescribed medications used to treat osteoporosis or men and women who have an increased risk of fracture. By decreasing the rate at which bone is broken down in your body, bisphosphonates are used to stop the loss of bone mass. You have a lower chance of fractures and broken bones as a result of maintaining bone density.

Bisphosphonates may be taken orally via tablet or liquid, or by injection.

They usually take six to 12 months to work, and you may need to take them for five years or longer. Additionally, you can be given calcium and vitamin D supplements to take separately from the bisphosphonate.

Hormone replacement therapy (HRT) 

Women going through menopause might take HRT to help manage symptoms. Oestrogen can support bone density maintenance, particularly when started soon after menopause. HRT has also been shown to maintain bone density and lower the chance of developing osteoporosis. It can strengthen your bones and lower your chance of fracturing a bone if you already have osteoporosis.

You will typically be advised to use HRT or hormonal contraception until at least age 51 if you have early menopause, which is when your periods stop before the age of 45. Oestrogen levels rise as a result, helping to shield you from osteoporosis and other conditions.

Your age, symptoms, and other risk factors you may have will determine whether HRT is the correct choice for you. The advantages of HRT typically outweigh the risks if you're under 60 and experiencing menopause symptoms.

Testosterone treatment

When insufficient production of male sex hormones results in osteoporosis in males, testosterone therapy may be beneficial.

For men, osteoporosis might be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone.

Raloxifene

This medication has been found to offer the benefits of oestrogen without many of the risks, although there is still an increased risk of blood clots.

Raloxifene is a selective oestrogen receptor modulator (SERM). SERMs are medicines that have a similar effect on bone as the hormone oestrogen. They help to maintain bone density and reduce the risk of fracture, particularly of the spine.

Raloxifene is the only type of SERM available for treating osteoporosis. It's only recommended for women, after menopause. It is taken as a daily tablet.

Biological or 'bone-building' medications

Biological medicines are made from proteins or other substances produced by the body.. If you have severe osteoporosis or if the more common treatments for osteoporosis such as bisphosphonates don't work well enough or you are unable to take them, your doctor might suggest trying biological medicines.

They function by increasing the rate at which your cells make new bone while decreasing the rate at which your bones are broken down. You will typically need to take another osteoporosis medicine to maintain the new bone growth after stopping any of these bone-building medications.

Calcium and vitamin D supplements

The primary mineral present in bones is calcium, so eating a diet high in calcium as part of a healthy, balanced diet is crucial for keeping strong bones.

The recommended daily calcium intake for most healthy adults is 700 milligrams (mg), which most people should be able to get via a varied diet that includes calcium-rich foods. But if you have osteoporosis, you might require additional calcium - typically in the form of supplements.

Your body needs vitamin D in order to properly absorb calcium. A daily dose of 10 micrograms of vitamin D is recommended for adults. The majority of healthy persons in the UK get their vitamin D from getting sun exposure throughout the summer. The majority of people should be able to acquire all the vitamin D they require from sunlight on their skin from late March or early April to the end of September. Vit D is stored in the liver to help maintain levels in the winter months when there is less sunlight.

People who cover their skin for cultural reasons, those who are housebound, and those who spend a lot of time indoors are among the at-risk demographics. Your doctor might offer pills with a higher dose than the one above if it turns out you don't get enough vitamin D.

Exercise is very important to support the health of your bones, especially weight-bearing exercises.

Weight-bearing exercises are performed with either your feet or your arms fixed to the ground or another surface. Examples include:

• Climbing stairs
• Resistance training, such as leg presses, squats or push-ups
• Weight training, such as working with resistance bands, dumbbells or resistance exercise machines

These workouts are beneficial because they make your muscles contract and relax in opposition to your bones. Your body will be instructed to create new bone tissue as a result, strengthening your bones.

Exercise offers you more advantages than only this, though. Exercise has numerous benefits for your weight, heart health, and balance and coordination, which can help you stay upright and prevent falls.

You should always speak to your consultant or a physiotherapist before starting any new exercise plan, especially if you are living with a condition such as osteoporosis.

We offer private physiotherapy sessions across our 50+ UK hospitals, where a highly trained specialist will work with you to develop a tailored exercise plan that can help you to support your bones, build muscle and improve posture, and much more.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times to fit your schedule
• The freedom to choose which consultant is right for you
• Bespoke, consultant-led treatment plans tailored to your individual needs
• Private ensuite rooms as standard
• Tasty and nutritious meals cooked onsite to your dietary requirements
• Support from the same compassionate clinical team from beginning to end
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help spread the cost of your care

If you want to know more about hip surgery and find out if it's the right treatment for you, book your appointment online today or call a member of our team directly on 0808 273 6667.