Osteoporosis

Who develops osteoporosis?

Throughout life, the skeleton is continually renewing itself through a process known as remodelling or bone turnover. In healthy bone, the rate of bone breakdown is linked to the rate of bone formation so that bone strength is maintained. As we get older, the rate at which bone is broken down increases and exceeds the rate at which bone is formed. This results in loss of bone and may lead to osteoporosis and an increased risk of fracture.
Several factors increase the risk of developing osteoporosis and/or fractures. These are age and ethnicity, medical risk factors and lifestyle factors. But being female and postmenopausal is a big risk factor for osteoporosis which is several times more common in women than in men (for more information see resources).
 
Age and ethnicity
Postmenopausal white and Asian women are most at risk of developing osteoporosis. Oestrogen protects bones and after the menopause levels decrease significantly.
 
Other medical risk factors
Medical factors that significantly increase the risk of people developing osteoporosis are' premature menopause (before the age of 45), steroid therapy, previous fragility fractures, low body weight and amenorrhoea (absence of menstrual period before the menopause). Thyroid disease, rheumatoid arthritis, low levels of testosterone in men and conditions that affect the absorption of food such as Crohn’s or coeliac disease are also risks factors for osteoporosis.

Other medical conditions include' endocrine disease, kidney disease, liver disease and obstructive lung disease. Myeloma is a cancer that is frequently associated with a rapid destruction of bone, leading to osteoporosis.

Several frequently used medications have also been associated with increased fracture risk' anti epileptic drugs, breast cancer treatments such as aromatase inhibitors, SSRI’s - selective serotonin receptor uptake inhibitors (a group of antidepressant medicine), thiazide diuretics (a common treatment for high blood pressure) and possibly proton pump inhibitors (commonly used to treat acid reflux and ulcers of the stomach and duodenum).

Lifestyle
Lifestyle factors include diet (calcium and vitamin D deficiency), drinking alcohol (more than 3 units per day); current smoking and immobility (physical inactivity).

At the time of their diagnosis most people didn’t know what could have caused their osteoporosis. Many understood that it could be hereditary but most were unaware of the many other factors that might trigger bone loss leading to osteoporosis. Here they talk about what they think and what their doctors told them about the risk factors associated with their osteoporosis.
 Many of the men and women we talked to were sure that they had inherited osteoporosis from their mothers and maternal grandmothers, who had been diagnosed with the condition. But not all were certain. Several elderly people said that they were not sure whether their mothers had osteoporosis because it was at a time when people knew little about osteoporosis or they simply weren’t diagnosed with it. Some said that in the past people commonly attributed the loss of height and the development of a ‘Dowagers hump’ – a rounding of the spine – to ‘old age’ rather than to osteoporosis.

In many cases there were one or more risk factors other than heredity. For example Jane’s osteoporosis was diagnosed through pregnancy and her mother also has the condition.. But she thinks that her coeliac disease, undiagnosed for many years, was the main factor in her osteoporosis. She said that it was an unfortunate coincidence the fact that she was pregnant at the time. Coeliac disease can lead to malabsorption of nutrients, including calcium, and it had affected a few of the women we talked to.
Several women thought an early menopause after hysterectomy had triggered their osteoporosis. Hysterectomy alone is not a big risk factor if ovaries are conserved. The average age of menopause is brought forward but much more relevant is whether ovaries are removed. It is important for women after hysterectomy to have measures of ovarian function especially if they have menopausal symptoms.
 
Lack of oestrogen has an effect on bone and if deficiency is shown it should be replaced. A couple of women were put on HRT after surgery but one did not receive the hormone treatment until years later. Other women, who had an early menopause not due to a hysterectomy, were not concerned at all about having an early menopause. At the time they were more than glad to see an end to their periods. It was only after diagnosis that they learnt that it is a main risk factor.
Thyroxine replacement therapy is not bad for bone health unless an inappropriate dose is used, for example too high. This treatment can be monitored with thyroid function tests. A few of the women we talked to had been diagnosed before or soon after the diagnosis of osteoporosis with thyroid disease. Two are on medication but one decided to stop it after she developed breathing difficulties.
Osteoporosis is commonly viewed as affecting women, primarily after the menopause, but it can also affect men. Deficiency of the sex hormone testosterone has been found in men with osteoporosis.
Two people we talked to had been on the antidepressant drugs phenelzine or tryptophan for many years. They learnt that these were a likely factor for the osteoporosis.
Several men and women had used oral steroid therapy (prednisolone) to treat various conditions such as rheumatic disease, inflammation of the bowel and some lung diseases. But several elderly people said that in the past they had been on ‘terrifically’ high doses of steroid for more than 3 months. Only one of them knew that steroids could cause bone loss and osteoporosis.

Many people think that lifestyle factors are primarily responsible for their osteoporosis in particular, calcium and vitamin deficiency in their diets. Several recalled that as children or young adults they had little milk or other dairy products in their diet. Two women suffered from ME and allergies and therefore avoided dairy products for many years. A few mentioned lack of exercise or smoking as ‘triggers’ for their osteoporosis. But not everyone realised that lifestyle could also contribute to bone loss and/or osteoporosis. Christine has been semi-paralysed for over 20 years and had  learnt only recently that immobility is a risk factor. Likewise, Valerie said that no one ever mentioned to her before she developed osteoporosis that cigarette smoking is a serious risk but in any case she does not intend to give it up (see also Osteoporosis, smoking and drinking alcohol).

Two elderly women attributed their osteoporosis to ‘wear and tear’ of their bodies from heavy physical work caring for an ill spouse over the years, combined with the menopause.

Some people could not explain their condition because they had none of the clinical or lifestyle factors and were relatively young. Many older people on the other hand attributed their osteoporosis more to aging than to anything else.

A very rare condition named mastocytosis was the risk factor linked to Rose's osteoporosis.

Anorexia nervosa, over exercising, secondary amenorrhoea and other gynaecological problems are some of the other factors that are putting men and pre-menopausal women at risk of developing osteoporosis.
You can find more information from our resources section.



Last reviewed July 2013
Last updated July 2011

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