How to spot ageing bones before you fall foul of a fracture

Osteoporosis has no symptoms. So how can you assess your bone health?

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How often do you think about the strength of your skeleton? In terms of future health, you’re probably more concerned about cancer or heart disease than broken bones.
But as we get older, the impact of a fracture can be devastating. It means loss of independence, and gruelling surgery. “The mortality rate one year after a hip fracture is 30 per cent,” says Mr Arman Memarzadeh, a consultant trauma and orthopaedic surgeon at Nuffield Health. “Even one month after a hip fracture, the mortality rate is 10 per cent.”
This is a very real risk in later life for the 3.5 million people in the UK with osteoporosis. Half of women and 20 per cent of men over 50 will break a bone due to osteoporosis. Despite its prevalence, it’s known as the “silent epidemic” because it has no symptoms. Often the first sign is a fracture, by which point it’s quite advanced. So can we find out how well our bones are ageing, and reduce our risk?
These are known as “fragility fractures”, and common ones are hip, wrist and spine. “Often, people don’t know that vertebral spinal fractures have happened,” says Julia Thomson, an osteoporosis nurse specialist who manages the Royal Osteoporosis Society’s helpline. “They’ll notice that they’ve lost three inches in height, their back has changed shape and they have debilitating back pain. It’s only after an X-ray they’ll realise that they have fractures in their spine.”
The drop in oestrogen around menopause accelerates bone loss for women. But both men and women reach peak bone health by the age of 30, after which it begins to decline. “Around 2 per cent of 50 year-olds have osteoporosis, but about 50 per cent of 80-year-olds have it,” says Memarzadeh. “I’m afraid it’s a downward trajectory.” Certain medications increase the risk, such as hormonal treatments for breast or prostate cancer, as well as steroids and anti-epilepsy drugs. There are also genetic factors so you’re more likely to suffer if your parents did.
A bone density scan, known as a DXA or DEXA (dual energy X-ray absorptiometry), uses low dose X-rays to see how dense your bones are. “It’s not invasive, there’s no injection involved, and you don’t have to go into a tunnel,” assures Thomson. 
The machine assesses the density of your bones and the result is a number known as a T-score. The base level T-score of zero is the bone density of a healthy young adult. If your T-score is above that, you have better than average bone density. If it’s below that, there is a sliding scale. A score of between 1 and -1 is considered normal. A score of -2.5 or lower is osteoporosis. Between -1 and -2.5 is known as osteopenia. 
“It’s not a condition,” says Thomson. “It’s just a measurement to show that bone density is less than average, but not low enough to be called osteoporosis. It’s not necessarily going to cause any problems, but it’s a good reminder to keep an eye on it.” 
Not as standard. You might be offered a DXA scan if you’ve had breast or prostate cancer. But most cases are spotted after a fragility fracture. “If a postmenopausal woman comes into A&E with a wrist fracture, she should be picked up by the fracture liaison service,” says Thomson. “Although you could argue that’s a bit late.”
If you would rather not wait to break a bone before getting a diagnosis, have a chat with your GP. They may refer you for a scan if you have a family history or other risk factors. A three-minute quiz on the Royal Osteoporosis Society website will assess your risk.
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You can pay for a private scan, although you’ll still have to be referred for one, either through an NHS or private GP. The price varies wildly, depending on your location and provider, but expect to pay anywhere between £75 and £300 for the scan itself.
The first line of treatment is usually a tablet taken orally, such as alendronic acid. “Your GP can prescribe it,” explains Thomson. “You take it on an empty stomach once a week, and remain upright for half an hour after you’ve swallowed it. It can cause digestive problems so, if people struggle, they can be referred to a specialist to prescribe zoledronic acid, which is an infusion, or denosumab, an injection. These bypass the digestive tract, making it easier for people who can’t tolerate the tablets.” 
Adcal is a daily pill of calcium and vitamin D, usually given alongside these drugs. Is it worth taking this over-the-counter supplement as a preventative measure? “Most of us can get the calcium we need from food,” says Memarzadeh. “But if you don’t eat dairy, then it could be a good idea.”
Can osteoporosis be reversed? “You won’t like this answer,” says Memarzadeh. “But no.” However, that doesn’t mean you should give up hope. Eating well, exercising and limiting alcohol at any age will support your skeleton, even if you’ve been diagnosed with osteoporosis. While you can’t regain bone density, it’s never too late to slow its decline.
Osteoporosis is not an inevitability, despite how many risk factors you have. 
For more information, visit the Royal Osteoporosis Society at theros.org.uk
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