Stop At One
October 20 was World Osteoporosis Day. This year’s theme, ‘Stop at One’, aims to encourage all those who have had osteoporotic fractures to get treatment to prevent another fracture.
WHEN your bones become fragile and brittle due to a loss of its density, you are suffering from osteoporosis (OP).
Bone is made up of organic materiala such as collagen (a protein) and inorganic materials consisting of carbonated hydroxyapatite (calcium and phosphate salts).
The collagen provides the structural framework on which the minerals such as calcium are deposited.
When OP occurs, the bone starts to lose its mineral content, particularly the calcium, which then causes it to become weak.
These weakened bones are therefore more likely to fracture. Typically, osteoporotic fractures occur after minimal trauma at the spine (vertebral fracture), hip and wrist (Colles’ fracture). For example, vertebral fractures can occur with daily activities such as lifting or pushing household items. Hip and Colles’ fractures can occur after a fall.
Hip fractures are associated with between 8.4 and 36% excess mortality within one year, with a higher mortality in men than in women. Approximately 20% of hip fracture patients require long-term nursing home care, and only 40% fully regain their pre-fracture level of independence.
Morbidity is also increased following vertebral fractures, which may result in complications that include back pain, height loss and kyphosis (a hunched back).
Why do we get osteoporosis?
Bone is constantly being remodelled, with areas of damage (“microcracks”) removed (bone resorption) and replaced with new bone (bone formation).
While we are young, and building our bones up to “peak bone mass”, bone remodelling results in a net gain of bone, i.e. more bone formation compared to resorption, and our bone density increases. Up to 90% of peak bone mass is acquired by age 18 in girls and age 20 in boys; thus the teenage years are the best time for maximising bone gain.
There is continued gain in bone until the age of 30, when peak bone mass is reached. Following this, there is a very slight gradual loss of bone after each remodelling cycle, i.e. more bone resorption compared to formation.
For the ladies, at the time of menopause, there is a sudden reduction in the levels of the hormone oestrogen, leading to a period of increased bone loss for approximately the next five years, as oestrogen is responsible for reducing bone resorption.
OP occurs when bone density drops below a certain level, making the bone weak. This can happen either as a result of low peak bone mass (so there is less to lose before levels become critical), or when there is a period of rapid bone loss (such as during the menopause in women).
What happens after the first fracture?
Previous articles on OP have emphasised the importance of prevention and early treatment of OP, and this advice still stands.
If one bone is osteoporotic, then the whole skeleton is likely to be osteoporotic. Thus, after the first osteoporotic fracture, there is an increased risk of sustaining a second osteoporotic fracture.
So, preventing the first fracture is best. However, people do get osteoporotic fractures without prior warning. Once a fracture occurs, studies have shown that women with pre-existing vertebral fractures had approximately four times greater risk of subsequent vertebral fractures than those without prior fractures.
This risk increases with the number of prior vertebral fractures. Those women who have had a prior hip fracture have approximately 2.5 times greater risk of having a subsequent vertebral or wrist fracture. Women who have had a prior wrist fracture have approximately two times greater risk of having a subsequent vertebral or hip fracture.
Therefore, it is important to treat individuals after their first fracture to prevent the next fracture; hence the the slogan “Stop at One”.
Does treatment reduce the risk of another fracture?
The answer is most definitely a “Yes”. All registered drug treatments for OP have been shown to improve bone density and to reduce the rate of further fractures by between 30 and 70% depending on the medication and fracture prevented.
There are now many treatments available for OP; you have a choice of taking a daily, weekly or monthly oral medication, or once every six months or yearly injections. Most OP treatments should be taken for between three to five years for the best efficacy.
But despite the best of intentions, studies have shown that even after a hip fracture, not all patients get drug treatment. One study from Finland showed that only one in four women and one in 10 men with a hip fracture were treated for osteoporosis.
Another study from Italy showed only 33.9% of patients were given drug treatment after a hip fracture.
A small study from Malaysia showed that 31.7% received drug treatment for their OP after their hip fracture, and only for an average of three months, which is not enough to build up their bone density significantly.
Please see your doctor for further assessment if you or your relative has had an OP fracture and are not on, or have not had, treatment.
Let us aim for all patients with osteoporotic fractures to STOP AT ONE.
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Published: 27 Oct 2013
Category: Features, Wellness and Complementary Therapies
