Osteoporosis - or fragile bones - can be extremely painful and often causes fractures of the hip, wrist or spine. A third of women will suffer a fracture due to osteoporosis: it causes 200,000 fractures every year. The likelihood increases with age, especially after menopause, but there are other risk factors too. Men are at about half the risk of women.
Targeting people at risk
Mass screening has been called for, but studies show that tests for low-bone density do not identify everyone likely to develop osteoporosis; up-to-date research recommends screening. Risk factors include early menopause (before 45), loss of periods for more than one year, being underweight, having already had a fracture, and a family history of hip fracture. Smoking increases the likelihood, as does taking high-dose corticosteroids for more than six months.
Treatment
Studies show hormone replacement therapy (HRT) slows, stops and even reverses bone loss. A trial of women in their 50s found it halved fractures. It works best taken soon after menopause, but may still work in elderly women. Slightly increased risks of breast cancer put some off. Other less-studied treatments include calcium and vitamin D supplements, calcitonins (which also help relieve pain), bisphosphonates, raloxifene, tibolone and calcitriol. Moderate exercise may relieve pain and reduce fractures; in frail, elderly people padded hip protectors can help prevent fractures. Apart from HRT, raloxifene and tibolone, the same therapies can be used for men.
Prevention
Healthy diet (taking recommended levels of calcium and vitamin D), regular but not excessive exercise and stopping smoking all appear to reduce the risk of osteoporosis.
More information
• The National Osteoporosis Society (01761 471771) runs a helpline for medical queries (01761 472721).
• What works? is based on reviews of the most up-to-date and reliable evidence available. It is written in collaboration with the NHS Centre for Reviews and Dissemination at York university (01904 433 634) and verified by experts.
