Introduction
Bone loss (medical term – osteoporosis) and the related condition of low bone mineral density (medical term – osteopenia) can cause problems with all joints in the body (including the hip joint) and makes bones more fragile and subject to fracture.
Osteoporosis can make seemingly innocuous small accidents like falling over high risk for bone fracture. One of the most common fractures due to osteoporosis is at the 'neck of femur' where the ball joint is connected to the top of the thigh bone (femur).
There is also another much rarer type of osteoporosis that affects the hip called 'transient osteoporosis', affecting mainly men aged 30-60 and women immediately before and after childbirth.
Causes
Osteoporosis is a natural process that happens to everyone as they grow older, and from the age of around 30-35 bone density decreases as the amount of bone tissue being created by the body drops below the bone tissue being reabsorbed by the body.
This gradual loss of bone tissue makes people older than 50 more likely to be affected than younger people. The condition affects women more than men, particularly after menopause. Other causes of osteoporosis and osteopenia include;
- Excess alcohol intake.
- Smoking.
- Insufficient dietary calcium intake.
- Low levels of vitamin D (caused by lack of exposure to sunlight).
- Being of Caucasian or Asian extraction.
- In women, low levels of oestrogen – either due to late menstruation onset, infrequent menstrual periods or menopause (especially if menopause is before the age of 45).
- In women, removal of ovaries before the age of 45.
- In men, low testosterone levels.
- Eating disorders (e.g. anorexia, bulimia nervosa).
- Excess physical activity levels in adolescence.
- Low levels of physical activity (especially weight bearing / strength training exercise).
- Family history.
- Long term use of corticosteroid medication (used to treat pituitary gland failure).
- Other medical conditions e.g. breast cancer, thyroid conditions, coeliac disease, chronic liver / kidney disease, rheumatoid arthritis, diabetes, multiple sclerosis, leukemia.
- Prior bone fracture.
- Body weight – being either underweight or overweight increases the risk.
Symptoms
Osteoporosis itself rarely causes any symptoms* and is often only discovered after a minor accident causes a bone fracture. In older people, any loss of height or adoption of a stooping posture is indicative of osteoporosis (due to bone loss in the vertebrae in the spine). Other symptoms that may indicate osteoporosis include:
- Receding gums (due to bone loss in the jaw).
- Decreasing grip strength.
- Brittle fingernails.
- Neck / back pain.
* the rare form of transient osteoporosis mentioned above does have noticeable symptoms, which include pain in the hip (with no other apparent cause), sudden onset of pain in the thigh, groin or buttocks and pain with weight bearing activity which goes away when resting; it sometimes causes a noticeable limp.
Tests / Diagnosis
There are a range of tests used to measure bone density, the primary test being a dual energy x-ray absorptiometry ('DXA scan'). Other tests that can diagnose (or confirm a diagnosis) of osteoporosis include:
- Ultrasound.
- CT scan.
- Lateral radiograph (a type of x-ray).
Treatment
Once detected osteoporosis can be treated with a range of medication. Preventative measures can be taken by avoiding high risk lifestyle and dietary factors listed above.