Q 1: What is Osteoporosis?

Answer: Osteoporosis is known as the Silent disease, even though the effects of it are NOT Silent. Osteoporosis affects the strength/thickness of bones, which makes the bones more fragile and is often not diagnosed until multiple fractures (broken bones) have occurred.

Note: It should NOT be considered normal for an adult to break a bone from a trip and fall from a standing position or less, even if on ice or cement.

Q2: What is osteopenia?

Answer: Osteopenia is the early stage of Osteoporosis. Having osteopenia places a person at risk of developing Osteoporosis. A diagnosis of osteopenia is a warning that you must start taking care of your bones and that the causes of your bone loss need to be investigated and addressed, to ensure you do not continue to lose bone. The risk factors for developing osteopenia are the same as for Osteoporosis.

Q 3: How can a person know if they have Osteoporosis?
What are the signs or symptoms?

Answer: There are NO signs or symptoms to warn a person that they are at high risk to break bones. A person will not know if they have Osteoporosis, unless they have a DXA scan of their spine and hips.

The following are signs and symptoms that a person may have undiagnosed Osteoporosis:

  • A broken bone/s: If you or a loved one has broken a bone from a trip and fall, from a standing position or less, you may have undiagnosed Osteoporosis. For example, a broken rib or bone in your spine, from a sneeze, cough, turning over in bed or getting out of chair.
  • Postural changes:

A person’s head starting to protrude forward from their body.

A person’s shoulders starting to become rounded.

A hump developing on your upper back, which is usually associated with loss of height.

A change in your body shape and size: A pot belly can occur when the stomach contents are pushed outwards due to the collapse of vertebrae (bones in the spine). This is usually associated with loss of height.

  • Loss of height: It should not be considered “Normal aging” for a person to lose height. It is a red flag that a person may have broken bones in their back, due to bone loss.
  • Upper, middle or low back pain: Especially if you have intermittent back pain or any of the signs or symptoms listed above.

Q4: I was diagnosed with Osteoporosis from an x-ray. Do I need a DXA scan?

Answer: Yes, unless you are bed bound or unable to lie still for approximately 10 minutes. If you do not get a DXA scan, you will not know if your bones are improving or disapproving. We recommend that a person get rescanned at a maximum every two years if access is available and preferably on the same machine.

Q5: My sister and I were both told that getting shorter is normal when you age. Both of us have lost several inches in height and I am developing what appears to be a hump on my upper back. Could I have Osteoporosis?

Answer: It is considered normal by many people to lose height, due to wear and tear of the bones and discs in the spine. However, loss in height should be investigated, especially with postural changes. A DXA scan would be recommended in your situation.

When a person develops a hump on their back, a DXA with an LVA (Lateral Vertebral Assessment), if available, is recommended. If not available on the DXA machine, a lateral thoracic X-ray of your spine should be done to rule out fractures in your spine.

Q6: My boyfriend is 34 and is under a huge amount of stress at work, he has been complaining of back pain and appears to be losing height. He has also lost interest in sex. Could this be Osteoporosis? If yes, can he be helped?

Answer:

  • Psychological stress can affect levels of sex hormones, which can affect a person’s libido and can also affect bone.
  • Undiagnosed, back pain should be investigated.
  • Loss of height should be investigated by a DXA with an LVA.
  • Stress, back pain, loss of height and loss of libido are risk factors for bone loss. Osteoporosis is treatable in most cases.
  • A DXA scan would be recommended, and if positive, investigating the causes of bone loss.

Q 7: I am 54 and I have always lived a healthy lifestyle, however over the last year I have developed a “pot belly” and my clothes do not fit the way they used to. I feel my shape is changing and my trousers seem to be longer, even though I have worn the same length for the last 40 years. I am eating the same amount of food and doing the same amount of exercise. Could I have Osteoporosis?

Answer: If you have noticed a change in your body shape and possible loss of height, it would be wise to have this investigated as there are no signs or symptoms, warning a person that they are losing bone.

A DXA scan with an LVA (Lateral Vertebral Assessment) is recommended if a person has lost height, if your head is forward from your body, your shoulders have become rounded or a hump has developed on your back. If an LVA is not available, then a lateral X-ray of your thoracic area is recommended.

Q 8: My mum has broken five bones from falls over the last two years but has never been tested for Osteoporosis.

Answer: She should contact us at the IOS as it should not be considered normal for an adult to break multiple bones from trips and falls from a standing position or less.

 Q 9: How is Osteoporosis diagnosed?

Answer:

  • A bone density scan of the spine and hips called a Dual Energy X-ray Absorptiometry (DXA /DEXA) scan, is the recommended gold standard for the diagnosis of Osteoporosis.
  • It is used to measure the density (Strength/thickness) of bones. It is a painless test, that usually takes between 10-15 minutes. It is not claustrophobic.

*The Irish Osteoporosis Society does not recommend ANY TYPE OF heel or shin scan for the screening or diagnosis of Osteoporosis.

*The Irish Osteoporosis Society does not recommend a person who is pregnant having a DXA scan, due to the possible affects to the unborn child.

Monitoring of your Osteoporosis

Q 10: I had a DXA scan three years ago and was told that I did not have to get rescanned. How do I know I am improving if I do not get re-scanned?

Answer: When possible you should be re-scanned every two years, to monitor your response to treatment and your results should not decline. If your results decline it is essential that this is investigated.

Myths

Q 11: Is it true that only old women get Osteoporosis?

Answer: No, it is not true. More women are affected than men because their bones are smaller and they also go through the menopause.

Note: 1 in 4 men over 50 will get Osteoporosis and children can also be affected.

Q 12: Is Osteoporosis preventable?

Answer: Yes, it is preventable in most cases.

Q 13: My mum is 84 and has just been diagnosed with Osteoporosis, but we have been told that it is not treatable. Is Osteoporosis treatable?

Answer: It is treatable, and we have had 90-year olds who have improved their bones and reduced their risk of further fractures. A person is never too young or too old to be diagnosed and treated.

Q 14: My local chemist is advertising that they do “bone density” testing. My friend got one done, they only did her heel and told her that their machine was just as accurate as the DXA test for the spine and hips, is this true?

Answer: The heel is NOT one of the most common areas to be affected, the spine, hip and forearm are the most common areas to be affected first. We do not recommend any type of heel or shin scan for the screening or diagnosis of Osteoporosis. These machines are ultra sound machines which cannot measure bone density.

Note: A heel scan is NOT as accurate as a DXA scan. A DXA scan is the World standard for diagnosing Osteoporosis.

The IOS does not recommend ANY TYPE OF heel or shin testing for screening or diagnosing of Osteoporosis.

Q15: I have heard that there are no treatments for Osteoporosis. Is this true?

Answer: No, this is not true. Adults, who have been diagnosed with Osteoporosis, should be put on an Osteoporosis medication, plus ensure to take the daily amounts of calcium, vitamin D3 and protein.

The cause/s of the person’s Osteoporosis should be identified and addressed. Treatment plans for children under 21 and women in childbearing years, are usually dealt with differently to those who are in the older age group. Contact us if your child had been diagnosed with Osteopenia and/or you think they have it. It is also important to seek advice from a registered dietician (www.indi.ie).

Q 16: I have been told that I have Osteoporosis, but I am only twenty-five years of age. I have always eaten healthily and exercised. I do not know how I got it and always thought it was an old woman’s disease?

Answer: You can contact us for further information

Prevention of Osteoporosis

Q 17: What can I do to help prevent Osteoporosis?

Answer: Bones require their owner to eat healthy foods containing adequate calories, calcium, vitamin D3, proteins. Normal levels of sex hormones along with appropriate weight bearing / strengthening exercise are also important.

Q 18: I was diagnosed with Osteoporosis four years ago and have been taking the recommended treatments, but my last scan showed my bones had declined. What could be wrong?

Answer: There could be many reasons why this happened and if you contact us we can help to guide you.

Q 19: I was diagnosed with Osteoporosis a year ago and was recommended to take an Osteoporosis medication. I did not take the medicine, as I don’t like to take pills. I have increased my calcium and vitamin D intake and I do weight bearing exercise every day. Is this enough to prevent it from getting worse?

Answer: No, Osteoporosis is a disease which needs to be treated by a medication that has had extensive research done on it, to prove that it works. The causes of your bone loss need to be investigated and addressed. Do not let anyone convince you to buy products that have not had extensive clinical research to prove they work. We would not recommend that anyone increase the amount of exercise you are doing when your bones are not protected by a treatment. You did not feel your bones getting thinner, you will not feel them declining further.

Q 20: When can you not have a DXA scan?

Answer: You should not have a scan:

  • if you are pregnant
  • if you have had a barium meal in the last week, you need to wait one week.
  • If you have had a barium enema in the last week, you need to wait one week.

Before you have a DXA scan.

  • If you have metal in an under-wire bra or belt you will be asked to remove it.
  • If you have a replacement hip, your other hip can be scanned. If you have metal in both hips, your spine and forearm can be scanned. If you have metal in both hips and the spine, your forearm can be scanned.

Q 21: I had a DXA scan of my spine and hips and I was told that I did not have Osteoporosis. However, I have a hump on my upper back, I have broken 5 bones and I am getting shorter.

Answer: If you have broken bones, we would consider you to have Osteoporosis, unless proven otherwise. The fact that you have developed a hump, a DXA scan with an LVA (Lateral Vertebral Assessment) of the thoracic spine (the area where hump is) is recommended if available. If not available, a lateral x-ray of your thoracic and lumbar spine is advised. This will show if the shape of the bones in this area are compressed due to an Osteoporosis fracture.

A person may have arthritic osteophytes or extra bony spurs (excess bone that the body develops to protect an area) of their lumbar spine which can give a false higher bone density reading.

Q 22: I had anorexia in my teens, I am now 29 would I be at risk of Osteoporosis?

Answer: Yes, you should consider getting a DXA scan. Anyone with a past or especially if you have any of the signs or symptoms of undiagnosed Osteoporosis.

There are nineteen-year olds, with the bones of eighty-year olds, with fractured vertebrae (broken bones in spine), secondary to undiagnosed Osteoporosis. Osteoporosis is treatable but the earlier you get diagnosed, the better the results.

Q 23: My 19-year-old daughter had a DXA scan and was told she had the bones of an74 year old women, how can that be? She looks thin, exercises several times a day but is not bent over or on any medication that affects bone. She did admit to me but not to her doctor that she has not had a period in 3 years.

Answer: A girl or woman who does not have periods, other than for reasons of pregnancy, shows a high risk factor for Osteoporosis. This needs to be investigated as it could also affect her chances of having children.

Over exercising is a sign that she may have an issue with her weight. It is very common for people with eating disorders (anorexia and/or bulimia) to be very good at hiding this problem. It is also not unusual to be diagnosed with Osteoporosis at a young age when an eating disorder is undiagnosed.

However, if the possible eating issue/missing periods are addressed as well as the Osteoporosis, she should be able to significantly improve her bone strength. The fact that she is upright and has not broken any bones, it is essential to have this problem sorted, sooner rather than later.

Q 24: I had an ovary removed when I was in my thirties. Am I at risk for Osteoporosis?

Answer: Removal of an ovary or ovaries can place a person at a higher risk of developing Osteoporosis. In the first few years of a woman going through the menopause, some woman can  lose up to 30% of their overall bone.

Q 25: I am 56 going through the menopause and having hot flushes sweats and I am very irritable. My doctor has recommended HRT, but I am very anxious as I have heard it causes breast cancer. I am having trouble concentrating in work and my husband says I am becoming unbearable to live with. What can I do?

Answer: There has been a lot of controversy over HRT. For many years HRT was the only treatment for Osteoporosis. However, now it is mainly used for the menopausal symptoms to improve a person’s quality of life.

  • It is usually not recommended for people who have a family history of breast cancer.

Your risk of multiple fractures is three-fold, by not protecting your bones.

1 in 12 women will get breast cancer.  However, 1 in 2 women over 50 will break bones due to Osteoporosis. More women die from Osteoporosis than the combined deaths of cancer of the ovaries, uterus and cervix. More men pass away from Osteoporosis than develop prostate cancer.

Cancer of the lungs is the only cancer that supersedes Osteoporosis in death rates.

When you are on HRT regular mammograms are done. If bones are not protected, women can lose up to 30% of their overall bone while going through the menopause. Seek advice at a menopause clinic.

Q 26: My mother was 81 and lived independently until she broke her hip and passed away several months later. I heard that it could be linked to Osteoporosis, is this true?

Answer: Approximately 90% of fractured hips in senior citizens are due to Osteoporosis. It is not normal for an adult of any age to break a bone from a trip and fall from a standing position. If a person’s bones were healthy they would not break easily. If she fractured it from being in a car accident, it is not unusual for a person to break a bone. If your mother broke her hip from a trip and fall, she may have had undiagnosed Osteoporosis.

20% of people aged 60+ who fracture a hip pass away within 6-12 months from the secondary complications of Osteoporosis.

50% of people aged 60+ who fracture a hip become dependent on others. They are unable to dress, bath or walk across a room independently.

Only 30% of people aged 60+ who fracture a hip regain their independence. The secondary complications are a blood clot, pneumonia or an infection. They usually develop after a person has been bed-bound because of a fracture.

Genetics is one of the strongest links for Osteoporosis, as 80% of bone is genetic.

Q 27: I have been told that my child who is 14 has Osteoporosis. I thought children could not get Osteoporosis?

Answer: The good news is that the majority of children can improve their bone density. However, the cause/s must be found and addressed, as well as the Osteoporosis itself being treated.

Children and adolescents can be affected by a variety of conditions such as:

Chromosome abnormalities:

  • Turner’s syndrome in girls and Klinefelter’s in boys
  • Genetics – Family history, especially with 2nd risk factor
  • Metabolic disorders that require a special diet e.g. Homcystinuria etc)
  • Still’s disease, juvenile rheumatoid arthritis
  • Collagen disorders
  • Marfan’s Syndrome etc.
  • Osteogenesis Imperfecta (Brittle bone disease)
  • Idiopathic juvenile Osteoporosis (IJO)
  • Eating disorders: anorexia, bulimia and / or binge eating
  • Malabsorption: Coeliac disease, Crohn’s disease, Ulcerative colitis. Cystic Fibrosis• Kidney disease: nephrotic syndrome etc.
  • Endocrine disorders: Cushing’s disease.
  • Bechet’s Syndrome
  • Severe eczema• Asthma – oral steroids and some inhalers have steroids in them which affect bone•
  • Chemotherapy and radiation for transplants or cancer
  • Mobility impairment (limited walking, being wheelchair or bed bound for six weeks or longer) especially in pre-puberty and teenage years e.g. Muscular dystrophy, Cerebral palsy.
  • Obesity: if a child eats unhealthy food and does not participate in sports they will not develop their bones to be healthy and strong.
  • Hip and knee replacements

Q 28: I am scheduled to get a hip replacement. Could this be due to Osteoporosis?

Answer: Joint replacements are usually due to arthritis. However, if you also have undiagnosed Osteoporosis the success rate of this surgery is usually significantly reduced.

A pin in any bone that has untreated or undiagnosed Osteoporosis, usually will not hold long term as there is very little bone for it to secure to.

Any person who is having an elective surgery (surgery is scheduled, not from a car accident) for any type of pinning or joint replacement should contact us about getting a DXA scan done prior to surgery. This way if the person has Osteoporosis they can build up their bones prior to surgery.

Q 29: I don’t eat meat or dairy products, as I am a vegan. How can I prevent myself from getting Osteoporosis?

Answer: A Vegan diet tends to contain very high fibre content. This may have an adverse effect on your hormones which can result in low oestrogen levels.

It may result in you having difficulty absorbing adequate protein, calcium and vitamin D3. This puts you at risk of developing Osteoporosis. Protein can be found in lentils and tofu. Too little protein can affect the collagen content of bone. Calcium, Vitamin D3 and protein supplements are available for those who cannot get any of them from food.

Excessive fibre in the diet can affect your hormones and in turn increase your risk of Osteoporosis. You should consider seeing a dietician to ensure you are getting the daily amounts to protect your bones. Please see nutrition section.

Q 30: Is calcium the only treatment for Osteoporosis?

Answer: No, calcium is not a treatment for Osteoporosis and Vitamin D3 is essential to absorb the calcium. Everybody should be taking all of these for their overall health.

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