Osteoporosis – the silent killer


One of the problems with medicine is that quite a few of the really dangerous illnesses do not hurt in their early stages. Often the pain develops once it is too late. A classic example of this is osteoporosis.

What is osteoporosis?

The word osteoporosis means, literally, porous bone. It is a condition where you gradually lose bone material causing your bones to become more fragile. As a result, they are more likely to break even after a minor fall.

What causes osteoporosis?

Our bones grow during childhood and are at their strongest when we are in our late 20s. As middle age approaches, the bones very gradually become weaker. This weakening, or thinning of the bones, continues as we grow older.

The process speeds up in women during the 10 years proceeding the menopause. The reason is because the ovaries stop producing the female sex hormone, oestrogen, which is important to keep the bones strong. Osteoporosis also sets in faster after the male andropause.

All of us are at risk of developing osteoporosis as we get older, which is why elderly people are more likely to break bones when they fall. The most likely areas to sustain a fracture are the wrist, hip and spine. But some people are more at risk than others. There are factors that can make a difference – age, steroids, oestrogen deficiency, diet, smoking, drinking and a family history.

How can osteoporosis

be detected?

There are no obvious, physical signs of the problem and it is a common misconception that it hurts – it is, in fact, a silent killer. Many older people die as a consequence of hip or spine fractures from complications which have arisen from them being immobile and bedridden.

No one can see the bones getting thinner. Osteoporosis can go unnoticed for years without causing any symptoms. Quite often, the first indication that someone has a problem is when they break a bone, in what would normally have been a minor accident. Relatively minor fractures of the spinal bones can cause a person’s shoulders to become rounded and give them the appearance of losing height. These fractures may be painless but can cause back pain in some patients.

If a doctor suspects a case of osteoporosis, they can order a scan to test the strength of the bone and its density. The patient will need to lie on a couch, fully clothed, for about 15 minutes while their bones are x-rayed. The technique is called a dual energx-ray absorptiometry (DEXA Scan). The result will tell what the risks are of the bones fracturing.

What are the consequences of osteoporosis?

People with osteoporosis are more likely to break bones in relatively minor falls. Spinal and breathing problems can occur after fractures of the vertebrae. Hip fractures often lead to long periods of immobility and then subsequently to pneumonia and thrombosis (often lethal).

The ‘little old lady’ with a humped and crooked back you may have seen in villages of the Alentejo would have had many of those unnoticed ‘collapses’ of vertebrae, causing her to seem shrunken and sometimes almost incapable of looking up straight.

An osteoporotic fracture is a serious warning sign and should be treated by an expert like a rheumatologist.

How can osteoporosis

be treated?

A healthy diet, with sufficient amounts of calcium, is very important. Weight bearing exercises are essential. Even the fittest astronauts in space develop osteoporosis quickly because they lack weight on their bones.

When it comes to using medication, it is important to weigh benefits against possible risks. HRT is the most effective weapon in the battle against the silent killer, but, as we now know, it is not without risks. There are other alternative medications like Fosamax and hormones from the parathyroid. Calcium supplements can rarely harm you and are mostly useful.

Which medication to use should be decided by you with the help of your physician. The diagnosis and prevention of osteoporosis is essentially a classical field of anti-ageing medicine.

And finally a word for my male readers. Osteoporosis is also common in men. If you are experiencing symptoms similar to those I have mentioned in the article – rounding shoulders, an appearance of height loss, then make an appointment with your doctor.

Best wishes,

Dr Thomas Kaiser

Medical Director of the Family Medical Centre in Vale do Lobo and Quinta do Lago. His special interests are family medicine, prevention and aesthetic medicine.