A patients guide to osteoporosis and DEXA scanning

Osteoporosis is a condition causing the bones to become porous and brittle, often resulting in fractures after relatively minor injuries.

Bone is a living tissue which is constantly being removed and renewed in a continuous cycle. From birth to around the age of 30, bone grows and becomes stronger by forming more new bone than is removed. After the age of 30, the rate of remove exceeds that of new bone formation, resulting in gradual loss of bone strength. It is therefore to everyone's advantage to build up the strongest bones possible during childhood and early adult life by eating a healthy diet and taking plenty of exercise.

Various other factors (see later) will affect bone strength in young people and the rate of bone loss as one becomes older. In females, after the menopause, there is rapid phase of bone loss due to a reduction in the amount of oestrogen produced by the ovaries.

An early menopause may lead to osteoporosis and fractures. Replacement of missing oestrogen can help
prevent or delay this premature bone loss.

Osteoporosis is a silent condition unless a fracture occurs. It can only be diagnosed by Bone Densomitry Scanning. One in three of all women will develop osteoporosis (and one in eight men). Each year Osteoporosis causes more than 60,000 hip fractures, 50,000 wrist fractures and 40,000 spinal fractures.

Signs to look for:

• fracture after a relatively minor injury
• increasing curvature of the back
• loss of height
• a band of pain running around the body from the spine

If you fall into the category of being at increased risk of Osteoporosis your doctor will be able to refer you for a DEXA scan.

• early menopause (before 45 years old)
• long term steroid treatment (you must never stop taking these without your doctor's approval)
• history of eating disorders (such as anorexia nervosa)
• malnutrition
• excess alcohol intake
• chronic liver disease
• smoking
• lack of exercise
• immobility

Children and young adults should build up strong healthy bones by taking at least an hour of exercise on most days, preferably weight bearing, eating a good diet and exposing their skin to natural sunlight (but beware of taking too much).

Your diet should contain plenty of calcium and vitamin D. Milk and other dairy products (including low fat) are good sources of calcium. Vitamin D is found in eggs, margarine, yoghurts and some breakfast cereals.

It is never too late to prevent further bone loss. The following will help reduce bone loss:

• regular weight bearing exercise (walking and dancing are good forms of exercise)
• health diet (as above)
• reduce alcohol intake
• stop or reduce smoking
• Calcium and Vitamin D supplements (available in pharmacies and health food shops)

• measures to reduce osteoporosis
• medication to treat osteoporosis
• correction of problems with eyesight
• wearing appropriate safe footwear
• use of mobility aids (sticks, frames etc)
• removal of obstacles from the home such as loose carpeting

If you feel that you may be at risk of developing osteoporosis you should consult your GP or other healthcare professional who will discuss if it is appropriate to refer you to the Borders General Hospital for scanning.

You will be asked to lie on a special table while the scanner takes reading and images of your hips and spine. You will not be enclosed in any tunnel or tight space. This takes only a few minutes. You will also be asked a few simple questions and may be asked to provide a blood sample for routine testing. The scanner calculates your bone density from which an assessment is made of your fracture risk.

Once the results of your scan have been reported a copy will be sent to your GP (Usually within 4 weeks) or to the Hospital Consultant who made the original request.

Depending on the results of the scan you may be prescribed treatment or if appropriate a referral will be made by your GP for you to be seen at the Osteoporosis Clinic to discuss other treatment options. If you are already known to the Osteoporosis Nurse, she will arrange to see you following the results to discuss
these with you.

If you have a normal scan a follow up Dexa scan will be recommended for two to three years.

What do DEXA scan results mean?

Your scan may be normal, or may show a degree of bone weakening.

Normal scan

This is a reassuring result. You should continue to take measures to preserve your bone strength. A follow up scan in two to three years may well be recommended.

Mild bone loss

This is often found in patients over the age of 50. You should continue to take measures to prevent further bone loss and you may be advised to take regular calcium and vitamin D supplements or other medication. You will probably be offered a follow up scan in 18 months time.

Significant bone loss

You will be at increased risk of fracture and should try hard to avoid falls and knocks. You will probably be prescribed treatment which will vary from patient to patient depending on your individual circumstances. It is absolutely essential that theses drugs are taken exactly as instructed, in order to gain benefit from them and avoid side effects. The bone forming drugs will help rebuild lost bone and a follow up scan should be performed to check progress.

Osteoporosis is a common disorder which can have major effects on peoples' lives. By following simple advice on lifestyle, everyone can help reduce the effects of osteoporosis but some patients will still need scanning and treatment which, together with avoidance of knocks and falls, can significantly reduce the risk of painful and potentially disabling fractures.