The most common bone condition in Ireland is osteoporosis, with approximately 300,000 people over 50 years estimated to have the condition. However, it is often referred to as a silent disease as it can go unnoticed, without symptoms, until a fracture occurs. In fact, only about 15 % of people with osteoporosis have been diagnosed. As a GP, we constantly look out for high risk patients or signs and symptoms to identify the condition. If osteoporosis is suspected, we then refer the patient for a DXA scan, to test their bone density.
Bone strength and fracture risk are largely determined by the density of our bones. The minerals in dense, healthy bones are more tightly packed giving them a stronger, more robust structure compared to bones with a lower density. A DXA (Dual-energy X-ray Absorptiometry ) scan is a quick, non-invasive measurement of bone mineral density. When assessing osteoporosis risk, DXA scans of the lumbar spine (lower back) and proximal femur (hip) are usually assessed in a hospital or specialised clinic. The level of risk is usually determined by the T-score value from a DXA, where a T-score of greater than or equal to -1.0 is indicative of normal bone density; between -1.5 and -2.49 is indicative of osteopenia, or low bone density; and a T-score of -2.5 or less is indicative of osteoporosis. However, your doctor will take additional factors into consideration before making any diagnosis.
The treatment of osteoporosis is very much dependant on the cause of the condition and for the majority of patients, it is manged rather than cured. However, early diagnosis and optimal treatment leads to positive outcomes for a wealth of patients. GPs or clinicians will tailor each treatment to suit the individual patient and it may include lifestyle interventions through diet and exercise or pharmaceuticals to act against bone loss and strengthen bone tissue. Osteoporosis can also be secondary to other conditions, so all of these factors will be into consideration for best management.
The most important approach for patients is to report any signs or symptoms to their GP, particularly if there is a family history of the condition. The most common osteoporotic fractures are vertebral, with only one third of these reported to cause pain. Therefore, I would advise patients not to ignore any loss of height or even minor back pain as this can be useful clinical indicator. As osteoporosis progresses it can lead to painful fractures and loss of independence so preventative lifestyle approaches are particularly important and can support overall health (see Top tips for a healthy musculoskeletal system).