Dr Peter Prouse
Diet is very important in preventing osteoporosis through having an adequate and appropriate diet, particularly with an adequate intake of Calcium and maintaining normal Vitamin D levels. In addition regular exercise is important particularly weight bearing exercise, which is, any activity that involves putting your body weight through your bones, such as walking and running.
As smoking affects hormone levels which could cause osteoporosis, we would strongly recommend that you stop smoking. Also drinking a lot of alcohol, that is more than 3 units a day can also lead to weakening of bone we would therefore recommend keeping with the maximum amount of alcohol recommended by the Government, that is 2 – 3 units a day for women and 3 – 4 units a day for men.
Dr Mike Irani
Under the age of 75 years, follow-up scans should be performed two years after the commencement of active treatment or those with significant osteopaenia but after 75 years the scans are unreliable due to presence of degenerative changes in bones, particularly the spine. Treatments are available for osteoporosis but this depends on the bone mineral density found on the DEXA scan.
Normal BMD: Lifestyle advice of exercise, discontinuing smoking and moderate alcohol consumption is needed to ensure that an adequate calcium and vitamin D intake. A repeat DEXA scan in two years is recommended.
Patients with osteopaenia in which the BMD is moderately lost according to DEXA scan; calcium and vitamin D, lifestyle advice and a repeat scan in three years is recommended. However, secondary causes have to be excluded with liver function test, ESR (inflammatory marker) and thyroid function tests.
For patients with significant osteoporosis: a repeat scan in two years and treatment with anti-bone resorptive agents such as bisphosphonates is recommended if the BMD continues to decrease.
For patients with frank osteoporosis: the calcium and vitamin D, lifestyle advice and repeat scan in 2-3 years is recommended as well as exclusion of secondary causes of osteoporosis. Anti-resorptive drugs should be recommended for that stage of BMD loss as well.
Other treatments such as denosumab, which is given by injection every six months, can help to further help to ameliorate bone loss but in order to increase BMD, parathyroid hormone analogue, Teriparatide, given daily may help.
Of course, appropriate management of a fracture if it is present is essential as is correction of posture with appropriate physiotherapy.