Over 200 million people worldwide are affected by osteoporosis (OP), a disease where low bone density results in the prevalence of bone fractures. In South Africa one in three women and one in five men will develop the disease in their lifetime.

"It is estimated that an osteoporotic fracture occurs every three seconds worldwide. Earlier detection and successful intervention may prevent the heavy toll this preventable disease can take on a person's future," said Dr Ankia Coetzee, an endocrinologist and senior lecturer at Stellenbosch University's (SU) Faculty of Medicine and Health Sciences and Tygerberg Hospital.

The International Osteoporosis Foundation's theme of this year's awareness campaign, "Love your bones – protect your future", calls on the general public to take early action to protect their bone and muscle health in order to enjoy a good quality of life and independence in the future.

Broken bones due to OP are a serious concern mainly due to the impact it has on the quality of life and longevity of the person affected. It is estimated that 20 to 24 percent of patients do not survive for another year after sustaining a hip fracture.

Coetzee explains that the common perception that OP is a disease of the white female is incorrect. "Research done at SU demonstrated similar vertebral fracture prevalence in black and white women, emphasising that the disease need to be suspected in patients of all ethnic groups."

To make matters worse, some fractures, mostly in the lower lumbar vertebrae, often go undiagnosed and even if a fracture is diagnosed OP is too infrequently considered as the underlying cause.

"The good news is that OP can to a great extent be prevented," said Coetzee. Frequently the factors that lead to OP are those that accelerate bone loss. Some of these accelerating factors can be out of a patient's control (such as family history).

Yet there are steps everyone can take to prevent bone loss. Good nutrition and regular weight-bearing exercise are very important ways to protect bone. It is recommended that a person exercises 30 to 40 minutes per day three to four times per week. Ensure an adequate intake of protein, calcium and vitamin D, limit alcohol intake and refrain from smoking.

"A frequently overseen aspect that deserves mentioning is to prevent falls at all cost, especially amongst the elderly," said Coetzee.

Bone mineral density (BMD) is generally assessed by means of a dual-energy x-ray absorptiometry (DEXA) scan. Because ageing itself is one of the biggest risk factors for OP it is advised that all women aged 65 or older and all men aged 70 years or older should be screened for low BMD even in the absence of additional risk factors.

In younger patients the presence of other clinical risk factors, for example early menopause, the use of glucocorticoids, concomitant conditions such as rheumatoid arthritis and so forth warrants screening.

It is, however, important to note that even though BMD is used to screen for OP it has numerous limitations and the assessment of fracture risk should be an integrated approach and should not rely on BMD alone.

Fractures, of particularly (but not restricted to) the hip and spine, often lead to a vicious cycle of more fractures. Furthermore it leads to chronic pain, immobility, and in most instances disability. As a result patients every so often face the loss of physical independence. Of the patients with hip fractures 40 percent are unable to walk independently and 33 percent are totally dependent on their families or care in a nursing home in the year following the fracture.

Prevention is always better than cure and the importance of lifestyle strategies cannot be overemphasised. But unfortunately for some, lifestyle measures alone will not be enough. It is therefore very important that people talk to their doctors to seek an early diagnosis and appropriate treatment if OP is indicated. Anyone at high risk must take advantage of all available measures to reduce the likelihood of future debilitating fractures.

What is osteoporosis?

Osteoporosis (OP) is a common condition characterised by low bone mass or bone mineral density (BMD) and decreased bone quality. "Osteo" literally means bone and "porosis" means porous. The term osteoporosis describes the appearance of bones were they to be broken in half and visually examined. Normal bone would have small holes but a bone with OP would have much more and larger pores or holes in them.

These changes result in decreased bone strength which leads to hip, spine and wrist fractures. It is often asymptomatic until complications, such as fractures, arise. The risk of fractures increases dramatically with age not only due to low BMD but also due to increased risk of elderly people sustaining falls.

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