Osteoporosis is often known as the “bone thinning” disease that strikes in old age – but is this an accurate description? And is it an inevitable problem in old age or are there steps for you to take right now that will make a difference?

The first thing to say is that osteoporosis is not a painful condition, but it can become painful if you fracture a bone, which is more likely if you have osteoporosis.

What happens in osteoporosis?

We often think of our bones as big solid lumps of calcium, but actually they are arranged in a matrix of criss-crossing pillars of calcium and protein called trabeculae. These run in lots of different directions, which means that the bone is strong in lots of different directions and able to resist forces through all kinds of movement.

Normal trabeculae in a hip bone

As we’ve discussed in previous posts, the body is highly adaptable, and is able to change its composition to deal with lots of different environments and challenges. This is true of muscles, for example, which get bigger and stronger with use. It’s also true of the nervous system, which is able to re-wire itself to learn a new skill or technique. And it’s also true of your bones, because they are able to deposit extra calcium along these trabeculae when the bones are regularly used and loaded. They are also able to do the opposite – to remove calcium from trabeculae that are not being used or loaded.

This is what we see in osteoporosis. When we look on an x-ray, the bones appear almost stripey, because the trabeculae running in one direction have thinned and become less dense, leaving a darker stripe running through the bone.

The classic stripey pattern of osteoporosis in the knee

What can I do to prevent/treat osteoporosis?

Some bone thinning in older age is normal, but when it occurs faster than it should, then this is diagnosed as osteoporosis. If you remember back to the blog post about osteoarthiritis, we saw there that certain cells called osteoblasts are responsible for building new bone. In osteoporosis, these cells are unable to do their job and there are 5 main causes for this:

  1. Inactivity – the osteoblast cells are stimulated by movement and loading, so a sedentary lifestyle will slow down the activity of these cells
  2. Drinking heavily and smoking – both alcohol and cigarette smoke are known to inhibit osteoblasts, and early research on vaping suggests it may also have a similar effect, although this is not conclusive.
  3. Having a low BMI – being underweight is a risk factor for developing osteoporosis, partly because it is indicative of a diet low in fat, calcium and Vitamin D – all of which are needed to build healthy bones. But weight is also important because it affects hormone levels (see below)
  4. Hormonal changes – osteoporosis is most common in post-menopausal women because osteoblasts slow down when there’s a drop in oestrogen, as happens in the menopause. Testosterone is also important for healthy bones in men, so changes in these hormone levels may cause osteoporosis too. Also too much of the thyroid hormones (in both men and women) can slow down osteoblasts
  5. Some medications – for example, long term use of corticosteroids

The great news is that, if osteoporosis is caught early enough, it is actually possible to reverse it completely. And even if it is caught later on and is already quite advanced, it is possible to slow its progress, stop it progressing completely or partially reverse it. From the list above we can clearly see that a healthy BMI with an active lifestyle, good diet, moderate alcohol intake and no smoking would help prevent osteoporosis.

If you have a family history of osteoporosis, or are have already been diagnosed with it I would recommend the following:

  1. Regular weight bearing exercises
  2. A strong calcium and Vitamin D supplement
  3. Quit smoking and reduce your alcohol intake
  4. Get some sunshine! (this helps with Vitamin D, but in the UK you will always need to take a supplement as well)
  5. See your GP for advice on medication (there are medications available which help with building bone back up again)

Ankylosing Spondylitis (AS)

Ankylosing spondylitis (AS) is a long-term condition in which the spine and other areas of the body become inflamed.

The symptoms of AS can vary but usually involve:

  • back pain and stiffness that improves with exercise and isn’t relieved by rest
  • pain and swelling in other parts of the body, such as the hips, knees and ribs
  • fatigue (extreme tiredness)

These symptoms tend to develop gradually, usually over several months or years, and may come and go over time.

In some people, the condition gets better with time, but for others it can get slowly worse.

It is not known what causes the condition, but there is thought to be a link with a particular gene known as HLA-B27. Having this gene does not necessarily mean you will develop AS. It is estimated that 8 in every 100 people in the general population have the HLA-B27 gene, but most do not have AS. It is thought that having this gene may make you more vulnerable to developing AS, and the condition is triggered by one or more environmental factors – although it is not known what these are.

AS tends to first develop in teenagers and young adults. Most cases first start in people aged 20-30, with only a minority of cases first affecting adults over 45.

AS is around three times more common in men than in women.

There are around 200,000 people in the UK who have been diagnosed with the condition.

Keeping active can improve your posture and range of spinal movement, along with preventing your spine from becoming stiff and painful.

As well as keeping active, manual therapy is a key part of treating AS. A chiropractor, osteopath or physiotherapist (a healthcare professional trained in using physical methods of treatment) can advise about the most effective exercises and draw up an exercise programme that suits you.

Some people prefer to swim or play sport to keep flexible. This is usually fine, although some daily stretching and exercise is also important.

You will also be prescribed medication. Some medication is taken to slow down or halt the progression of AS, others are to help with pain or inflammatroy “flare ups”

top 5 tips for managing AS
  1. a tailored exercise programme – to relieve stiffness and discomfort and improve strength and flexibility
  2. massage – your muscles and other soft tissues are manipulated to relieve pain and improve movement
  3. hydrotherapy – exercise in water (usually a warm, shallow swimming pool or a special hydrotherapy bath); the buoyancy of the water helps make movement easier by supporting you, and the warmth can relax your muscles
  4. quit smoking – not only will the inflammatory chemicals in tobacco make your symptoms worse, but AS also puts you at a higher risk or heart disease, and smoking will contribute to this too
  5. improve your diet – introduce foods which will reduce inflammation, such as fresh vegetables, oily fish and spices like turmeric. You should also increase your calcium and Vitamin D intake to support the health of your bones, as AS puts you at a higher risk of osteoporosis (thinning bones)

Inflammatory Arthritis

In our last blog post, we talked about the two different types of arthritis – osteoarthritis and inflammatory arthropathies (aka rheumatic diseases). This posts will concentrate on inflammatory arthropathies, the most common of which is rheumatoid arthritis (RA)

RA is a type of autoimmune disease – the immune system mistakenly attacks the lining of the joints, thinking it is a foreign substance. This causes the joint to become red, hot, swollen and stiff. The symptoms are particularly worse if you’ve been sleeping or had a period of inactivity. You can also get “flare-ups” where the symptoms become particularly severe. It often runs in families, and is more common in women and in the over 50s. It can sometimes have effects in other areas of the body, such as the eyes, heart and lungs. It’s also common to get other symptoms like fatigue and poor appetite. No-one knows why the immune system starts to behave this way, and the only known risk factor is smoking.

In a previous blog, I talked about inflammation as the first stage of the healing process, and this is true. However, in the case of these autoimmune conditions, the inflammation is happening in the absence of injury, and so the immune system is breaking down perfectly healthy tissue. In these cases the inflammation is inappropriate and so, rather than letting it run its course (like in an injury), it is best to stop it in its tracks.

There is no cure for RA, or any of the other inflammatory arthropathies. However, the medication currently available is very effective and there are many other things you can do to help manage the symptoms.

  1. Appropriate Exercise Movement in the joint will provide relief from stiffness and swelling, and strengthening the muscles, tendons, ligaments and bony structures around the joint will also help the joint to stay stable and healthy. However, overly strenuous activity can lead to a release of substances that promote inflammation, so it’s best to avoid high impact exercise like running/aerobics or contact sports like rugby and football. For a tailored programme specific to you, talk to a chiropractor, physiotherapist or OT.
  2. Diet The things we digest become the things that make up our bodies, so eating things that promote the formation of anti-inflammatory substances can be helpful in RA. These include fresh leafy vegetables, tomatoes, fish and spices like turmeric. Similarly, avoiding things that promote inflammation can be helpful, like nut butters, meats that have been battered and/or deep fried, and alcohol.
  3. Smoking Smoking increases the risk of developing RA and it also exacerbates the symptoms
  4. Supplements The government recommends that everyone, regardless of age, should take a 10mg Vitamin D supplement every day. However, evidence has shown that Vitamin D at higher doses can help to properly regulate the immune system, and therefore help manage RA. There is also some (slightly weaker) evidence that a high dose Vitamin D supplement can reduce the risk of ever getting RA, but this is less clear.
  5. Treatment Manual Therapies such as chiropractic, and also medical acupuncture, can help with pain relief during a flare-up, and reduce the frequency and severity of a flare-up
  6. Get Support RA and the other inflammatory diseases are life-long conditions. Although good medication is available and good self-care can help enormously with symptom control, it is almost inevitable that flare-ups and relapses will occur. This is a condition you will have to learn to manage for the rest of your life. Sometimes it can help to talk to people who are going through the same thing. You can find your local branch of VersusArthritis (previously ArthritisCare) here.