Women face epidemic of brittle bones
Drinking, smoking and dieting will cause far more osteoporosis cases
Sunday 13 February 2011
A dramatic increase in brittle-bone diseases is forecast to hit a generation of British women at massive cost to the National Health Service. Clinicians report increasing numbers of younger women suffering low bone density, exposing them to higher risk of developing the porous bone disease osteoporosis in later life. The shift comes as the number of people with the condition is already increasingly rapidly, due to the UK's ageing population.
Lifestyle issues such as dieting, lack of exercise, excessive drinking, smoking, contraceptive injections and high-factor sun block are being considered as contributing to a significant increase in the risk of contracting osteoporosis. Experts fear all these factors could create a surge of fragile-bone disease when this generation of young women hits the menopause. Fractures are already at "epidemic proportions". Osteoporosis affects both sexes but is much more common in post-menopausal women, as it is often brought on by a lowering of oestrogen levels.
Hip fractures – frequently a symptom of brittle-bone disease – have increased by 17 per cent in a decade in England, and there are about 230,000 fragility fractures in the UK every year. At present the cost of osteoporotic hip fractures to the NHS is an estimated £2bn a year. That is expected to rise to £3bn by 2020.
The disease, which is often only discovered after a serious fracture in older age, can be fatal. Almost one in 10 women over the age of 55 who are admitted with a hip fracture do not make it out of hospital alive.
To raise the profile of the disease, the Duchess of Cornwall will appear this week on the radio drama The Archers, in her role as president of the National Osteoporosis Society. In the episode, aired on BBC Radio 4 on Thursday, she attends a tea party for the Borsetshire Osteoporosis Society.
Nicola Peel, a consultant at the Metabolic Bone Centre at Sheffield Teaching Hospital, said: "We are seeing an increasing number of referrals for young women [with] low bone density and many more who have the risk factors. They're likely to reach the menopause at sub-optimal bone health, which will put them at risk of fractures. Binge drinking is harmful to the skeleton, smoking is a risk factor, as is a sedentary lifestyle, and we believe reduced levels of activity in childhood will have an effect on bone growth."
Bone density reaches a peak in the mid-20s, making a healthy lifestyle from childhood to the age of 25 crucial to bone development. Later in life, good nutrition and exercise help to maintain bones. Exposing the skin to sunlight is important, too, as without this the body cannot manufacture vitamin D, which – along with calcium – is crucial to bone formation.
Jonathan Tobias, professor of rheumatology at Bristol University, has just completed a study into the bone density of 15 year olds. He found that those who did regular vigorous exercise had significantly stronger bones, and is worried that the sedentary lifestyles of younger people will put their bones in danger.
"There's a potential constellation of risk factors for young women – including lack of exercise, excess dieting and progesterone-only contraceptive injections – which could mean their risk of osteoporosis in later life is even greater than that of the elderly of today. There is potentially a time bomb in terms of the incidence of fractures due to osteoporosis, which is already of epidemic proportions."
Paul Mitchell, a lecturer at the University of Derby who specialises in hip-fracture prevention, said simple steps could prevent the problem burdening the NHS. "Of the 80,000 people who are likely to get hip fractures this year, 40,000 will have presented before with a fracture since they were 50. If we consistently intervened with the first fracture, using Fracture Liaison Services, we have the potential to prevent up to a quarter of all future hip fractures through osteoporosis drug treatment and fall prevention."
But the latest figures show just 24 per cent of hospitals in England and Wales use Fracture Liaison Services, despite the fact that projections suggest they could save the NHS approximately £8.5m over five years.
"There is unquestionably an opportunity to improve care of this condition," Mr Mitchell added. "We need to make sure younger adults are attaining their peak bone mass through good calcium intake, good exercise and moderate alcohol intake."
The All-Party Parliamentary Osteoporosis Group is conducting an inquiry on the impact of nutrition on bone health, which it will finish later this spring. The group's chair, Baroness Cumberlege, said: "There's a very real concern that with the lifestyles people lead there's going to be a generation with weaker bones."
Campaigners say that the situation is exacerbated by the fact that the disease has been left out of the Quality and Outcomes Framework (QOF) for GPs. The framework, an annual reward and incentive programme for doctors, has been credited with improving treatment and diagnosis for conditions such as asthma, heart disease and stroke. The want the condition to be included when QOF is reconsidered in June.
A National Osteoporosis Society spokesman said: "The society believes that osteoporosis deserves the same recognition as other long-term conditions. Incentives are given for recognising other illnesses; we need the same for osteoporosis to ensure that it is identified and treated where appropriate."
28, model from Northwood, Middlesex
"I starved myself from the age of eight and eventually started eating properly when I was 16. By that time I hadn't gone through puberty so my oestrogen levels were very low.
"In 2007 I developed osteoporosis, which I've got in my spine and hips. My spine is worse than a 70-year-old woman's.
"I didn't get much sunlight when I was growing up because I spent so much time in hospital, and I smoked 20 a day between 13 and 16. They warned me when I was at Great Ormond Street about osteoporosis, but I was too ill and it didn't bother me. It really saddens me now. I have to have regular scans and take a calcium supplement... I have half a pint of milk a day and do weight-bearing exercise.
"Every time I wear high heels I think I'd better not get too drunk because if I fall over and break a bone I could end up in a wheelchair."
62, retired, from west London
"About three years ago I tripped on a wobbly pavement, chipped my tooth and broke my wrist. I was unhappy, so I went for a bone-density scan. I thought I'd be fine but I discovered I'd got the first level of osteoporosis in my spine and hip. I got a real shock because it doesn't run in my family.
"I feel it was self-inflicted in a way. I did flirt with anorexia when I was a teenager. I was at a girl's boarding school and we were inspired by Twiggy. We wanted to squeeze ourselves into miniskirts.
"I would eat rather erratically and then when I was at university I drank too much. If someone had said: 'Be careful, eat properly or you'll end up with brittle bones', I might have done things differently. I am sure that there will be many younger women who are now predisposing themselves to it.
"I'm fortunate that I had a fall and was alerted to it when I could do something about rebuilding bone density with medicine and exercise, rather than finding out too late after a terrible fall when I am much older."
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