Osteoporosis is the thinning of bones associated with older age and disuse. The structure of bone changes as we get older so that less calcium and also less of the protein framework of bone is present. The body lays down bone during early life, reaching a peak in the thirties and forties. After this bone mass tends to decrease slowly in men. Women receive some protection from this until their menopause. When their periods stop the loss of oestrogen hormones leads to a rapid phase of bone thinning and in some women this reaches levels where the bone is put at risk of fracturing. It takes many years for the bone to thin sufficiently for this. Common sites of fracture are the wrist, the hip and the backbone.

There is an alarmingly high incidence of osteoporotic fractures in the UK:

• each year there are 50,000 fractures of the distal forearm, 50,000 hip fractures, and 40,000 clinically diagnosed vertebral fractures
• 22.5% in women aged 50 and over have osteoporosis of the hip
• progressive bone loss over the years may amount to as much as 30-40%
• as many as 20% of patients who survive a hip fracture may die within one year
• the average length of hospital stay for patients with hip fracture is 23 days
• of those patients who do survive, more than 50% will be severely disabled—many of them permanently. Only one third of survivors regain full mobility

Osteoporosis is a disease that will affect 50% of women by the age of 80. One in five women will die following hip fracture, and osteoporosis is directly linked to more than 14 premature deaths each and every day.

Putting it into the context of diseases that receive far more attention, there is a greater lifetime risk of women having hip fracture than all the female cancers (breast, cervical, and ovarian) put together.

Preventing osteoporosis is difficult. Firstly, exercise is important in helping the body lay down enough bone in early life. This enables the body to lose bone mass later on without reaching critical limits. All people are encouraged to exercise regularly to achieve a higher peak bone mass or maintain the bone that they already possess. Exercise also confers benefits for your heart, blood pressure and general well being. You should aim to exercise at least 20 minutes every other day for this to be useful.

Smoking is known to increase osteoporosis. Smokers are advised to stop. Stopping smoking also confers additional benefits such as less risk to your heart and lungs, less bad breath, increased fitness and more money to spend.

In recent years, research has shown that the risks of Hormone Replacement Therapy (HRT) probably outweigh the benefits of taking HRT solely to try and prevent osteoporosis. However, if menopausal symptoms are severe enough to bother you, it may be appropriate to take HRT and this might prove beneficial for preventing osteoporosis.

Once osteoporosis occurs it is difficult to restore bone. Women and men with established osteoporosis may benefit from a group of drugs called biphosphonates. These help to stabilise bone and may prevent the situation from deteriorating. Exercise will also help to stabilise the bone density.

In so far as prevention is better than cure, one cannot stress to highly the necessity for achieving a high peak bone mass in earlier years—this means regular exercise and no smoking.