A number of clinics are offering gold standard osteoporosis treatment and new diagnostic tools.
One such clinic is headed by one of the UK’s leading authorities on bone health and DEXA scanning. Another clinic specialises in osteoporosis associated with the menopause.
Professor David Reid – who is also Emeritus Professor of Rheumatology at the University of Aberdeen is a consultant rheumatologist.
The professor, a Voluntary Ambassador for The National Osteoporosis Society is a passionate advocate of bone scanning – once patients know their risk, they can receive the most appropriate treatment.
Mr Michael Savvas - is a consultant gynaecologist at King's College Hospital, London and his team at The London PMS and Menopause Clinic are consultant gynaecologists specialising in treating menopause.
Michael Savvas has worked in the field of Menopause and PMS for over 30 years. He has conducted research into menopause and the effects of HRT on skin and in the prevention of osteoporosis. He also has many years’ experience in infertility and was Clinical Lead for King’s College Hospital Assisted Conception Unit.
Prof John Studd has pioneered treatment for osteoporosis. He is also responsible for leading most of the research on the protective role that oestrogen has on collagen and bones. He was the cofounder of the National Osteoporosis Society NOS (now the Royal Osteoporosis Society ROS) and served as Chairman and Vice President for many years. His team of gynaecologists at London PMS & Menopause Clinic continue to lead the way in providing treatment for this otherwise devastating disorder.
What is DEXA?
Bone scanning is done using DEXA – also referred to as DXA – and an abbreviation of dual energy X-ray absorptiometry.
No referral is required as the radiation used in DEXA is very low.
The DEXA machines used by different clinics vary, but are the gold standard as recommended by the National Osteoporosis Society (NOS) for bone density measurements.
What is osteoporosis?
Osteoporosis is identified by measuring bone mineral density (BMD), as low bone density means that action should be taken. Bone density is assessed by Dual Energy X-ray (DXA) scanning, usually at the lower back (lumbar spine) and/or the hip. It is interesting to note that bone density is as strong an indicator risk factor for fracture risk, as high blood pressure is for future stroke and high cholesterol is for a heart attack.
At least one in three women and one in five men over the age of fifty will sustain a fracture in their remaining lifetime that could be related to osteoporosis The most common sites of fracture are the wrist (Colles Fracture), the shoulder, the vertebrae (small bones of the spine) and the hip but really almost any bone fracture can be related to osteoporosis perhaps with the exception of the skull!
Top osteoporosis experts
Professor David Reid and Mr Mike Savvas assess and analyse each DEXA scan.
A DEXA scan is recommended for any male or female over the age of 40 years with clinical risk factors will benefit from a risk assessment using the risk calculators. The risk factors for both men and women include the following:
- Other family members have suffered hip fractures
- You’ve broken a bone – even if the fall was minor
- Early menopause has occurred
- There’s a history of smoking and heavy drinking
- Oral glucocorticoids (designed to stop inflammation) have been taken for three months or more
- Family history of osteoporosis
- Overactive thyroid or parathyroid glands
- Eating disorders (especially anorexia nervosa)
- Chronic liver or kidney disease
- Limited mobility due to neurological disease
- Frequent fallers
- Coeliac disease or poor absorption of food
- Chronic steroid (glucocorticoid) use
- Rheumatoid arthritis
- Ankylosing spondylitis
Best osteoporosis treatment
A DEXA scan may be given as part of a consultation with the professor, or it is available for anyone who is concerned about osteoporosis. If your results are of concern patients can book a consultation.
The Professor favours an integrated approach to the treatment of osteoporosis including the use of supplements.
He says: “The evidence base for the value of vitamin D has hardened in recent years. Adequate vitamin D levels from the diet or by sunlight exposure is hard to achieve especially in the winter months or in those who expose little skin to the sun. Recent nutritional advice in the UK has indicated that many adults may need to take an additional 400 -1000IU of vitamin D from the diet or as a supplement.”
However, for many with osteoporosis, taking vitamins will need to be combined with other drug treatment approaches.
The Professor states: “For more than two decades we have known that drugs which reduce the rate of bone breakdown (bone resorption) significantly reduce the likelihood of fractures in the spine, at the hip and for many drugs at other non-spine sites.”
He adds, “The primary group of drugs used are the bisphosphonates, such as alendronate and risedronate. They are inexpensive and generally safe in the short-term and therefore can be prescribed for anyone with osteoporosis. They are mainly taken as a tablet once a week.”
However, with regard to women, the gynaecologists will point out it would be ideal if improving lifestyle factors alone could reduce fractures, however, bone loss is due to lack of oestrogen - and so HRT seems the most natural treatment. For those people with significant increased risk of fracture, especially in those diagnosed with osteoporosis by DXA scan, drug therapy will usually be advised. Unfortunately, calcium supplements (with or without vitamin D) are not sufficient and there is increasing anxiety that higher doses of calcium may be associated with increased risk of cardiovascular events such as a heart attack and stroke. While this risk is not proven preventative therapy with calcium and vitamin D alone in women around the time of the menopause is not recommended and other approaches are preferable.
See - The Effective Treatment of Osteoporosis with Oestrogen Hormone
Body composition with DEXA
As well as telling you your risk of a bone fracture in the next ten years, a DEXA scan equipped with ‘Advanced Body Composition’ capabilities and a Visceral Adipose Tissue (VAT) option can also tell exactly where the fat on your body lies, giving you the chance to make appropriate lifestyle changes, which could reverse your risk of getting diabetes, heart problems and of course osteoporosis.
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