Understanding and Assessing Bone Health and Condition

Specialist bone experts

The accurate interpretation of blood and urine tests, combined with the latest, multi-view DXA scans is complex. Therefore this requires experienced experts to assess bone balance, which should be viewed in relation to bone density changes and clinical condition.

Bone formation and breakdown

Bone is an amazing organ that is continually undergoing change in formation to accommodate the stresses and strains put on it by daily living. Old bone breaks down and new bone forms on a continuous basis.

There are three special types of cell that are only found in bone. These are osteoblasts, which are responsible for producing new bone, osteoclasts, which are cells that dissolve bone and osteocytes, which are cells within bone. These cells are responsible for making and maintaining bone and there is a constant balance between osteoblasts forming new bone and osteoclasts breaking down bone. During growth and development bone turnover favours the osteoblast.  During subsequent years there is consolidation when bone formation is in balance with bone breakdown and most of the adult skeleton is replaced about every 10 years.

Hormones and bone health

A number of hormones are important to the maintenance of good bone health including calcium-regulating hormones and sex hormones. Both oestrogen and testosterone have an effect on bone. Oestrogen acts on both osteoblasts and osteoclasts to inhibit bone breakdown at all stages in life and it may also stimulate bone formation. As a consequence, the marked decrease in oestrogen that occurs during the menopause leads to rapid bone loss. Accelerated bone loss results in fragility and a predisposition to osteoporosis and fracturing.

Understanding the “cross-talk” between the forming and resorbing bone cells has led to the development of drug treatments to halt bone loss or to stimulate bone formation with the choice of specific medication depending on several factors.

Accelerated bone loss during menopause

In postmenopausal women there is accelerated bone loss and therefore bone anti-resorptive drugs, such as bisphosphonates, are helpful to slow the osteoclastic activity and to allow normal bone formation by the osteoblast to continue.  Bone fragility is identified by measuring bone mineral density (BMD), as low bone density means that bones may have lost strength. Bone density is assessed by specialised Dual Energy X-ray (DXA) scanning.
See also Diagnosing Osteoporosis and Age Related Spinal Fractures using DXA scanning by the leading specialist in this area, Professor David Reid.

Bone Turnover Marker Tests

Ongoing bone balance can be assessed using Bone Turnover Markers (BTMs), which are biochemical laboratory tests performed on urine or blood samples. A combination of DXA scanning and BTMs testing is very helpful for when deciding on an appropriate integrated treatment and for monitoring on-going efficacy of that treatment. Not all laboratories offer this test and those that do should have an accreditation certificate. There are some difficulties with interpretation of results and they require an experienced expert to assess bone balance, which should be in relation to the bone density changes and clinical condition.
See also effective treatments for osteoporosis provided by Consultant Rheumatologists such as Dr Stephanie Kaye-Barrett
A class of drugs used in osteoporosis and other bone diseases to reduce loss of bone mass Full medical glossary
A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
An element that forms the structure of bones and teeth and is essential to many of the body's functions. Full medical glossary
The basic unit of all living organisms. Full medical glossary
An abbreviation for dual energy X-ray absorptiometry. Full medical glossary
A substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. Full medical glossary
Relating to the menopause, the time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. Full medical glossary

The time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle, and her periods cease

Full medical glossary
A hormone involved in female sexual development, produced by the ovaries. Full medical glossary
large cells that absorb bone tissue Full medical glossary
A condition resulting in brittle bones due to loss of bony tissue. Full medical glossary
Relating to injury or concern. Full medical glossary
The main male sex hormone. Full medical glossary
A type of electromagnetic radiation used to produce images of the body. Full medical glossary