Fracture

OSTEOPOROSIS

• Osteoporosis is characterised by reduced bone strength, predisposing to fracture.
• It affects 1 in 3 women, compared to 1 in 5 men.
• Bone loss itself does not cause any symptoms, and it is a silent process until fracture occurs.
• It is estimated that 1 in 2 women in the UK will suffer a fracture after the age of 50 years.

BONE LOSS AT MENOPAUSE

• In women, the menopause transition represents a time of increased bone loss.
• Research from SWAN, which is a large longitudinal study, indicates that resorption begins around 2 years before the final menstrual period, peaks approximately 1.5 years after the final period, and then plateaus.
• During this 3-year-long interval, the average rate of decline in bone mineral density in white women was 2.5% per year in the lumbar spine and 1.8% per year in the femoral neck.
• Changes in oestrogen levels appear to drive this bone loss. Oestrogen can alter the activity of osteoclasts, osteoblasts and osteocytes, with the principal effects as an antiresorptive agent through reduction of osteoclast numbers and function.

RISK ASSESSMENT

• Risk factors for osteoporosis should be assessed and advice on bone health given if indicated.
• The FRAX risk calculator tool gives a 10-year probability of hip or major osteoporotic fracture and can be used to aid decisions about when to give lifestyle advice alone, measure BMD, treat or consider specialist referral.
• The FRAX tool is not validated for women under 40 years.