What is osteoporosis? 

    Osteoporosis is a condition that
    weakens bones, making them fragile and more likely to break. People with axial
    SpA (
    axial spondyloarthritis)
    are at higher risk of osteoporosis. 

    Recent research shows that axial SpA
    patients have a higher prevalence of both osteoporosis and osteopenia. High
    disease activity and hip involvement are risk factors for bone loss in axial

    During childhood, bones grow and
    repair very quickly, but this process slows, as you get older. Bones stop
    growing in length between the ages of 16 and 18 but continue to increase in
    density until you are in your late 20s. You gradually start to lose bone
    density from about 35 years of age. Women lose bone rapidly in the first few
    years after menopause. 

    Losing bone is a normal part of the
    aging process, but for some people, it can lead to osteoporosis and an
    increased risk of fractures. People with inflammatory conditions such as axial
    SpA are at higher risk of developing osteoporosis. 

    Osteoporosis is often referred to as
    the ‘silent disease’ because, although almost 3 million people in the UK are
    estimated to have osteoporosis, few know they have it until they break a bone. 

    Orthopedic Institute of New Jersey 

    Diagnosing osteoporosis 

    Your GP can use an online program
    such as the Fracture Risk Assessment Tool to help assess your risk of fracture.
    They may also refer you for a bone mineral density scan, known as a DXA scan. 

    A DXA scan is a quick, safe and
    painless procedure that usually takes about five minutes, depending on the part
    of the body being scanned. The scan measures your bone mineral density and
    compares it to the bone mineral density of a healthy young adult and someone who
    is the same age and sex as you. 

    The difference between the density
    of your bones and that of a healthy young adult is calculated as a standard
    deviation (SD) and is called a T score. A T score of: 

    • above -1 SD is normal 
    • between -1 and -2.5 SD is defined as
      decreased bone mineral density compared with peak bone mass 
    • below -2.5 is defined as

    Treating osteoporosis 

    There are medications that can help
    strengthen bones. 

    • Calcium and vitamin D supplements
    • Bisphosphonates slow the rate bone
      is broken down in your body. This maintains bone density and reduces the risk
      of fracture. There are several different bisphosphonates, including
      alendronate, ibandronate, risedronate, and zoledronic acid. They are given as a
      tablet or injection 
    • Selective estrogen receptor
      modulators (SERMs) are medications that have a similar effect on bone as the
      hormone estrogen. They help to maintain bone density and reduce the risk of
      fracture, particularly of the spine. Raloxifene is the only type of SERM
      available for treating osteoporosis. It’s taken as a daily tablet 
    • Parathyroid hormone (teriparatide) is
      used to stimulate cells that create new bone (osteoblasts). They’re given by
      injection. They  can increase bone
      density but are only used where bone density is very low and when other
      treatments aren’t working  
    • Hormone replacement therapy (HRT)
      has been shown to maintain bone density and reduce the risk of fracture during

    How can I help myself? 

    There are steps you can take to
    lower your risk of osteoporosis and improve your bone health. 


    Your bones will be stronger if you
    do regular weight-bearing exercise. This is any kind of physical activity where
    your feet and legs bear the weight of your own body. Brisk walking is ideal.
    For most benefit you should exercise regularly, aiming for 30 minutes at least
    5 times a week. Muscle strengthening exercises are also important as they will
    help give strength to the supporting muscles around bones 

    Food and diet 

    Calcium is important for maintaining
    strong bones. Adults need 700mg a day, which you should be able to get from
    your daily diet. Calcium-rich foods include leafy green vegetables, dried fruit,
    and yogurt. Vitamin D is also important for good bone health. Your body needs a
    good supply of vitamin D to absorb the calcium you are eating and drinking.
    Vitamin D can be found in eggs, milk, and oily fish. Vitamin D is also made by
    your body after exposure to the sun 

    Smoking and drinking 

    is associated with an increased risk of osteoporosis. It is another good reason
    to try to give up. Enjoying the odd drink is fine but drinking too much alcohol
    can damage your bones and increases your risk of fracture. 

    For more details visit NASS.CO.UK