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Ageing bone and osteoporosis

Eugene McCloskey discusses how our bones age from a clinician’s perspective, demonstrating with elderly patients.
Bones play a really important role in the musculoskeletal system because they really are the framework on which the whole musculoskeletal system is built. Throughout our early lives, our bones are growing to the size and shape that we ultimately become. And then in the second half of our lives, from adulthood onwards to old age, we’re continually replacing old bone with new bone. At a microscopic level, there are tiny cells attaching to the bone surface, called osteoclasts, that resorb holes in bone, and then those holes get filled in again by bone-building cells. That process by which we replace old bone with new bone allows us to maintain our skeletal strength throughout most of our lives.
And it’s only really when we get into older ages, or perhaps we develop some disease processes that cause excessive bone loss, that we run into trouble with pathological or fragility fractures. Osteoporosis is the most common condition that we see affecting the skeleton. And osteoporosis is defined, really, as an increase in skeletal fragility, an increased ease of breaking bones. And it’s reflected by a loss of bone mass, and also an alteration in the microstructure of bone. Within the spongy bone of the spine, that means loss of the tiny trabeculae that form the spongy network within bone. And within the cortex, or the hard, compact, envelope of bone, it’s the increase in the holes within that cortex.
The loss of bone mass, this deterioration of microarchitecture, leads to an increase in fragility of bone so that a simple fall may result in a fracture or even something like coughing, sneezing, turning over in bed, helping an elderly - or caring for an elderly relative - these things can place you at risk of fractures that wouldn’t normally occur at younger ages. Patients are finding more difficulty in rising out of chairs and getting out of cars. The chronic back pain will impair their ability to prepare meals, to do housework and so on. Patients can become socially isolated. The pain is enough to stop them going out.
The fact that they are scared of falling and perhaps sustaining another fracture also impedes them from interacting socially with their neighbours. I would really encourage patients who have had fractures, particularly if elderly and perhaps a little bit isolated, to look around in the neighbourhood because there are often opportunities, exercise classes, for example, that are provided in the community, often targeted at this type of problem. To make contact with them and to go along to those classes, because you get both the benefit of the exercise and it removes the social isolation that can occur. In our clinics, we’re often asked by patients and their relatives, what can they do for themselves?
What can they do to minimise the chances of osteoporosis either now or in the future? One of the easiest answers is that it goes back to what your bones do. Your bones are there to carry you around. They respond to exercise. So exercise is really important for bone strength. In fact, the best evidence that exercise is good for bone is that no exercise is really bad for bone. Weight-bearing exercise, walking, fast walking is really sufficient to maintain our bones in a good state of health. So mobility is important. Nutrition is, of course, important.
Our skeletons are made up of calcium and phosphate, so we need to ensure that we have enough of those building blocks that come in from our diet. So we need a good, balanced diet of dairy products or other sources of calcium in our diets. Even more importantly, we need some vitamin D. That helps us to absorb the calcium from our diet. We need to take care that if we have an elderly relative who is housebound and doesn’t get out in the sun in the summer, that we can replace their vitamin D through other means. If we’re younger and we’re able to, then we should be getting out and getting some vitamin D exposure in the summer months.
And of course, during the winter, our vitamin D levels will drop. In the UK, between the months of October and March, even if the sun shines every day, we will not make any vitamin D. It’s the wrong type of sunshine.

In this video, Professor Eugene McCloskey from the University of Sheffield discusses how bones change with age and a common age-related bone condition, osteoporosis.

Bone strength decreases with age and significantly lower bone density places individuals at higher risk of breaking (fracture) under stress that healthy bone could withstand. Osteoporosis is a condition in which low bone strength leaves the bone framework brittle and susceptible to fracture.

In the UK’s ageing population, osteoporosis is a significant cause of fractures resulting in hospital admission (over 70,000 cases per year), costing the NHS £1.7million annually and hip fractures are a leading cause of early death.

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The Musculoskeletal System: The Science of Staying Active into Old Age

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