EVEN WOMEN in their thirties who look as young and vibrant as Kylie Minogue are already beginning to lose their bone density; this generally starts to decline at the age of 35. The loss of bone mass accelerates once oestrogen levels fall and the menopause approaches. At some time in her life one woman in three will have symptoms as a result of this loss of bone density (or “thinning of the bones”, as patients usually describe it). If the bone thinning is too great, fractures occur readily, sometimes almost spontaneously.

The sites most frequently affected are the spine, hips and wrists. Once one fracture has occurred, a patient with osteoporosis is five times more likely to have another fracture of some sort and three times more likely to break a hip. This is too often the prelude in old age to disability, and even death. There are 70,000 hip fractures and 60,000 wrist fractures every year; their repair contributes to the £1.7 billion costs that osteoporosis inflicts on the NHS.

I met an old friend this week who is about my age. About three years ago she twisted her ankle and broke four bones in her foot. No sooner had she recovered from this than her wrist snapped when lifting a heavy cast iron pot off the stove. A month or two later she sustained a crack in one of the spinal bones in her neck, and a crush fracture of the lower lumbar vertebrae. Over the past three years she has had “more broken ribs than I care to remember ”, without ever suffering a significant accident. She has had extensive treatment for osteoporosis since her troubles started, but only now is the osteoporosis beginning to be controlled as the bones regain some of their past density.

This woman, tall and well exercised, is used to striding over the Northumberland hills and doesn’t look the typical patient likely to develop osteoporosis. She is as surprised as the doctors she knows that Nice, the government body that determines treatment by influencing the likelihood of reimbursement for prescriptions, has recommended that only patients who have had bone scans confirming osteoporosis should be prescribed preventive measures necessary to keep it at bay.

Now that HRT is not recommended for the prevention of osteoporosis, it is important that women who could have the condition should be prescribed treatment without delay.

As well as taking additional calcium and vitamin D, they need HRT alternatives such as Evista (raloxifene), one of the bisphosphonates such as Fosamax, or such recently introduced preparations as Forsteo (teriparatide) or Protelos (strontium ranelate). A recent paper in the New England Journal of Medicine reported that patients taking Protelos had a 59 per cent reduction in fractures of the spine in the first year of treatment.

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