Young women in Malaga face hidden osteoporosis threat as bone fragility cases rise

Often dubbed a 'silent' condition because it produces no symptoms until a bone breaks, specialists consulted by SUR confirm that the growing number of diagnoses among younger women stems from improved screening, greater clinical awareness and better diagnostic tools.

The key test is bone densitometry, which is used to “measure bone quality and calcification”, explained Dr Francisco J. Tinahones, head of the endocrinology department at the Virgen de la Victoria university clinical hospital.

Tinahones said, "It is not that there are more women under the age of 50 with the menopause or osteoporosis, but rather that we are now detecting far more cases. It is true that over the past 20 or 30 years, certain lifestyle habits, such as a decline in physical activity, may be having an impact. However, with a reasonable amount of exercise and an adequate intake of calcium and vitamin D, the rates should not rise. The difference is that, fortunately, we are now diagnosing many more cases at an earlier age."

Detection

Tinahones stressed that preventative screening using bone density scans is the only way to detect the condition early before vertebral or limb fractures occur. He noted that while menopausal osteoporosis relates to ageing and declining hormone levels, cases in younger patients require thorough medical investigations to rule out secondary causes, such as severe vitamin D deficiency, kidney disease, endocrine disorders (including hyperthyroidism and hyperparathyroidism) or prolonged corticosteroid treatment.

Where no secondary cause is identified, the condition is classified as idiopathic osteoporosis.

The data

The head of the department of traumatology, orthopaedic surgery and sports medicine at Vithas Xanit international hospital, Dr Antonio Narváez, agrees with Tinahones that more cases of osteoporosis are being detected in younger women today because more diagnoses are being made.

In Spain, around three million people have osteoporosis, and almost eight out of ten are women. Among those aged 50 and over, approximately 22.5 per cent of women and 6.8 per cent of men suffer from the condition. Every year, there are nearly 290,000 fragility fractures in the country – around 33 every hour. For every man, just over three women suffer a fracture, although the proportion of men is rising, according to this specialist.

Uncommon

In young women, he explained, osteoporosis is rare and is almost always the result of another underlying condition. “What I see in my practice is an increase in young women with stress fractures or fractures following minor falls. Many are athletes or have been on very strict diets for periods of time,” Narváez said.

Risk factors include certain medicines, endocrine, kidney or inflammatory diseases, eating disorders, prolonged absence of menstruation, early menopause, smoking and alcohol.

Early menopause, he said, "accelerates bone loss". Thus, a 40-year-old woman may have the bone density of a 55-year-old. “The most effective approach is hormone replacement therapy until the usual age of the menopause,” he explained, combined with weight-bearing exercise, a diet rich in calcium and vitamin D, giving up smoking and regular bone density scans.

What signs might suggest abnormal bone fragility? “The clearest sign is a fracture caused by a minor impact, such as a fall from standing height, or recurring stress fractures. We should also be alert to a loss of height or back pain that occurs after minimal exertion,” added Narváez.

There is, therefore, under-diagnosis in this age group. “Many fractures in young women are simply dismissed as accidents and nobody examines the bone. As there are no symptoms, people still assume it’s something that only affects older people, and there is no screening programme for this age group. The fracture is the key moment, and it is often overlooked,” he said.

Strength

María Rosa Alhambra Expósito, a member of the mineral and bone metabolism working group of the Spanish society of endocrinology and nutrition, agrees that osteoporosis is rare in people under the age of 50, which means there is greater detection and a better understanding of its secondary causes. Identifying risk factors, she said, is key, as is ensuring that women who need it undergo an assessment.

During childhood, adolescence and the early years of adulthood, she explained, "a large proportion of the bone mass that will serve as a reserve for the rest of one’s life is built up. Diets that are highly restrictive or deficient in energy, protein, calcium and vitamin D can prevent the attainment of an adequate peak bone mass, particularly if they also lead to underweight or menstrual irregularities". Furthermore, a sedentary lifestyle reduces "the stimulus that exercise exerts on bone formation".

This specialist recommends weight-bearing exercises, such as walking at a brisk pace, climbing stairs, running or jumping, which force the skeleton to support the body’s weight. Strength training, meanwhile, also promotes bone density and strength.