In this post I will discuss the risk factors for osteoporosis, scanning for osteoporosis and my experience of a DEXA scan.
If you have been diagnosed with M.E. (Myalgic Encephalomyelitis) or CFS (chronic fatigue syndrome) an awareness of the risk factors for osteoporosis is important.
Bone Density
After the age of about 35 bone density gradually decreases as part of the natural ageing process. This coincides with the second age peak for developing ME or CFS which is thought to be between 30 to 39 years. (The first age peak is between 10 – 19 years).
Weight bearing exercise is an important factor in increasing and maintaining bone density but is a major challenge for people with ME or CFS. Osteoporosis is diagnosed when your bone density is found to be significantly reduced and as a result you are at higher risk of breaking bones, also known as a fracture.
The most common fractures as a result of osteoporosis are in the hip, spine and wrist. These can cause substantial pain and severe disability, often leading to a reduced quality of life.
D'oh
Last summer I had a meds review with my GP. Usually this is a 'tick box' exercise. My M.E. Consultant retired in 2007 and since then the meds my consultant prescribed have simply been re-issued by my GP. This time I was warned not to take Domperidone (for nausea) on a long term basis due to new advice regarding cardiac side effects - handy to know!
My current GP, although appearing to show no interest whatsoever in M.E. (the term M.E. or CFS has yet to pass her lips) did recognise that I have risk factors for osteoporosis.
In my case they included:
There are other risk factors which I have listed at the
bottom of this post. They have been taken from the National Osteoporosis Society website. The NOS also produces a useful range of leaflets, a bone health quiz and an provides an excellent helpline on 0808 800 0035.
Treasure Your Bones!
Bone Density
After the age of about 35 bone density gradually decreases as part of the natural ageing process. This coincides with the second age peak for developing ME or CFS which is thought to be between 30 to 39 years. (The first age peak is between 10 – 19 years).
Weight bearing exercise is an important factor in increasing and maintaining bone density but is a major challenge for people with ME or CFS. Osteoporosis is diagnosed when your bone density is found to be significantly reduced and as a result you are at higher risk of breaking bones, also known as a fracture.
The most common fractures as a result of osteoporosis are in the hip, spine and wrist. These can cause substantial pain and severe disability, often leading to a reduced quality of life.
Image of bone scans from NHS Choices
Unhappy Statistics
According to NICE hip and vertebral fractures are associated with decreased life expectancy. Hip fracture nearly always requires hospitalisation, is fatal in 20% of cases and permanently disables 50% of those affected. Only 30% of patients who suffer a hip fracture fully recover. These are not happy statistics.
D'oh
Although aware that my inability to undertake weight bearing exercise is a risk factor for osteoporosis I had not given it any serious thought until my GP raised the issue at my annual meds review. Managing my activity levels, and just getting through each day had crowded out concerns for more long term issues.
Meds Review
My current GP, although appearing to show no interest whatsoever in M.E. (the term M.E. or CFS has yet to pass her lips) did recognise that I have risk factors for osteoporosis.
Risk Factors for Osteoporosis
- Low weight - my BMI is below 19 - my bones are likely to be smaller so osteoporosis is more likely
- Female - women are at greater risk of osteoporosis than men
- Aged over 50 - 1 in 2 women and 1 in 5 men over 50 will break a bone, mainly as a result of poor bone health. Menopause accelerates the process of bone turnover, and the production of oestrogen, which has a protective effect on bones, is greatly reduced and ceases.
- Caucasian - Caucasians and Asians tend to be at greater risk of fragile bones than people from other ethnic backgrounds
- Inactive lifestyle - no weight bearing exercise to maintain / increase bone density
- Lactose intolerant - I avoid milk and dairy products - other calcium rich foods include broccoli (which however hard I try I simply don't like it) and dried apricots (yum but pricey).
- Lack of exposure to sunlight - I burn easily, plus due to M.E. I'm often not well enough to sit outside - Vitamin D levels in my blood came up as low end of normal.
- Use of Proton Pump Inhibitors - I've been taking Losec for years for reflux and inflammation
Other Risk Factors
DXA Scans
My experience of a DXA Scan
Image of DXA Scan from NHS Choices
From the M.E. point of view the scan itself is relatively easy, (compared to say a mammogram) although travel and waiting in the waiting room will use up precious energy. You lay on a padded table and the scan thing chugs along over your hip and spine. You do need to keep still whilst being scanned. I was able to take a break between the hip and spine elements of the scan.
The scan doesn't enclose you unlike MRI or CT scans and takes about 15 minutes. Although I'm quite noise sensitive, the frequency of the sound was low and wasn't painful. The light in the room was bright so I covered my eyes with a scarf. The radiographer was kind and gave me wet paper towels to cool me down when I overheated.
Image of DXA Scan from NHS Choices.
I had the cushion under my knees which was a lot more comfortable than the lady in the picture looks. I didn't need to undress and put on a gown. I also had a short conversation with the radiographer who checked my personal details were correct, that my lifestyle factors and list of medications were up to date.
Risks and Benefits of a DXA Scan
Risks & Limitations of a DXA Scan
- Symptom Exacerbation - Travelling to access the scan and undergoing the scan may well exacerbate your ME or CFS symptoms. I'm severely affected and I needed extended rest for a few days afterwards and my symptoms were aggravated, especially the pain in my legs. This was probably due to sitting in the car to travel and sitting in my wheelchair in the waiting room
- Lack of knowledge about ME - The radiographer may not be sympathetic to people with M.E. or CFS which can be upsetting if insensitive comments like 'we all get tired sometimes' are made. Or the radiographer may not help you as much as you would like with getting on and off the table or removing and replacing any clothing if needed.
- Low exposure to radiation - A DXA scan involves the use of radiation. However, the amount of radiation is very low, less than two days’ exposure to natural background radiation. A chest x-ray is the equivalent of about 5 days exposure to natural background radiation.
- Partial view of bone health - A DXA scan will show your bone density, but not your bone quality. A DXA scan is only part of the picture and your other risk factors will also need to be taken into account in assessing the level of your fracture risk
- Not predictive - A DXA test cannot predict if you will experience a fracture but can provide indications of relative risk
- Information is of limited use - you may not be able to make the changes recommended to improve bone health due to
- Difficulty tolerating medication
- Difficulty undertaking weight bearing exercise
- Difficulty tolerating dietary changes
Benefits of a DXA Scan
- Accurate and reliable measure of bone density
- Simple to undergo and painless
- Local - Scanner likely to be available locally so you don’t have to travel too far
- Informed choice - When you get the DXA scan results you can then make an informed choice taking into account your other risk factors, needs and preferences. You can consider your options regarding medications, supplements and lifestyle changes
In my case the benefits far outweighed the risks so I went ahead with the scan.
DXA Scan Results
- a diagnosis of osteoporosis
- recommendations for treatment and management
It was very useful having an opportunity to review the scan results and recommendations before went back to my GP.
In Treasure Your Bones! M.E. and Osteoporosis Part 2, I will upload my scan results, describe the problems I have had with medication, and explore the treatment and management options in more detail.
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The National Osteoporosis Society: Other risk factors for Osteoporosis include:
- Smoking
- Drinking alcohol (alcohol intolerance is common in ME)
- Previous fractures as a result of a minor bump or fall
- Losing inches in height - this can be due to compression fractures in the spine
- Family history of osteoporosis, hip or vertebral fracture, or a family member with a 'dowagers hump' or curve in the spine
Medical conditions which increase the risk of osteoporosis:
- Rheumatoid arthritis
- An eating disorder causing severe weight loss
- A condition which affects absorption of food such as Crohn's or coeliac disease
- Long periods of immobility (from conditions causing disability such as a stroke or multiple sclerosis)
- Early menopause (before 45) without hormone replacement therapy (HRT)
- Hysterectomy with removal of ovaries (before 45) without hormone replacement therapy (HRT)
- Excessive exercise which may have reduced hormone levels and stopped menstrual periods
- Hyperthyroidism when levels of thyroid hormone are abnormally high
- Parathyroid disease when levels of parathyroid hormone are abnormally high
- Other conditions which may be linked to fragile bones such as diabetes, HIV (AIDS), organ transplant or respiratory disease
- Low levels of the sex hormone testosterone (following surgery for some cancers or treatment for prostate cancer with Zoladex/Prostap, for example)
- Klinefelter's disease
- Kallman's syndrome.
Medications that can increase the risk of osteoporosis:
- Corticosteroid tablets for over three months
- Anti-epileptic drugs
- Breast cancer treatments (such as aromatase inhibitors)
- Prostate cancer drugs that reduce hormone levels
- Diabetic drugs in the glitazone group (including rosiglitazone and pioglitazone)
- Drugs to reduce inflammation of the stomach and oesophagus called proton pump inhibitors (PPIs)
- Injectable progestogen contraceptives e.g. medroxyprogesterone acetate (known as Depo Provera)
- Drugs used for mental health problems (particularly psychosis).
Other lifestyle:
- Prone to falling
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References
Two age peaks in the incidence of CFS/ME: A population registry based study from Norway 2008 - 2012
NICE CG 146 - Osteoporosis: assessing the risk of fragility fracture. August 2012
Gov.uk: Domperidone - risk of cardiac side effects
National Osteoporosis Society - Risk factors for osteoporosis
https://www.nos.org.uk/healthy-bones-and-risks/are-you-at-risk
Womens Health Concern - Bone health following menopause
National Osteoporosis Society - Bone health quiz
World Health Organisation Fracture Risk Assessment Tool
National Osteoporosis Society - Scans & Tests - DXA Scan
NHS Choices - Osteoporosis
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