Metabolic Bone Clinic
The Metabolic Bone Clinic at ROH is an ancillary clinic, supporting other clinics within the hospital.
Metabolic bone diseases are disorders of bone strength, usually caused by abnormalities of minerals (such as calcium or phosphorus), vitamin D, bone mass or bone structure.
The most common metabolic bone disorder is osteoporosis. When untreated, it can lead to fragility fractures, bone deformities and serious disability. Those at high-risk for osteoporosis include older patients, those with small body size, a history of fractures, those who use steroid, have intestinal diseases, have had organ transplants or have kidney disorders. Men and women of all ages may suffer from skeletal disorders. The most common include osteoporosis, osteomalacia, Paget’s disease and parathyroid disorders.
Conditions we treat
Conditions and health issues treated in the metabolic bone clinic and wider MSK service include:
- Low bone density
- Fragility fractures
- Vertebral fracture prevention
- Fracture prevention
- Vitamin D deficiency
- Paget's disease
- Brown tumours
- Hyperparathyroidism and hypoparathyroidism
- Fibrous dysplasia
- Rare bone diseases
- Osteogenesis imperfecta
- Raised alkaline phosphatase
- Hypophosphataemia and hypophosphatasia
- Endocrine-related bone diseases.
Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture).
The most common injuries in people with osteoporosis are:
- broken wrist
- broken hip (hip fracture)
- broken spinal bones (vertebrae)
However, breaks can also happen in other bones, such as in the arm or pelvis. Sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine.
Osteoporosis is not usually painful until a bone is broken, but broken bones in the spine are a common cause of long-term pain.
Although a broken bone is often the first sign of osteoporosis, some older people develop the characteristic stooped (bent forward) posture. It happens when the bones in the spine have broken, making it difficult to support the weight of the body.
Osteoporosis can be treated with bone strengthening medicines.
Bone loss before osteoporosis (osteopenia)
The stage before osteoporosis is called osteopenia. This is when a bone density scan shows you have lower bone density than the average for your age, but not low enough to be classed as osteoporosis.
Osteopenia does not always lead to osteoporosis. It depends on many factors.
If you have osteopenia, there are steps you can take to keep your bones healthy and reduce your risk of developing osteoporosis.
Your doctor may also prescribe one of the bone-strengthening treatments that are given to people with osteoporosis, depending on how weak your bones are and your risk of breaking a bone.
Causes of osteoporosis
Losing bone is a normal part of ageing, but some people lose bone much faster than normal. This can lead to osteoporosis and an increased risk of broken bones.
Women also lose bone rapidly in the first few years after the menopause. Women are more at risk of osteoporosis than men, particularly if the menopause begins early (before the age of 45) or they've had their ovaries removed.
However, osteoporosis can also affect men, younger women and children.
Many other factors can also increase the risk of developing osteoporosis, including:
- taking high-dose steroid tablets for more than 3 months
- other medical conditions – such as inflammatory conditions, hormone-related conditions, or malabsorption problems
- a family history of osteoporosis – particularly a hip fracture in a parent
- long-term use of certain medicines that can affect bone strength or hormone levels, such as anti-oestrogen tablets that many women take after breast cancer
- having or having had an eating disorder such as anorexia or bulimia
- having a low body mass index (BMI)
- not exercising regularly
- heavy drinking and smoking
Read more about the causes of osteoporosis.
Diagnosing osteoporosis and osteopenia
If your doctor suspects you have osteoporosis, they can work out your future risk of breaking a bone using an online programme, such as FRAX or Q-Fracture.
Treatment for osteoporosis is based on treating and preventing broken bones, and taking medicine to strengthen your bones.
The decision about whether you need treatment depends on your risk of breaking a bone in the future. This will be based on a number of factors such as your age, sex and the results of your bone density scan.
If you need treatment, your doctor can suggest the safest and most effective treatment plan for you.
If you're at risk of developing osteoporosis, you should take steps to help keep your bones healthy. This may include:
- taking regular exercise to keep your bones as strong as possible
- healthy eating – including foods rich in calcium and vitamin D
- taking a daily supplement containing 10 micrograms of vitamin D
- making lifestyle changes – such as giving up smoking and reducing your alcohol consumption
Living with osteoporosis
If you're diagnosed with osteoporosis, there are steps you can take to reduce your chances of a fall, such as removing hazards from your home and having regular sight tests and hearing tests.
To help you recover from a fracture, you can try using:
- hot and cold treatments, such as warm baths and cold packs
- relaxation techniques and other ways to reduce pain
Speak to your GP or nurse if you're worried about living with a long-term condition. They may be able to answer any questions you have.
You may also find it helpful to talk to a trained counsellor or psychologist, or other people with the condition.
Read more about living with osteoporosis.
The Royal Osteoporosis Society is the UK's national charity for osteoporosis.
It has detailed information about osteoporosis prevention and treatment, and support groups throughout the UK.
The Royal Osteoporosis Society's free telephone helpline may be particularly helpful if you're newly diagnosed with osteoporosis.
The helpline number is 0808 800 0035