Health

Saturday 26 July 2014

'I had a fracture at six and told I had osteopenia at 27'

Since childhood Rav Jeawon has been breaking bones. After years visiting A&E departments, he was diagnosed with osteopenia, which leads to osteoporosis, a disease associated with older people, writes Shane Cochrane

Ravind Jeawon

RAV Jeawon had a history of breaking bones. "It happened when I was running backwards, training for hockey. And it happened when I was out, socially. I'd had a few drinks – to be honest with you."

But this had been going on since childhood. Every trip or fall required a visit to A&E. When he was 27 years-old, he was diagnosed with osteopenia, the precursor to osteoporosis.

"People were shocked," he says.

"My friends and colleagues couldn't believe it."

They were shocked because we still regard osteoporosis as an old woman's disease – a wasting of the bones brought on by the menopause.

According to the Irish Osteoporosis Society, 300,000 people in Ireland have osteoporosis. However, 85pc of that number are unaware they have the condition. Many of those who have the disease are otherwise fit and healthy and, contrary to popular belief, many of them are young men.

We all lose bone density as we get older, but this process is accelerated in those with osteoporosis.

Their bones become so fragile that, in extreme cases, coughing or sneezing can break them.

Despite the severity of the condition, it's relatively symptomless and can remain undetected for years. There are some signs, such as sudden and severe back pain. Becoming shorter is another. We normally associate this with old age but, according to the Irish Osteoporosis Society, it's not normal to lose height at any age. Height loss is a sure sign of fractured vertebra.

But for most sufferers, the first indication that something is wrong is a fracture from a minor trip or fall – known as a low impact fracture.

"I have had a history of these fractures," says Rav. "I was probably about six years old when I had the first one."

Rav would suffer fractures from relatively minor incidents, such as tripping over a toy, or falling during hockey practice.

"They were all so low impact. I'd think, 'that can't have been a fracture.' But then I'd get the swelling and the pain."

Rav's doctors failed to recognise these low impact fractures as a definite sign of osteoporosis.

"They just treated my fractures as they occurred. They weren't really looking at it in terms of prevention."

Things changed when Rav's younger sister suffered a low impact fracture and was referred to Professor Moira O'Brien, an osteoporosis specialist. She told the professor about her brother's history of fractures. O'Brien immediately recognised the symptoms and recommended he have a DXA scan.

A DXA scan is a special type of x-ray that measures bone density, and is regarded the "gold standard" for diagnosing osteoporosis. The scan produces a T score: a negative T score indicates a problem, and the number provides an indication of the severity of the problem. A T score of -1.00 to -2.49 is osteopenia, while a score of -2.49 or higher is osteoporosis.

The scan detected osteopenia. Blood tests also revealed that Rav had very low levels of vitamin D, the vitamin essential for healthy bones.

Pete Watts was in his 50s before he was diagnosed with osteoporosis. He too had a history of low impact fractures. One incident, in particular, sticks in his mind.

"I broke my ankle, just by balancing on one leg when I was putting my trousers on."

 

As well as the frequent fractures, Pete was suffering with severe back pain. "I'd been suffering with backache for about five years," he says. "I'd been going to see doctors in England – because I was working over there, but they could find nothing wrong."

Not that the doctors weren't trying. They subjected him to just about every blood test, scan and x-ray imaginable.

"I had a full-body MRI scan. The cost of that must have been phenomenal."

But the doctors never considered that Pete might have osteoporosis.

"They never mentioned it at all. They thought I had all sorts of things. They thought I had myeloma, which is a blood cancer that affects the bones."

A GP in Ireland finally recognised the symptoms for what they were, and arranged a DXA scan.

But by the time he was diagnosed, Pete was in pretty bad shape. The osteoporosis was advanced, and the scan revealed a number of fractures in his spine. The damage had taken 3.5 inches off Pete's height.

"It was quite a blow, really," he says. "I was very upset at the time."

Pete's experience is further evidence that doctors, like the rest of us, consider osteoporosis to be an old woman's disease.

The decrease in oestrogen levels brought about by the menopause does leave middle-aged women at a higher risk of developing osteoporosis. Oestrogen is essential for healthy bone growth in women.

However, testosterone is every bit as essential for bone growth in men.

And while men don't experience a menopause-type event that reduces their testosterone levels, damage to the testes – through disease, injury or some cancer treatments – can reduce the hormone to levels that increase the risk of osteoporosis.

There are other factors. About 80pc of bone growth is dictated by our genes. And healthy bones require calcium, vitamin D, adequate calories and protein; along with regular weight-bearing exercise – that is, any exercise where your feet support the full weight of your body.

Like many conditions, osteoporosis tends to be caused by a combination of factors.

We have to look at the whole picture," says Professor O'Brien. "We had a family where both parents had osteoporosis. They had three boys: one aged 19, one aged 16, and one aged 12. The two younger boys exercised, took dairy and had good healthy lifestyles. The 19-year-old did no exercise, took no dairy – and smoked.

"We did DXA scans on the three of them. The 19-year-old's T score was -3.00. He was worse than either of his parents."

Some groups have a high risk of developing osteoporosis. Anyone with an eating disorder or sensitivity to a particular foodstuff may not be getting enough calories or the right nutrients in their diets. And the ability to absorb nutrients from food is impaired in those suffering from stress.

The usual suspects are also at risk: the smokers, the drinkers and the couch potatoes.

But osteoporosis can be an occupational hazard for some of the fittest people on the planet.

"There are athletes who over-train and don't get enough calories, says Professor O'Brien.

"And some sports are more likely to cause low bone density because they're non-weight-bearing."

"Cycling is non-weight-bearing, and cyclists are more prone to low bone density. They also train harder than most other people, and a lot of them don't eat enough for what they're doing. The physical and psychological stress of competing also takes its toll."

In short, there's a lot more to osteoporosis than age and sex.

Osteoporosis is treatable. In many cases, bone density can be returned to normal levels.

"The most important thing is to find the cause," says Professor O'Brien. "You find the cause, then you treat the cause."

In some cases, drugs are needed to prevent further bone loss.

"It very much depends on the person's other medical conditions, and what they can take – and what they can tolerate," she explains.

"You've got to treat each patient individually. There isn't one thing that you give everybody."

Certainly, Rav and Pete have had very different treatment experiences.

Rav's treatment has centred on changing his diet, increasing his vitamin D intake and getting him to exercise more.

"I have a gluten-free lifestyle now. Well – I'm 70pc compliant," he laughs. "I also play a bit of golf. That seems to have helped: my bones had improved at the last scan."

Pete's condition, however, required a more aggressive, drug-based intervention.

"There were a lot of side effects from that. I lost a lot of my hair, and I had skin rashes and all sorts of things," he says.

"I was always fairly keen on DIY and being outside – gardening, and that sort of thing. They've told me that, for the next 12 months at least, I really shouldn't do anything. Basically, the whole of my spine is hollow. The professor thinks it could snap like a twig if I do something daft."

Though it may take some time, and discomfort, Pete's bone density is expected to return to an "acceptable level." And given that osteoporosis is a potentially crippling and ultimately fatal condition, Pete's happy to endure the treatment.

But 70pc of osteoporosis sufferers discontinue their treatment within the first year. For some, the side effects of the medication are the reason. But, because bone growth is every bit as symptomless as bone loss, many believe they're not getting better.

Sometimes Rav struggles with the changes he's had to make to his life, but he's determined to stick with it.

"Generally it's for the best," he says. "If you have osteopenia, you're more likely to suffer fractures, so I have to be careful. I'm aware of what I can and can't do, and that minimises the risks."

Rav's condition was caught early, and he's been able to undo most of the damage. But he's conscious of how bad things could have been, and he's eager to alert other young men to the possibility of osteoporosis.

"It's not something that's talked about. You hear about heart disease, you hear about cancer, and you hear about other, less extreme conditions," he says. "There's just no awareness of bone health. We need to get young people thinking about it so they don't get osteoporosis.

"Normally, we just treat the symptoms as they appear, like we do with many things. But osteoporosis is one of those things that really needs preventative action."

For more information, visit the Irish Osteoporosis Society website: www.irishosteoporosis.ie

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