The big three take their toll

Three of the most commonly occurring musculoskeletal conditions are osteoporosis osteoarthritis and rheumatoid arthritis. Rhiannon Smith takes a closer look at the “big three”

OSTEOPOROSIS

For three million people in the UK, a wet floor, loose rug, raised paving-stone or a brief distraction can change life forever. A minor fall can leave people with osteoporosis with a fractured wrist, hip or even spine. Around a quarter of a million fractures occur every year in the UK because of osteoporosis and the threat grows as we age.

A recent report by the National Osteoporosis Society and Age UK says: “At 89,000 cases per year, UK hip fracture rates are among the highest in the EU.” So why does the UK have such poor bone health?

Vitamin D deficiency is one reason, says Dr Peter Selby, consultant physician at Central Manchester University Hospitals NHS Foundation Trust, with an interest in bone diseases. Vitamin D allows us to absorb calcium, strengthening bones. Most of it is generated by the action of the sun on our skin. Compared with the rest of Europe, many people in the UK are deficient. Given our weather, it is perhaps clear why.

The cost of treating fractures each year in the UK is equivalent to the cost of the London Olympics

As we age, our bone density decreases and osteoporosis risk goes up. Women suffer more because levels of oestrogen, which protects the bones, fall during the menopause. Heavy smoking and drinking, and being underweight all add to the risk of osteoporosis.

For many older people, a fracture can mean an end to independent living, and a future filled with pain, sleeping problems and even early death. And the cost to society is high too. The National Osteoporosis Society estimates the cost of treating fractures each year in the UK is equivalent to the cost of the London Olympics.

Most people with a hip fracture have broken bones before, so it is crucial, says Dr Pam Brown, a GP specialising in osteoporosis, that everyone is assessed for the condition after their first fracture, to reduce the risk of another.

OSTEOARTHRITIS

In the UK, more than a million people say they suffer “unbearable” pain from osteoarthritis, according to the charity Arthritis Care. The disease affects more than 8.5 million people. That is close to the populations of Scotland and Wales combined.

Along with pain and stiffness, people with osteoarthritis might get a grating feeling when they move their joints, and there may be swellings on the joints as well.

It can happen in any joint, but is most common in the knees, hips, spine, the base of the big toe and in the fingers. It develops when the cartilage lining the end of a bone becomes thin and rough. Eventually the bones may rub together.

Osteoarthritis tends to progress slowly, says Dr Louise Warburton, a GP and president of the Primary Care Rheumatology Society. There is no cure, but painkillers, anti-inflammatories, physiotherapy and supportive shoes can help the pain. Surgery is an option in severe cases.

The condition is more common in women than men and is a function of age for many. It is most likely if you’re in your late-40s or older, overweight, if your parents had osteoarthritis or if your joints have been damaged before, by injury, gout or rheumatoid arthritis, for example.

Losing weight improves osteoarthritis, particularly in the knees, and exercise is important for strengthening muscles. Dr Brown says: “There is no evidence that using the joints increases damage, so stay active and take pain relief to achieve this.”

RHEUMATOID ARTHRITIS

Can you name one of the most preventable causes of disability? I imagine you didn’t guess rheumatoid arthritis. Yet, according to Dr Chris Deighton, a consultant rheumatologist and president of the British Society for Rheumatology, it is.

Rheumatoid arthritis is an inflammatory condition affecting not only the joints, but the rest of the body too. It is much rarer than osteoarthritis, but still affects more than half a million people in England. And it can cause significant disability if not treated early. The cause is not known.

Affecting around three times more women than men, rheumatoid arthritis generally develops between the ages of 40 and 60, although it can begin at any age. Many symptoms are similar to osteoarthritis – joint stiffness, pain and swelling – but in rheumatoid arthritis, inflammatory chemicals in the joints can be released into the blood, causing flu-like symptoms, fever, weight-loss and fatigue. It can also lead to more serious problems, including heart and lung disease.

Without the correct care and treatment, Dr Deighton says it can have a “profound impact” on people’s quality and length of life.

Early on, osteoarthritis and rheumatoid arthritis can be easily confused, says Dr Warburton, so “any new joint pain or swelling and systemic symptoms should prompt a patient to see their GP”.

A National Audit Office report said that treatment of rheumatoid arthritis should be started as early as possible – ideally within three months of symptoms appearing – to control inflammation and slow disease progression. But the report found that up to three quarters of sufferers delay seeing their GP for three months or more.

Osteoarthritis and rheumatoid arthritis are very different conditions, albeit with some similar features. There are more than 200 types of arthritis, such as gout and psoriatic arthritis, which cause aches, pains and untold problems for millions of people.

The cost of the disease runs to billions of pounds in medical costs and lost earnings.  And the personal cost is massive too –years of pain and disability, which can lead on to obesity, heart disease and depression.

DIET AND OSTEOPOROSIS

Calcium is key to staying healthy

The key is a rounded, well-balanced diet, with adequate calcium, says Dr Peter Selby, consultant physician at Central Manchester University Hospitals NHS Foundation Trust.

“Bones are part of the living body, they’re not just the girders that hold a building up – you need a healthy lifestyle to keep your bones healthy,” he adds.

This should include protein, from fish for example, and fruit and vegetables.

The bones in our body contain up to a kilogram of calcium. So a diet rich in the vitamin is vital to protect against fractures. GP and osteoporosis specialist Dr Pam Brown recommends 800mg per day for most people or 1,000mg for women who have been through the menopause.

According to the National Osteoporosis Society, good sources of calcium include:

 Fish

Fried whitebait: 860mg of calcium/100g

Sardines in oil: 500mg/100g

Vegetables

Curly kale boiled: 150mg/100g

Watercress: 170mg/100g

Pulses, beans and seeds

Steamed tofu: 510mg/100g

Baked beans: 53mg/100g

Green/French beans: 56mg/100g

Sesame seeds: 670mg/100g

Bread

White bread: 177mg/100g

Wholemeal bread: 106mg/100g

Fruit

Dried apricots: 73mg/100g

Dried figs: 250mg/100g

Dairy

Skimmed milk: 122mg/100ml

Semi-skimmed milk: 120mg/100ml

Whole milk: 118mg/100ml

Cheddar cheese: 739mg/100g

Vitamin D is also vital to allow the body to absorb calcium, strengthening the bones. But, only 10 per cent comes through our food; most vitamin D is made in our bodies by the action of the sun on our skin. Dr Brown advises 20 minutes of sunlight per day on the forearms and face in the summer months. Other lifestyle changes can improve bone health too, such as stopping smoking and only drinking alcohol in moderation. But, Dr Brown stresses, these are no replacement for medication if you are at high risk of fractures.