Osteoporosis has no designated specialist field, nor is there a dedicated certification programme for healthcare professionals wishing to qualify in this discipline. Because many diseases and disorders have been linked to osteoporosis, there are physicians in a number of corresponding fields who have developed an interest in this brittle-bone condition, as well as many other healthcare professionals whose assistance may be required to prevent or manage its onset and progress.
Medical specialists who may become involved in treating osteoporosis include:
- internists, whose general internal medical training helps them treat a broad range of diseases.
- gynaecologists, whose expertise in treating conditions and disorders of the female reproductive system helps their understanding of those groups most at risk from osteoporosis.
- family physicians, whose ability to offer comprehensive customised care, underpinned by experience in areas such as internal medicine and gynaecology, offers invaluable support to those affected by osteoporosis.
- endocrinologists, who treat the glands and hormones of the endocrine system, which controls metabolic activity within the human body.
- rheumatologists, who are responsible for the diagnosis and treatment of disease in the body’s joints, muscles, bones and tendons, and who are also experts in arthritis and collagen diseases.
- physiatrists, whose discipline covers physical medicine and rehabilitation. These doctors assess and treat patients with impairments or disabilities, or pain arising from bone fractures and other medical problems, in order to restore physical, psychological, social and vocational functioning.
- orthopaedic surgeons, who care for patients with musculoskeletal problems, which can include bone fractures and infections, congenital skeletal malformations, metabolic problems and more.
- geriatricians, whose specialist expertise lies in their understanding of the ageing process and the conditions and diseases that frequently occur among the elderly – including falls, incontinence and dementia.
Specialists from different fields will naturally develop their own perspective on osteoporosis, but each will be aware of the need to maintain a broad focus when dealing with a condition that can have many contributory causes.
Because osteoporosis displays few signs and symptoms, multidisciplinary responses have an important role to play in protecting those potentially at risk. Thus, osteoporosis specialists are involved in screening and prevention initiatives, as well as in the diagnosis and management of the disease.
Diagnosis involves the calculation of an individual’s risk of fragility fractures, using a range of personal health factors, plus an estimate of BMD (bone mineral density) as a risk indicator. Bone condition can be evaluated via the following methods:
- radiography, which uses internal imaging to identify bone fractures and reductions in bone mass
- dual-energy X-ray (DXA), which uses sophisticated BMD scoring to produce an extremely accurate diagnosis of bone condition
- biomarkers, which provide a chemical means of assessing the amount of bone degradation by supplying measurable biological indicators
In addition, an osteoporosis specialist will recommend blood tests to check for the presence of any (perhaps treatable or modifiable) underlying conditions that may be responsible for the development of osteoporosis, as well as to rule out other causes (e.g. bone cancers).
Management of osteoporosis is primarily achieved using medications and lifestyle initiatives to reduce the risk of injuries and damage, plus regular monitoring to check whether there are any significant changes in bone density.
Medications likely to be used include:
- bisphosphonates, which are drugs used to reduce or prevent bone loss and to coax bone-making cells into producing fresh bone. To eliminate or minimise side effects, these powerful drugs must be taken exactly as prescribed – for example, you should inform your dentist or other medical professional that you are taking bisphosphonates. Postmenopausal women with osteoporosis will usually require a modified drug programme.
- parathyroid hormone peptide medication is sometimes recommended for those who have already suffered a fragility fracture. The aim is to reduce the risk of sustaining another fracture.
- calcium and vitamin D tablets are usually recommended to supplement the body’s natural supplies. These tablets will often be prescribed alongside other medications.
Lifestyle adjustments will help to optimise the ability of each patient to manage the disease. Recommended measures may include:
- giving up smoking
- reducing alcohol intake
- developing weight-bearing and balance exercises as a means of reducing the risk of falls
- using muscle strengthening exercises to maintain or increase BMD
The risk of falls is a major concern for osteoporosis patients, and additional preventive measures may be required, such as:
- vision and hearing checks
- a home check for slip, trip and fall hazards
- a review of medications that may cause drowsiness
- wearing hip protectors
- staying at home in icy weather
Osteoporosis often requires a multidisciplinary approach and lacks its own speciality. Therefore, the most important qualities an osteoporosis specialist should possess are plenty of experience, a track record of good practice and a detailed knowledge of the condition.
