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Polymyalgia rheumatica: diagnosing the condition

A patient presents with a sudden onset of stiffness and muscle aches, particularly around the hips and shoulders. These symptoms are so severe that they change her day-to-day life – she can’t dress herself, do exercise, or go to the shops. She feels old; much older than she should.

The case Dr Mahmud took the case of a female patient over the age of 50 suffering from pain and stiffness around the two “girdles” (groups of bones that form a ring to anchor the limbs to the body) – the pelvic girdle and the shoulder girdle. She presented with the following symptoms:

  • Aching around the shoulders, hip girdle and neck
  • Stiffness, particularly in the mornings

Her quality of life was being hampered by these symptoms. She struggled to dress herself, needing to swing her trousers to hook them over her foot in order to get them on. She was unable to go to the shops and back, let alone the gym to do some exercise, and generally felt like an old person.

Diagnosis: polymyalgia rheumatica (PMR) The patient was diagnosed with polymyalgia rheumatica – an inflammatory rheumatic condition.


Classic polymyalgia rheumatica symptoms include aching and stiffness in the mornings around the shoulders, neck and hips, as seen in our patient. PMR may also cause tiredness, loss of appetite, weight loss, and depression.

Polymyalgia rheumatica rarely occurs in patients under 50 years of age, and its prevalence increases with age, with the majority of cases being diagnosed in patients between 70 and 80.

PMR is more common in women than in men, and occurs more often in Caucasians than other races; however the lifetime risk is relatively high across the board, and as far as systemic rheumatic diseases go, it is second common only to rheumatoid arthritis. In fact, sometimes PMR can be a feature of rheumatoid arthritis and other inflammatory conditions.

PMR is often associated with temporal arteritis, a.k.a. giant cell arteritis (GCA) – an inflammatory disease involving the narrowing or even blockage of blood vessels in the neck, arms, and scalp. Temporal arteritis can prove very serious, potentially leading to blindness.


Treating polymyalgia rheumatica

Polymyalgia rheumatica treatment usually consists of steroid medication to manage the symptoms. The corticosteroid prednisolone is commonly prescribed, due to its ability to block the effects of chemicals in the body that cause inflammation. However, steroids such as this do not cure the condition; rather they work to improve quality of life. Steroids, like many medications, can potentially cause side effects, and you should always consult your doctor or a specialist before taking anything, as they will be able to recommend the best course of action for you. In the case of our patient, Dr Mahmud was able to successfully diagnose polymyalgia rheumatica, and treat the condition accordingly. The patient responded rapidly to the treatment. Her symptoms cleared up, and she was once again able to dress herself, go to the gym, play with her grandchildren, and live her life to the fullest. In her words, she had her life back.

Diagnosing Osteoporosis and Determining Bone Strength by DEXA Scan

What is a DEXA scan?

A DEXA scan, or DXA scan, is a type of X-ray that is used to measure bone density. DEXA stands for dual energy X-ray absorptiometry, and there are different ways to refer to the scan, including DXA, bone density scan, and bone densitometry scan.

DEXA Scanner at The Shard

Why is a DEXA scan performed?

Usually, a DEXA scan is performed to diagnose or assess the risk of osteoporosis. Osteoporosis weakens the bones, so a DEXA scan can help to identify this and check the density of your bones.

Who should have a DEXA scan for osteoporosis?

A DEXA scan is recommended in those over 50, at risk from developing osteoporosis. You are more likely to be at risk if members in your family have experienced fractures at some point. A bone density scan may also be taken with those under 50 with additional risk factors, such as smoking, excessive drinking, or having fractured a bone already.

A DEXA scan may also be considered if:

  • You are a woman experiencing early menopause, or who has had early menopause and not received hormone replacement therapy. After menopause, oestrogen in the body declines, which can result in a bone mineral density decrease.
  • You have a condition such as arthritis, or other inflammatory conditions, which can result in low bone density
  • You take medication which can contribute to bone weakening over time
  • You are a woman with large gaps between periods

How is a DEXA scan performed?

DEXA scans are quick and painless. You may be able to remain dressed, but you have to remove clothes with metal in, such as hooks, or zips. You do not need to prepare anything, fast, or follow any special diet.

When the scan is performed, you lie on your back, but a DEXA scan is not like an MRI, where you must go into a tunnel-like device. The X-ray table is flat, and open, so you are unlikely to feel closed in or claustrophobic.

A large scanning machine is passed over the body, emitting a low-dose X-ray beam to measure bone density in your skeleton. The machine can scan various parts of your body, but the most common areas examined are the hip, spine, and wrist.

Scans take a very short amount of time, perhaps five minutes – depending on the part of the body being scanned. There is no need to wait in hospital and you can go home after the scan.

What do DEXA scan results mean?

Bone density has a healthy-level ‘score’ – a number which varies on age, ethnicity, and gender. The DEXA scan will give you a certain score too, and the difference between the expected healthy score, and your DEXA result is called the T score.

T scores are classified like this:

  • Normal: above -1 deviation
  • Slightly reduced: between -1 and -2.5 deviation
  • Osteoporosis: at or below 2.5

These results will give a fair indication of bone strength, but cannot tell you whether you will get a fracture, or not. Some people even with normal bone density can experience a fracture at some point.

Your doctor will look at your results after the test, and take into account risk factors, before deciding on a course of treatment, or deciding if it is necessary.

8 conditions you might not know are linked to osteoporosis

Many people think osteoporosis is simply linked to old age – the older we get, the more chance we have of developing osteoporosis. While this is true in some ways, age isn’t the only factor involved, and osteoporosis is linked to various other medical conditions, some of which might be surprising. While it’s not certain that people will develop osteoporosis simply because they have these conditions, it is important for individuals to be aware of the increased risk and how other diseases are connected to osteoporosis. Dr Taher Mahmud of the London Osteoporosis Clinic explains more.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease, meaning the body attacks its own cells and tissues. Osteoporosis and rheumatoid arthritis are closely linked, and osteoporosis can be caused by RA in a number of ways. Rheumatoid arthritis has no cure, and is currently treated through management of the symptoms. Chronic inflammation over time has an effect on the body, accelerating bone loss, as do drugs which are used to control the inflammation. Everybody loses bone mass over time, but rheumatoid arthritis speeds up the process and contributes to bone damage, increasing the risk of fracture.

Inflammatory bowel disease & coeliac disease

Inflammatory bowel disease, or IBD, describes a group of intestinal disorders which cause inflammation in the digestive tract. Coeliac disease is a digestive condition in which the small intestine cannot absorb nutrients correctly, caused by an adverse reaction to gluten. IBD and other gastrointestinal diseases have been linked to osteoporosis, through nutritional factors (levels of calcium, vitamin D, and other minerals may not be as high as in those with no intestinal disorder), corticosteroid use over time, and the long-term inflammation.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease, meaning the body attacks its own cells and tissues. Osteoporosis and rheumatoid arthritis are closely linked, and osteoporosis can be caused by RA in a number of ways. Rheumatoid arthritis has no cure, and is currently treated through management of the symptoms. Chronic inflammation over time has an effect on the body, accelerating bone loss, as do drugs which are used to control the inflammation. Everybody loses bone mass over time, but rheumatoid arthritis speeds up the process and contributes to bone damage, increasing the risk of fracture.

Inflammatory bowel disease & coeliac disease

Inflammatory bowel disease, or IBD, describes a group of intestinal disorders which cause inflammation in the digestive tract. Coeliac disease is a digestive condition in which the small intestine cannot absorb nutrients correctly, caused by an adverse reaction to gluten. IBD and other gastrointestinal diseases have been linked to osteoporosis, through nutritional factors (levels of calcium, vitamin D, and other minerals may not be as high as in those with no intestinal disorder), corticosteroid use over time, and the long-term inflammation.


Diabetes is linked to many medical conditions and illnesses, including osteoporosis. Type 1 diabetes is linked to low bone density, and difficulty reaching ideal bone mass. Our bones grow and get stronger until they reach their peak bone mass, so if this is low to begin with, patients have a greater chance of developing osteoporosis or experiencing a fracture. Diabetes is also associated with being overweight, which can contribute to osteoporosis and fracture risk. It is important for diabetes patients to get the correct nutrition and exercise regularly, in order to reduce the risk of osteoporosis and other medical conditions linked with diabetes.


Both dementia and osteoporosis are commonly seen conditions in those with old age, but the two are also connected. Those who suffer from dementia run a significantly higher risk of hip fracture than those who have no cognitive disorder. There are many factors which increase the risk of hip fracture, but falls are more common in those with dementia – particularly multiple falls. In those with dementia, the correct care and attention is crucial and can help patients to reduce the risk of fracture.

Chronic kidney disease

Chronic kidney disease, or CKD, describes the gradual loss of kidney function, and is associated with bone disorders and an increased risk of fracture. In those with CKD, fractures in elderly patients are twice as common as in those with normal kidney function.


Hypogonadism refers to the decreased function of the gonads, which in men is the testes, and the ovaries in women. This means less oestrogen or testosterone is produced or there is a deficiency in production. Oestrogen deficiency is connected with osteoporosis – menopausal women have been proven to be more at risk – and some studies have shown there is a relationship between testosterone levels and bone density.

COPD (Chronic Obstructive Pulmonary Disease)

Progressive lung diseases such as chronic bronchitis and emphysema fall under the umbrella of COPD, which is a term used to describe various inflammatory airway diseases. Reports have shown that low bone mineral density is prevalent in those with COPD, along with reduced physical activity, and vitamin D insufficiency/deficiency, increasing the risk of both osteoporosis and osteoporotic fracture. In those with COPD, screening is recommended as a routine procedure for earlier diagnosis of osteoporosis and appropriate treatment.

Chronic conditions in childhood

Some of the above conditions can also occur in childhood, such as inflammatory bowel disease, and diabetes. Other chronic conditions such as juvenile arthritis also increase the risk of osteoporosis, either through impact on skeletal health or inability to achieve ideal peak bone mass.

If you have a question please contact our office by email or phone.

Managing gout at Christmas – what to avoid and how to help

Gout is a type of arthritis, and is an inflammatory condition which can cause attacks of swelling, which generally are sudden and can be very painful. Gout affects an estimated two out of every hundred people in the UK, with men suffering more from the condition than women. As our lifestyle becomes more indulgent – and especially so at Christmas – gout attacks become more common, and cases of gout are on the rise. Dr Taher Mahmud of the London Osteoporosis Clinic advises what you can do to reduce your risk of developing gout, and how lifestyle measures can help minimise the risk of an attack.

What is gout?

Gout is a type of inflammatory arthritis which occurs in those with high levels of uric acid in the blood. Uric acid forms crystals in joints, more frequently in areas such as the feet and toes. As a result, swelling and pain develop in the joint, which is known as a bout, or attack, of gout. A gout attack usually develops quickly, over the course of only a few hours, then going on to last several days. After some time has passed, the inflammation and pain go down, and the joint returns to normal.

What are the symptoms of gout?

Common symptoms of gout, often felt in the toes, ankles, knees, fingers, and elbows, include:

  • Heat and tenderness felt in the joint, with the joint often becoming unbearable to touch
  • Mobility being affected by intense, severe pain
  • Red, shiny skin on or around the skin of the joint affected
  • Swelling in the affected area, or around it
  • Itchy skin, or skin which peels and flakes as the swelling reduces

An attack of gout can come on at any time, but bouts do occur more frequently at night, and they develop quickly. After your first attack, it is likely that you will experience another, but this can happen after months or years have passed. It is important that gout is treated, as if left alone, it can develop and attacks will become more frequent.

What is the treatment for gout?

Treatment for gout focuses on relieving symptoms when they occur, and trying to prevent further attacks from happening. Symptoms during an attack can be reduced through anti-inflammatory drugs, and certain types of medication. To prevent attacks of gout, and to reduce the likelihood of the condition developing, however, the best approach is a change in lifestyle to help reduce levels of uric acid, and prevent crystal deposits from developing.

Things you can do to help prevent gout

  • Rest well and get enough sleep
  • Even in those who do not suffer from gout, aiming for 8 hours sleep every night should be the ideal. Getting the right amount of sleep can help your immune system, which in turn helps prevent against infection and inflammation. Getting enough sleep can help to manage levels of stress and improve your memory, too.
  • Exercise frequently
  • Staying active should be a healthy habit which everyone strives towards, but getting enough exercise can also help prevent against attacks of gout. Being overweight or obese can also be a risk factor for gout, so being at a healthy weight can help prevent the onset.
  • Try to reduce stress levels
  • Stress can trigger a gout attack, and make symptoms worse when they do occur. Seek out ways to help reduce stress, or help to manage what you have on your plate – even managing in small ways, such as writing lists of what you have to do on a specific day, or setting 30 minutes aside in your day devoted to just you, can help to minimise stress.

What to avoid to help prevent gout attacks

  • Limit your alcohol consumption
  • Alcohol (in all forms) is thought to increase uric acid production, so moderation with alcohol is key in preventing gout attacks. It can be difficult at times like Christmas to avoid drinking, but having a large glass of water after each drink may help you to moderate the amount you drink, and keep track of exactly what you are drinking so you are aware of your consumption.
  • Try to stick to a low-purine diet
  • Purine compounds, found in many different foods (and alcohol) increase the build-up of uric acid crystals in the body.
  • Eat more:
  • Fruit and vegetables
  • Dairy products (low-fat)
  • Cherries – these have been linked to decreased levels of uric acid
  • Vitamin C – an increased level of vitamin C may help to decrease the risk of a gout attack
  • You should also drink plenty of water and stay hydrated, as fluid helps to flush uric acid out and hinder the development of crystals

Eat less:

  • Particular types of seafood and shellfish, including shrimp, scallops, and mussels
  • Certain types of fish, like haddock, codfish, anchovies, trout, and sardines
  • Red meat (meat in general contains levels of purine, but white meat is generally considered to be a better choice)
  • Organ meats, like liver, and kidneys

If you do suffer from gout, remember not to suffer in silence and make sure you get the right treatment. If left, gout can lead to further problems and attacks can become much more frequent. Talk to your healthcare provider for advice and support.


If you have any questions about arthritis, gout, osteoporosis you can contact the LOC office for advice or clinic appointment.

What happens to bones as we age

Bones strength increases to the age of 35, remains steady for mid-adulthood, then declines by 1-2% per annum but precipitously arpund menopause when bone loss can be 5% per annum for 4-5 years perimenopausally.

Bone strength can also be impacted by activities, lifestyle, genetics, medical conditions more details here

Osteoporosis happens when bones become gradually more fragile. This can progress painlessly, until a bone suddenly breaks. Our bones are made of a thick outer shell, which surrounds a strong mesh network filled with calcium salts, collagen (protein), and other important minerals. When the mesh becomes thin, it can break easily.

In the body, bones are constantly in a state of renewal. Old bone breaks down, and new bone is made. This happens more slowly in old age. In young people, the body makes new bone faster than it breaks down the old bone, so bone mass is increased.

Over time, this process slows down. We reach our peak bone mass level in our early 30s, and from them, bones break down faster than the body is able to create them.

Therefore, the more you produce bone and accumulate bone mass in your younger years, the less likely you are to develop osteoporosis as you age. Think of your body like a bank, saving bone for later in life.

10 tips for a healthy heart (also good for your bones!)

Cardiovascular disease is the leading cause of death worldwide. According to the British Heart Foundation, 7 million people across the UK are affected by the condition, with it causing 26% of all deaths across the country. The good news, however, is that most cases of cardiovascular disease – conditions affecting the heart and circulatory system – are preventable, and leading a healthy lifestyle can not only lead to a healthy heart, but numerous other benefits too. Dr Taher Mahmud explains what you can do in your daily life to improve your heart health, and lower your risk of both cardiovascular disease and other health conditions.

1. Quit smoking

These days it almost goes without saying, but smoking is linked to all manner of conditions, including respiratory disease, cancer, osteoporosis, and heart disease. Smoking is one of the main causes of coronary heart disease, but even after one year of quitting, the risk of having a heart attack drops to being half that of a smoker’s.

2. Exercise

39% of adults in the UK do not meet official recommendations for physical activity, which translate to about 30 minutes of moderate intense activity 5 days a week, or 75 minutes of intense activity spread across the week. Even walking at a brisker pace can contribute to meeting these recommendations, or carrying the groceries back from the supermarket! Try to break up periods of being sedentary by taking breaks, reducing the time you spend watching TV or on the computer, and substituting part of your everyday journeys through walking or cycling some of the way.

If exercise were a pill, it would be prescribed by every doctor. Just meeting the recommended guidelines can reduce your risk of stroke, heart disease, osteoporosis, and even cancer.

3. Know your limits

Keeping to your alcohol limits can reduce the risk of cardiovascular disease, protect your bones, and ensure the health of vital organs in the body such as the liver. The UK government puts the low risk alcohol guidelines at 14 units a week for both men and women, which translates to six 175ml glasses of wine a week, six pints of lager, or fourteen 25ml glasses of 40% spirits. You can calculate the units you’re drinking at Drinkaware, and keep track of exactly what you’re consuming using their free app.

4. Manage your weight

You don’t have to be in and out of the gym, or restrict your diet forever, but managing your weight with a healthy balanced diet combined with regular physical activity should be one of your goals. You should be aiming for a healthy weight, which varies from person to person.

5. Lower your cholesterol

Cholesterol is a fatty substance found in the blood, which in healthy doses is necessary, but in excess can lead to heart disease or stroke. Visit your GP to get your cholesterol levels measured every five years or so, and if you have high cholesterol, talk to your doctor about ways you can work towards reducing it.

6. Lower your blood pressure

You may not know if you have high blood pressure, but it can lead to cardiovascular problems and increase the risk of stroke. It can also cause kidney disease, and has been linked to certain forms of dementia. Many of the heart-friendly measures listed here can help you to lower your blood pressure, and you can keep an eye on it with the help of your healthcare provider.

7. Eat less salt

75% of our everyday food contains salt, so think twice before reaching for the shaker. Try to cut down on the amount which you add to food, and check the salt content in your food to become aware of what you are consuming. Even things you might think of as being healthy, like soup and cereal can often have high salt content. Food which often have a high salt content are smoked foods such as bacon or other types of meat, cheese, olives, pickles and salted nuts. There’s nothing wrong with eating these foods, but try to make sure that you eat them less frequently or cut back on your portion size.

8. Eat your five a day

Plenty of fruit and veg is good for you, and good for the heart. Find more ways to work fruits and vegetables into your diet – it’s not as difficult as it might seem. Even frozen vegetables count towards your five a day, and keeping frozen fruit in the freezer means it’s always on hand for a quick smoothie. Add lentils or pulses to soups – these count as a portion of your five a day – and have a salad or some vegetables as a side along with your meal. Add extra vegetables to your sauces, such as carrots in bolognese, or mushrooms in a stir fry. Mix fruit into yoghurt for a healthy, tasty breakfast.

9. Increase your fibre intake

Switch up your white loaf for a wholegrain one, or substitute regular pasta for the wholewheat variety. Fibre can lower your risk of cardiovascular disease, and recommendations put the ideal intake at at least 30g a day. Don’t cut the skin off your jacket potatoes, try eating porridge for breakfast, and snack on dried fruit and (unsalted) nuts. Baked beans contain fibre, but all beans are good sources of it, and adding beans to your salad or using kidney beans in chilli can help to up your intake.

10. De-stress

Looking after your mental health is important for your heart health, too. In those who are stressed, or depressed, the risk of cardiovascular disease increases. In day to day life, try to find activities that help you to relax and escape, and try to find a hobby that lets you divert your energy into something you enjoy. Try to find the balance between work life and social life, and build your social support network. Find ways to manage your stress and rethink the way you look at situations. Even changing your outlook can be one small way that helps with how you handle stress.

How to reduce back pain

Back pain is one of the most common day-to-day health complaints, suffered by most of the UK population at one point or another. Most of the time, back pain gets better over time, and it’s nothing to particularly worry about. That said, if you have to cope with back pain that lasts a long time, it can be difficult to deal with, and cause significant discomfort.

Back pain usually lasts a few days or weeks, and there are ways to help recovery along and reduce the pain. In order to relieve short-term back pain, you can try some of the following:

  • Doing exercise for back pain. This can be in the form of particular stretches and exercises, or perhaps attending yoga or pilates classes. Swimming and walking can also be beneficial – nothing too high impact.
  • As well as exercising, it’s important to be active throughout the day, instead of allowing the pain to keep you either indoors or rest. Going through your daily activities as normal is one of the best things you can do to help, as being inactive for a long time is likely to make the pain worse.
  • Apply hot or cold packs, or a hot water bottle, depending on which you find relieves the pain more. You can even wrap ice or frozen vegetables in a tea towel or cloth if you can’t get cold packs, or want instant relief while at home.
  • Try over-the-counter anti-inflammatory painkillers as short-term relief
  • Stay positive and optimistic as much as is possible! You’re more likely to recover quicker if you try steer yourself away from a negative outlook.

However, if back pain lasts longer than a few weeks, or months, you may need to consider visiting your GP, especially if the pain stops you continuing daily activities, or you’re finding it difficult to manage. If the pain gets worse or more frequent, it’s also a reason to visit a healthcare professional. Your GP will assess you, and refer you on to a specialist if they feel it is necessary.

Causes of back pain

Back pain can have various causes, including trauma or injury, or a specific medical condition. More common conditions causing back pain include:

  • A slipped or herniated disc in the spine. Discs in the spine work together to provide stability in the back, and allow a wide range of movement. Over time these discs may become injured due to pressure and stress, age, or trauma. This can cause lower back pain, leg pain, or numbness and weakness.
  • Sciatica, which occurs when the nerve running down from the pelvis to the feet becomes irritated. Sciatica usually affects one side of the body, and can also cause numbness in the leg.
  • A sprain or strain in the back, which can also limit movement
  • Compression on nerves in the spine

Back pain may also have no obvious cause, in which it is identified as ‘non-specific back pain’. Back pain is treated differently depending on if it has a specific cause, or if it is non-specific.

When back pain becomes an emergency

If you experience any of the following symptoms combined with back pain, it is best to see a doctor as soon as possible:

  • Swelling or deformity in the back
  • Weight loss with no particular reason
  • Lack of control over bladder or bowels
  • Difficulties when urinating
  • Pain in the chest
  • Numbness or a tingling sensation in the buttocks or genitals
  • High temperature (fever above 38°C)

If you experience back pain after having been in an accident or after falling, for example, you should contact your healthcare provider, as it could be an indication of a more serious injury.

Treatment for back pain

Treatment for back pain depends on the type of back pain or condition which the patient is suffering from. Your GP may recommend particular methods of treatment, or they may refer you on to a specialist who can deal with specific conditions and different kinds of pain.

Many methods of treatment include exercise and physiotherapy, where the patient is taught how to practice exercises which will hopefully improve their condition by improving muscle strength and tone. Posture can also be improved on, which in turn can help reduce pain.

With manual therapy or physiotherapy, massages or manipulation of a particular area in the spine may be recommended. Make sure to visit a healthcare professional such as a physiotherapist or chiropractor to have this treatment carried out.

Some patients may need emotional or psychological support to help them cope with the pain. It can be a struggle to deal with pain that doesn’t go away over a long period of time, and cognitive therapy may be a solution which gives the patient the support they need.

With some conditions, surgery may be a solution, but this is only recommended for particular cases when the doctor or healthcare professional has evaluated all the symptoms and assessed the patient’s condition.


If you experience back pain in your day-to-day life, there are small lifestyle changes and tips which can help you to cope with the pain and manage it at home. Find out more here.

Back pain can be caused by spine fractures

Osteoporosis is a common condition affecting an estimated 3 million people across the UK. Osteoporosis happens when bones gradually become more fragile, progressing silently until a bone breaks. A fracture is usually the first sign of the disease being present, with fractures most common in the hip, wrist, and spine.

While osteoporosis usually displays no symptoms, one thing that sufferers may notice is the appearance of back pain. In those with osteoporosis or those who have low bone density, back pain is most commonly causes by fractures experienced in the lower back or spine. As bone weakens and loses density over time, the more likely a vertebral fracture becomes.

Patients with osteoporosis can present with a vertebral fracture after even everyday things such as quickly bending down, lifting an object, or by sneezing. Pain from vertebral fractures, and the subsequent muscle pain it triggers, are commonly found in those with osteoporosis.

Ways to prevent back pain

Preventing back pain is no easy task, but you can help to reduce your risk by following some of these tips:

  • Be active and exercise. By doing exercise you can help to keep your back strong. Try to exercise for 30 minutes a day if you can, but the NHS recommend doing at least 150 minutes of moderate aerobic activity a week.
  • As part of your exercise routine, try to include strength exercises, back exercises and stretches. If you are unsure about the right type of exercise for you, ask your GP, or a physiotherapist.
  • Make sure that you lift objects correctly. When lifting incorrectly or too quickly, damage and stress can be done to the back. Make sure you are stable, that you have the right hold, and keep the object close to your waist. Don’t bend your back, and squat to lift rather than bending down.
  • If you work in an office or similar environment and spend a lot of time in the day sitting down, try to get up every so often and take small breaks. The same goes for long periods of sitting while travelling, such as when driving, or on a plane journey. Get up every so often, or stop the car and have a rest.
  • If you are overweight, try to lose weight and keep healthy through exercise and diet, as being overweight can contribute to the risk of developing back pain.
  • Your sleeping habits are also important – certain positions can contribute to back pain as they put more pressure on your shoulders, neck, hips, and lower back. Having the right mattress and pillow is also important – make sure your mattress provides you with the right support.
  • Equally, posture while awake is something to consider. While watching TV, or on the computer, be aware of your posture and try to support your back. Certain tips which can help include resting your feet on the floor, making sure you have the correct kind of chair, and if working at a computer, make sure your screen is at eye level. Of course, if you are sitting for long periods of time, make sure to change position when you can. Short breaks from time to time are much better than one long break in the middle of the day.

It is important that you visit your healthcare provider if you have experienced a fracture, or if you are worried about osteoporosis and back pain, as they can help to advise on the best course of treatment and prevention, if necessary. Many vertebral fractures are not treated appropriately, meaning the problem can get worse and become more serious.

World Osteoporosis day

In preparation for World Osteoporosis Day on the 20th of October, we asked Dr Taher Mahmud of the London Osteoporosis Clinic why bone health is important, and what we can all do in our everyday lives to help prevent osteoporosis.

Dr Mahmud and the London Osteoporosis Clinic are holding a special osteoporosis and menopause information day on the 20th, with a drop-in clinic to advise on bone health and talk about the clinic’s work. They will also be offering discounted DEXA scans to assess bone density.  

TD (Top Doctors): Dr Mahmud, how common is osteoporosis?

DM (Dr Mahmud): Osteoporosis is actually much more common than people think.  It is often associated with old age, and in fact many people associate it with women rather than men.  While it’s true more women are affected, bone fractures affect 1 in 5 men over the age of 50, so the risk is there.  For women, the risk is even greater, with 1 in 2 over the age of 50 affected.  You can see from these statistics alone that osteoporosis is not at all rare, and it is important for us to be aware exactly how many people are affected so we can work together to try prevent the multitude of fractures occurring.

TD: How do you know if you have osteoporosis?

DM: The thing is, osteoporosis is usually silent and does not display any symptoms in its early stages.  As we age, our bone mass decreases and our bones progressively weaken, but you may not be aware of this until you actually experience a fracture.  Some of the symptoms which occasionally develop include a gradual loss in height along with a stooped posture, and intermittent back pain.

TD: Why are bone health check-ups so important?

DM: Because osteoporosis is silent, it is important to assess your risk factors and speak to your healthcare provider if you suspect you may be at risk of developing osteoporosis in the future.  If a direct family member has osteoporosis, or has experienced fractures, this may indicate that you are more at risk of osteoporosis.  Other factors to consider include smoking, excessive drinking, or having already fractured a bone. We usually recommend bone scans to be taken over the age of 50 to assess bone health and state, but bone scans can also be taken earlier, especially if risk factors are present.

These bone density scans can give you a fair indication of your bone strength, and help your healthcare specialist decide on a course of action.  If you have early indication of osteoporosis, bone check-ups can help identify this, and we can act accordingly.

TD: Is osteoporosis preventable?

DM: The good news is that we can all help to reduce our risk of developing osteoporosis, even with simple changes in lifestyle. Our bones change throughout our life, but there are a number of factors that increase and reduce their strength.  Nutrition is a key factor is increasing strength, particularly your intake of vitamin D and calcium.  Getting enough exercise and being active is also important – we recommend at least 30 minutes a day.

If you are inactive, smoke, drink excessively, or take medication such as steroids, these can all be contributing factors to bone weakness, meaning the likelihood of fractures is greater.  Certain medical conditions like arthritis, diabetes, and inflammatory bowel disease can also increase the risk. If you have any of these conditions it is important that you get appropriate treatment which in turn will reduce the negative consequences on your bone health.

TD: What if I have osteoporosis? Can it be treated?

DM: Prevention is always better than cure, but in some cases it is not possible to completely prevent osteoporosis.  Osteoporosis can fortunately be treated in a number of ways, the foundation of which being lifestyle changes, which will be advised by your healthcare provider.  We can also prescribe drug and non-drug treatments to help deal with osteoporosis and try to prevent fractures.  In some cases we can even reverse osteoporosis, so the earlier it is found, the better. This is why we are always keen to advocate bone health and awareness, and promote understanding of the effect osteoporosis has on society.


Learn more about osteoporosis through Dr Mahmud’s previous articles for Top Doctors and on his clinic website, http://blog.londonosteoporosisclinic.com/blog.

Ways in which you can help prevent osteoporosis

  1. In order to promote bone growth and keep your bones healthy, it is important to get enough calcium, vitamin D and other nutrients. If you are lactose intolerant, it may be difficult to get enough calcium from food alone.
  2. Eat plenty of fruit and vegetables, which does not just benefit your bone health, but your health overall.
  3. Bones can be made stronger through exercise, so at least two and a half hours a week is recommended for their strength.
  4. Osteoporosis prevention and bone health can be improved at any age – do not feel it is too late, and consult a GP or healthcare provider for advice on how to improve your bone health.
  5. In order to check your bone density and overall bone health, tests can be made, meaning you can have an idea of your situation and if you need to take action. Ask your healthcare provider when you can take a bone density test.