Health: Osteoporosis and Fractures

Baroness Finlay of Llandaff Excerpts

Thursday 14th September 2023 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am president of the Chartered Society of Physiotherapy and that I chair the Commission on Alcohol Harm.

We must all appreciate the noble Lord, Lord Black of Brentwood, for having secured this very important debate. Osteoporosis is predicted to cost the UK health service £2.2 billion by 2025, so I want to focus on the very early part of the prevention pathway. With age, fragility fractures become more common, particularly in the long bones of the arms and legs and in the vertebrae. These bones are made up of a scaffolding of less dense and trabecular, and therefore less heavy, bone, where about 26% of bone is remodelled every year. Old bone is gobbled up by osteoclasts, and osteoblasts, under the influence of signalling cells, lay down a scaffolding of unmineralised osteoid, which then becomes fragilely mineralised as the new bone solidifies. As we have just heard, many hormones—proteins, vitamin D, calcium—all influence this process. When imbalanced, prolonged osteoclast activity gobbles up more bone and the bone becomes increasingly fragile.

In osteoporosis, this bone loss in the long bones and the vertebrae is particularly evident. Bone mass declines over time, accelerated by smoking and moderate to high alcohol intake, as well as by illness and its treatment, such as some cancer treatments and treatments with steroids, as we have heard. Gut disease, diabetes and chronic kidney disease all impair absorption of calcium and magnesium, as do some of the indigestion drugs so commonly taken across the population and anti-epileptic drugs, which impede the absorption of nutrients required for bone growth.

No one would advocate not treating this serious condition, but all is worsened by physical inactivity. Preserving skeletal muscle with exercise increases bone strength and slows the development of osteoporosis, as well as improving balance, thereby reducing the risk of falls. A diet rich in fruit and vegetables, with an increased protein intake, helps maintain muscle mass and bone strength.

Yet, we are a nation of inactivity, with 36% of the adult population physically inactive. Our healthcare costs related to inactivity are the third highest across 15 nations in western Europe, running at £20.53 per person in the UK, compared to £5.11 in Finland or £12.25 in France, which is near the middle of group. When bone has become fragile, early treatments, as we have heard, can lessen the chance of fragility fractures and prove cost effective, but prevention through exercise and healthy eating is essential. It is never too late to start.