Then and now – your bones

Today three million woman in the UK are diagnosed with so-called brittle bone disease, but back in the 1960s, it was poorly understood. Old ladies were told they had widow’s hump which was considered a normal part of ageing. Few hospital consultants had a good knowledge of osteoporosis and a recognised definition was not produced by the World Health Organisation until 1994.

‘For patients, getting a diagnosis was very difficult,’ explains Professor Tahir Masud, a consultant physician at the University of Nottingham Hospitals NHS Trust, and a spokesperson for the National Osteoporosis Society. ‘We also didn’t have bone density scanners (dual energy x-ray absorptiometry (DXA) scanners), now recognised as the gold-standard method for measuring bone mineral density (BMD) and diagnosing osteoporosis. At the time, they were only being used for research purposes.’

Bisphosphonates, now recognised as the first line bone protecting treatment throughout the world, were not approved for use in osteoporosis and hence were rarely used. The first bisphosphonate treatment for osteoporosis, etidronate was launched in 1997, though bisphosphonates were first investigated in the 1960s.

‘Today, there are lots of newer treatments for women suffering from brittle bones, including denosumab which is a monoclonal antibody injections which last for 6 months and prevents calcium from leaching out of bones,’ says Professor Masud. Some NHS patients, who have tried other treatments unsuccessfully, may be offered a bone building agent, teriparatide which actually encourages new bone to grow. It is very expensive – costing around £7000 per patient for a 2 year course, and is only prescribed for patients who have severe bone loss.

Arthritis

Arthritis, and other conditions of the joints, bones and muscles, which affect more than ten million people in the UK, were also a widespread problem in the 1960s.

Osteoarthritis, caused when the normally smooth surface of the joint becomes damaged, affects around 8 million people in the UK and is more common in women than men particularly after the age of 50. Rheumatoid arthritis is a different type of arthritis that leads to inflammation in joints that the body cannot switch off. It causes significant pain and swelling in joints and can affect people of any age, although you are three times more likely to get rheumatoid arthritis if you are a woman.

‘In the 1960s, women with rheumatoid arthritis were often seriously disabled by the disease, as treatment options were limited,’ said Dr Inam Haq, Chair of the Education Strategy Group at Arthritis Research UK, the charity dedicated to stopping the devastating impact that arthritis has on people’s lives. ‘Newer treatments for rheumatoid arthritis, such as Anti-TNF therapies, mean that people are far less likely to become disabled and can live well with the disease. These treatments do still cause side effects and don’t work for everyone, but we are working hard to find better and more targeted treatments for everyone living with rheumatoid arthritis.’

The number of people with osteoarthritis is increasing and the charity predicts that there could be double the number of people with knee osteoarthritis by 2035. Although there is still no drug treatment for OA, joint replacement surgery has improved hugely since the 1960s. ‘Joint replacements are more effective, they last longer and the length of stay in hospital is much shorter, which has made a huge difference to men and women who have severe pain in their hips and knees because of OA,’ Said Dr Haq.