It is estimated that 300,000 people in Ireland have osteoporosis.One in four men and one in two women over 50 will fracture a bone as a result of osteoporosis, and children can also be affected. Dr Máire Finn from Ennis Family Medical Centre joined the Today With Claire Byrne show on RTÉ Radio 1 to discuss the condition and answer questions from listeners (This piece includes excerpts from the conversation which have been lightly edited for length and clarity - full discussion can be heard above).

What is osteoporosis?

"It's a bone disorder, which results in the loss of bone mass so your bones become weak and porous and therefore they break more easily. We lay down our bone as children and young adults. When we're children, our bones not only grow longer, they grow stronger. Up to the age of about 25, we're laying down bone, but from then onwards, we're actually losing bone mass so if it is significantly weakened, it would break easily. That can cause huge problems, particularly in women over the age of menopause, older people, both men and women in older ages and Asian women are particularly effected as well."

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From RTÉ Archives, George Devlin reports on people suffering from osteoporosis in Ireland in 1988

How can you spot it?

"This is the whole issue. Most people with early osteoporosis have no symptoms whatsoever and it's too late once you've had a fracture. Even in late disease, the symptoms are actually quite reduced. It's only the breaking of the bone is the big issue so we need to look for it. Anybody over the age of menopause needs to do a DEXA scan. Anybody who's had a very restricted diet in their youth. Anybody who's had eating disorders or continues to have an eating disorder, people who've had problems with their gut, like a surgery, or something like celiac disease or issues that may actually counteract how well you absorb your calcium and vitamin D. And anybody on long-term medication, that can affect your bones too, like steroids. It's too late once you've had a fracture."

What's the story with diet and osteoporosis?

"It's become incredibly fashionable in the last decade for people to actually restrict their dairy intake in particular. That's reasonable if they have a problem with dairy intake, but they need to make sure they're getting calcium and vitamin D through some other source. What's most important is to try and get your dietary requirements through your diet. That is the most important way. It's the most efficient way to take anything that you need.

"However, if you have a restricted diet, for some real reason, you can take a calcium and vitamin supplement. The vitamin D is more important than the calcium, really. If you take an excess amount of calcium can cause renal stones and other problems as well. As parents, that's something we always have to watch for and try to encourage our children. If they are going on some sort of restricted diet, be it vegetarian or vegan, that they understand that they need to compensate for any restrictions they have made."

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From RTÉ News, a 2017 report on a study which reports that uoghurt can 'significantly reduce' risk of osteoporosis

Tell us about the DEXA scan

"It's the gold standard. With the DEXA scan, there's a score we make, a FRAX score, which takes into account your own individual risks as well. Osteoporosis is far more common in women, but it is something that we need to be very cautious of in men as well. If your risk is relatively low of developing a fracture, what we would normally suggest is have another scan in two to three years. If a decision has been made that you're on a drug holiday or not on medication, you might do it within a year. So again, it's a very fluid situation and it's all about the scoring/

"People get very obsessed with the DEXA score. The score is only one piece of the information. What's really important is we're trying to reduce your risk of a fracture so the other things are really important too. All those lifestyle factors: you want to make sure that your posture is good. You want to make sure that your balance is good. Improve your balance, improve your exercise, weight bearing exercise, long walks in the daylight. There are other things that can actually really help and reduce your fracture risk so that takes the medication and the scoring out of the equation a little."

What's involved in the treatment of osteoporosis?

"There's been a huge amount of work about the treatment of osteoporosis and how long somebody can stay on medication. A big study was published in 2019 and its outcomes were unclear and suggests more work needed to be done. We know they're safe, we know they reduce your fracture risk, but how long can you stay on them?

From RTÉ Radio 1's Mooney Goes Wild, Fergus Sweeney reports on male osteoporosis

"It's very often suggested to stay on the bisphosphonates, which are the most common treatment we use, for three to five years. You would do another DEXA scan then, and maybe take a break from treatment. Sometimes, the Prolia injection is the next step. It's our second line of treatment that we would use, but again, we don't know how long you can stay on that. They need to have a blood test taken to make sure that their calcium levels are high enough so that they can take the medication.

"It's tricky and it's a collaborative approach that your doctor and yourself take depending on your risk of fracture, your family history. The decision is based not just on the medication or the DEXA score, it's based on what's her risk of a fracture in the future."