October 20 marks World Osteoporosis Day – but despite being a relatively common condition, many people are unaware they’re at risk. According to Age UK, osteoporosis – which is associated with weakened bones and often referred to as a ‘silent disease’, as symptoms can creep up on people – affects approximately three million people in the UK. Yet, many only find out they have it when they break a bone. “[Osteoporosis] is a condition characterised by weakened bones, making them more prone to fractures,” explains Dr Zulqarnain Shah, a medical director at SSP Health. “It occurs when the body loses too much bone or makes too little bone, or both. Diagnosis of osteoporosis typically involves a combination of medical history, physical examination, and specialised tests, such as bone mineral density scans,” Shah adds. Could I be at risk of osteoporosis? According to Age UK, around half of women over 50, and around one in nine men in the same age group, will experience a fracture due to osteoporosis. However, several risk factors contribute to the development of the condition, meaning some people may be more likely to get it. “These include menopause, low calcium and vitamin D intake during younger years, family history, a sedentary lifestyle, smoking, excessive alcohol consumption, and certain medications,” explains Shah. “While it may not be possible to prevent all cases of osteoporosis, adopting a healthy lifestyle with regular weight-bearing exercise, a balanced diet rich in calcium and vitamin D, and avoiding smoking and excessive alcohol intake can help reduce the risk.” Being aware of osteoporosis can be particularly important if you have a family history. “A family history of osteoporosis or fragility fractures can indicate an increased risk,” explains Dr Elise Dallas, GP at The London General Practice. Other things that increase risk include having a history of “rheumatoid arthritis, low levels of oestrogen due to early menopause, anorexia nervosa or Turner’s syndrome, hyperthyroidism, parathyroid disease, Crohn’s and coeliac disease, and conditions that cause long periods of immobility”, adds Dallas. What are the symptoms of osteoporosis? When you have osteoporosis, you may suffer from “increased fracture risk, height loss, and chronic pain”, says Shah. “Fractures associated with osteoporosis are known as ‘fragility fractures’, which can occur with minimal impact. Fractures commonly occur in the spine, hip, and wrist, and can lead to significant pain, disability, and reduced quality of life,” he explains. Are there any early warning signs? Shah says: “Early signs of osteoporosis may not be apparent until a fracture occurs. However, a precursor condition called osteopenia may be detected through scans before the onset of full-blown osteoporosis.” Osteopenia is where the density of the bones decreases, but not thoroughly enough to be classed as osteoporosis. There are no real symptoms however, so it can only be detected with scans. The good news is, lifestyle measures and sometimes treatment can help prevent it getting worse. How is osteoporosis treated? Treatment for osteoporosis is mostly aimed at “strengthening bones and preventing fractures”, says Shah. “This typically involves a combination of lifestyle modifications, such as exercise and dietary changes, along with medication. “Medications may include calcium, vitamin D and bisphosphonates, hormone therapy for postmenopausal women, selective oestrogen receptor modulators (SERMs), and other options. “SERMS help manage the way oestrogen interacts with your body and has a similar impact on osteoporosis as hormone replacement therapy, to help mitigate the impacts of hormones on osteoporosis,” Shah explains. “Regular monitoring and adherence to treatment plans can help slow down or stop the progression of osteoporosis. A bone density scan – also known as a DEXA scan – can help monitor the progress of a condition and may be done at three to five-year intervals to assess progress. “Once a patient has been on bisphosphonates for five years, they may go on a ‘pill holiday’ for a couple of years, though the benefits of taking bisphosphonates continue long after the medication is stopped.” Getting support and advice to manage any pain and mobility challenges and reduce the risk of falls and injuries can also be very important for people living with osteoporosis, along with finding ways to stay active. If you are worried about your bones and osteoporosis risk you can reach out to charities like the Royal Osteoporosis Society and find out about your risk level. Read More How to support a child with a stammer From colourful gowns to drones, these wedding trends are set take over 2024 Call The Midwife ‘should come with a health warning’ Halloween: 10 wicked ways to kit out your haunted house Black magic: Go back to black this season with the catwalk-inspired trend How to prep your home for when the clocks go back

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Newcastle United host Manchester United on Saturday night with just one point and one place between them in the Premier League table. Their relative standings might be in close proximity but the two clubs feel worlds apart right now – even as they share a curious overlapping in many factors this season. Both clubs drew in midweek, in Champions League matches with a huge amount resting on the outcomes. The Magpies, of course, earnt the better result but perhaps ended up feeling worse; such is the rollercoaster of emotions within football, holding Paris Saint-Germain to a 1-1 draw but conceding in the final minutes to a hotly debated penalty. The Red Devils, meanwhile, threw away a two-goal lead much earlier in the game and still could have won their match, eventually leaving Galatasaray with a 3-3 draw. Neither currently stand to progress in their groups, and both face an uphill battle domestically to regain a top-four place to return and try again among Europe’s elite in 2024-25. It’s the visitors to St. James’ Park who seem to have a host of problems stacked against them: an underperforming, big-money goalkeeper, a manager facing increased scrutiny, a litany of off-field problems this season, an ongoing takeover moving at glacial pace and mutiny among the fanbase towards the current owners, who now look like staying in place. Against that, Newcastle as a club look cohesive and together: a coaching group who have clearly improved the squad, remaining progressive in competitive terms compared to only two years ago and gradually adding to the memorable occasions on home soil. And yet, it’s Man United who come into the game ahead in the table, United who have taken more points across the last four league fixtures and United who have a far shorter injury and absence list to contend with. Such a convoluted mix of truths and perceptions is not uncommon, but this head-to-head in particular looks a potentially defining one in the battle for top-four places. Despite initial appearances, it’s tough to go against Newcastle as being in the better frame of mind to emerge with precious points. Their work rate, team chemistry and near-impeccable home form are all big factors for this fixture in isolation against Ten Hag’s team, who still appear tactically fractured and very brittle mentally when periods of matches go against them. Add in the fact they do not score a shed-load of goals – just 16 is the lowest in the Premier League’s top 12 – and that their away wins this term have all come at teams ranked 14th or lower, and it becomes even more difficult to see the Red Devils pulling off a morale-boosting victory. Looking in more granular detail at the head-to-head battles which might shape the match brings up a wider-lens, longer-term rivalry: players up against each other for places in England’s Euro 2024 squad. With Mason Mount well out of the picture for now, Man United hold perhaps three who would be seen as general certainties under Gareth Southgate: Harry Maguire, now a first-teamer again at club level; Marcus Rashford – woefully out of form and shifted to the right flank recently – and Luke Shaw, just returned from injury at left-back. Maguire appears untouchable, in part due to a lack of elite-level alternative candidates, but arguably the same cannot be said for the other two. Having switched wings, Rashford may now be in direct confrontation with two names of interest to the Three Lions, including one player suggested in some quarters as being so in-form that he cannot be continually overlooked: Anthony Gordon, Newcastle’s left-sided forward, as well as Tino Livramento, nominally a right-back but excellent on the left against PSG. It might be fanciful to suggest Livramento might usurp a senior so quickly and outside his normal role, but with a dearth of consistently available and excellent left-back options around for Southgate, it’s not an impossibility either, particularly if he defends the way he did at the Parc des Princes with regularity. Further forward it’s a different story. By the numbers, Rashford is still having an effect on United’s attack in terms of the basic dribbling and shooting traits he brings, but his end product has been woeful. He takes more shots than Gordon – total number and per 90 league minutes – yet fewer are on target. His decision-making can come into question at times too, with more shots blocked this term than anyone else at Man United has even attempted, Bruno Fernandes aside. And there’s the fact he has tallied just two goals total across all competitions, one a penalty, against Gordon’s five. The Newcastle man has found the finishing touch which had previously been conspicuously lacking, even thriving when asked to lead the line for the team – while Rashford, who has had several stints at the same job at Old Trafford, appears further away than ever at being a regular centre-forward, now even shifted away from his preferred left flank. As considerations for the national team, they overlap in plenty of attributes: ball-carriers at pace, direct runners behind the defence, hard workers defensively and a goal threat in central areas. Form, by its very nature, will ebb and flow. It’s no secret which of the two is nearer their peak right now, and if April and May – a time of trophies and international selections – seems a long way away, one team appears to be far better placed to give their forward a platform to consistently succeed. One game in isolation won’t decide the fate of these clubs, who pushes for a top-four finish or indeed who makes the final 23 for England. But if the game is decided by the in-form Gordon in particular, expect the calls for inclusion to only grow louder – and Rashford is the obvious candidate who would need to make way. Read More Newcastle boss Eddie Howe believes more VAR ‘would ruin the game’ Newcastle did not deserve penalty heartbreak - they were robbed by VAR Champions League: What do Man United, Arsenal and Newcastle need to reach last 16? Alan Shearer rages at ‘disgusting’ penalty decision as Newcastle denied famous win Newcastle let down by ‘poor’ penalty call to leave Howe ‘hugely frustrated’ PSG vs Newcastle LIVE: Champions League result and reaction

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