Doctors thought Derek's crippling lower back pain was cancer... until they discovered he was suffering from this condition that 'only' affects post-menopausal women - these are the signs you can't ignore
At 49, Derek Wilks was a picture of health. The accountant from Purley, in south London, had run marathons around the world and kept himself fit with regular training.But one morning he felt a sharp pain across his lower back while jogging.‘I thought I hadn’t warmed up properly,’ he recalls. ‘I kept running for a few miles thinking I’d run it off.‘But after the run, the pain got worse. Suddenly I couldn’t sit, couldn’t drive because of pain across my lower back – and that evening I had to sleep upright in a chair.’He tried painkillers such as paracetamol and ibuprofen, but they barely touched it.So after two weeks of agony he went to his GP, who prescribed more painkillers and referred him to a physio.‘The assumption at that point was that it was muscular,’ he recalls. ‘So I did lots of stretches.’When the pain still didn’t ease about three months after, he was sent for an MRI scan. Then came the shock. Derek Wilks was a picture of health aged 49, but a sudden bone break utterly changed his life‘My consultant told me I’d fractured three vertebrae,’ says Derek. ‘I had no idea it had even happened.’An unexpected and unnoticed bone break can be a warning sign for bone cancer. But after blood tests for this came back negative, he was referred for a bone-density scan.This revealed he had osteoporosis in his spine and osteopenia – early bone thinning (a precursor to osteoporosis) in his hip.Given how active he was, the diagnosis literally ‘knocked me off my chair’, recalls Derek, now 52.Not least because he, like many others, thought only post-menopausal women developed the condition.Osteoporosis in women is typically triggered by the drop in oestrogen after the menopause, because the hormone helps keep bones strong.In men, bone loss is more gradual and can go unnoticed for years. Causes include low testosterone (the hormone helps keep bone-building cells active and slows the rate of bone loss); heavy drinking (which reduces the absorption of nutrients); and certain treatments, including for prostate cancer.Lower calcium and vitamin D intake (which helps the body absorb calcium) are risk factors for men and women, and there is also a strong genetic link – if you have a first-degree relative with osteoporosis, your risk can double.Lack of exercise is also a risk factor: weight-bearing movement – such as brisk walking, climbing stairs or lifting light weights – sends a signal to bone cells to stay dense and strong. Without that regular stress, bones gradually lose strength and become fragile.More than 3.5million Britons live with osteoporosis and, although it’s much more common in women, few realise how common it is in men.Around one in four men over 50 are thought to have low bone density, or osteoporosis. One in five will break a bone because of it.Yet the problem in men is often missed: a US study published this year in Osteoporosis International found that 86.9 per cent of men with the disease are undiagnosed.‘It’s still seen as a women’s problem,’ says Dr Nicholas Fuggle, a consultant rheumatologist at Southampton University Hospital.‘That stereotype means men are diagnosed later, often only after a serious break.‘By that point, they’ve already lost a lot of bone strength.’Research for the Royal Osteoporosis Society shows around half of men with osteoporosis are undiagnosed, often because their symptoms are blamed on age or arthritis.Now the Society is launching a digital tool, The Great British Bone Check, to tackle the lack of diagnosis generally – but they hope it will be used by men who might never otherwise consider their bone health or book a bone-density scan, called dual-energy X-ray absorptiometry or Dexa, which measures how solid your skeleton is.Results are given as T-scores, which compare bone strength to that of a healthy young adult.A reading above -1 is considered normal; between -1 and -2.5 signals osteopenia; while below -2.5 is osteoporosis.Derek’s first scan in August 2022 showed a T-score of -1.4 in his hip, and -2.6 in his spine.As Dr Fuggle explains: ‘Even a small drop on the scale can mean a much higher fracture risk, so this is an important tool to catch problems early – Dexas are vital for spotting bone loss before it leads to a break.’Yet most never have one until after they have already broken a bone – access is a postcode lottery.Worryingly, more men are now developing fragile bones earlier in life, the Royal Osteoporosis Society has warned. Before his diagnosis, Derek ran several marathons. He has since built up his strength again to complete the London Marathon in just over four hours and intends to do the same next yearThis is partly due to poor diet, low vitamin D and lifestyle factors such as smoking, alcohol and inactivity.Lifestyle factors can quietly chip at bone strength, explains Kirsty Carne, a senior clinical nurse at the Royal Osteoporosis Society.‘Bones are living tissue,’ she explains. ‘They’re constantly being broken down and rebuilt. Smoking and heavy alcohol use both slow the rebuilding process and interfere with how the body absorbs calcium and vitamin D. Over time that means more bone is lost than replaced.’Certain medicines can have a similar effect.‘Long-term steroids – which some people take for conditions such as asthma, arthritis and autoimmune diseases – and common heartburn tablets, called proton-pump inhibitors, can all thin bone,’ says Dr Fuggle.Steroids slow bone-building cells and blocks absorption of calcium from food, while proton-pump inhibitors reduce stomach acid production, which is needed for calcium absorption;Derek doesn’t smoke and drinks only moderately. His biggest risk factors were family history: his mother, aunt and grandmother all had the condition.‘When they told me it was osteoporosis, I couldn’t believe it,’ says Derek.‘I’ve always looked after myself – I eat well and I run. I never thought something like that could happen to me.‘I thought it was a women’s disease. I wasn’t aware how genetics could cause it.’He adds that if he’d known about this link, he could have acted earlier to take action to protect his bones.After diagnosis, most patients start on bisphosphonate medication, such as alendronic acid. These drugs work by slowing down the cells that break bones down, giving the body a chance to ‘strengthen what’s already there’, explains Kirsty Carne.Patients are also put on vitamin D and calcium supplements.If bisphosphonates don’t work, or cause side-effects – they can sometimes irritate the stomach, for instance – other options include denosumab injections, which reduce bone breakdown, or romosozumab, which stimulates new bone.The National Institute for Health and Care Excellence guidelines recommend weight-bearing and resistance exercise, too, and balance training to reduce falls.High-impact sports such as running can be safe once bones are stronger and pain has settled.Three years on from his diagnosis, Derek has learned how to live with osteoporosis.He takes alendronic acid, as well as calcium and vitamin D supplements.And on the advice of his consultant, he began simple strength and balance exercises.‘I was told to keep moving,’ he says. ‘I started walking every day, added light weights – which I’d never used before – and stretches, and built it up slowly.’After six months he was able to return to jogging short distances outdoors, no more than 1.2 miles, compared with a minimum of 3.7 miles he’d managed before his diagnosis.Six months after that he went skiing, explaining: ‘I had padded protection and a back brace. I was a lot more cautious on the slopes than before.’Last year, Derek completed the London Marathon – he’d done it four times, but had thought after his diagnosis it would be impossible to do again. In fact, he did it in just over four hours. He plans to run it again next year.This month, Derek’s Dexa readings had improved to -1.2 in his hip, and -2.0 in his spine, showing clear gains in bone strength.‘The difference was remarkable,’ he says. ‘It showed that treatment and exercise really can rebuild bone.‘I’ve been three years without another fracture.‘The diagnosis was a shock, but it hasn’t stopped me doing the things I love. You just learn to do them differently.’To try The Great British Bone Check tool, visit: thegreatbritishbonecheck.org.uk
