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Osteoporosis

What is osteoporosis?

Osteoporosis is a condition in which the bones become fragile and brittle, leading to a higher risk of fractures.

Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, leading to a loss of bone thickness (bone mass or density). As a result, bones become thinner and less dense, so that even a minor bump or accident can cause serious fractures. These are known as fragility or minimal trauma fractures. Any bone can be affected by osteoporosis, but the most common sites are bones in the hip, spine, wrist, ribs, pelvis and upper arm.


Fractures due to osteoporosis (osteoporotic fractures) can lead to changes in posture (e.g. developing a stoop or Dowager's hump in your back), muscle weakness, loss of height and bone deformity of the spine. Fractures can lead to chronic pain, disability, loss of independence. Every 5-6 minutes, someone is admitted to an Australian hospital with an osteoporotic fracture.


About 50% of people with one fracture due to osteoporosis will have another. The risk of future fractures rises with each new fracture, the 'cascade effect'. The 'cascade effect' means that women who have suffered a fracture in their spine are over 4 times more likely to have another fracture within the next year, compared to women who have never had an osteoporotic fracture.

Who gets osteoporosis?

Osteoporosis affects both women and men. 1 in 2 women and 1 in 3 men over 60 years will have an osteoporotic fracture in Australia.

Women are at a greater risk of developing osteoporosis than men, mainly due to the rapid decline in oestrogen levels after menopause. Oestrogen is an important hormone for maintaining healthy bones. When oestrogen levels decrease, the bones lose calcium (and other minerals) at a much faster rate - bone loss is approximately 1% - 5% per year after menopause.

Men also lose bone as they age, but their bone mass generally remains adequate until much later in life. However, certain risk factors such as reduced calcium intake and low levels of vitamin D can increase age related bone loss. Although osteoporotic fractures are less common in men than in women, when they occur, these fractures are associated with higher disability and death than in women.

Risk factors

The following risk factors can increase your chance of developing osteoporosis:

• Any family history of osteoporosis and fracture
• Cortico-steroids (commonly used for asthma and a variety of other medical conditions)
• Rheumatoid arthritis
• Over-active thyroid or parathyroid glands
• Coeliac disease and other chronic gut conditions
• Chronic liver or kidney disease
• Smoking
• Excessive alcohol consumption
• Diet lacking in calcium
• Lack of sunlight exposure, which may cause vitamin D deficiency
• Sedentary lifestyle over many years

Prevention of osteoporosis

Bone health is maintained in the body by getting adequate:

Calcium

Our bodies cannot make calcium, so it must come from our diets. When you are not getting sufficient amounts of calcium in your diet, some of the calcium crystals in bone dissolve and give their calcium back to the bloodstream.

Calcium intake is important and how well the calcium is absorbed is also important. Calcium absorption may be reduced by excessive caffeine and alcohol, soft drinks containing phosphates and diets high in animal proteins. As well, calcium is continually lost from your body each day through your skin and nails, sweat, and urine.

For most Australians, dairy foods are the main source of calcium. Dairy foods are the most convenient way to obtain adequate calcium because milk, yoghurt and most cheeses are particularly high in calcium. Small amounts of calcium are found in nuts, breads, cereals, fruits and vegetables. Three servings of dairy products each day will generally provide you with the recommended daily calcium intake around 1000 mg/day. If you cannot get enough calcium in your diet, your doctor may suggest that you take a calcium supplement.

Vitamin D

Vitamin D is essential for bone health, because it helps:

• increase the absorption of calcium and phosphorous from the stomach
• regulate the amount of calcium in the blood
• strengthen the skeleton

For Australians, the main source of vitamin D is from exposure to sunlight. Vitamin D3 is formed by the action of sunlight (UV light) on the skin. A deficiency of vitamin D can contribute to osteoporosis because without it, calcium will not be fully absorbed by your body. If you have low vitamin D levels in your blood, your doctor may suggest that you take a vitamin D supplement. Sometimes vitamin D is combined with calcium.

Exercise

Regular physical activity on a long-term basis has a particularly important role in maintaining healthy bones. Exercise can maintain and increase bone strength by increasing bone mass or by slowing age-related bone loss. Muscle strength is also increased, which is important for supporting the joints and preventing falls.

There are two main types of exercises that are beneficial to bone health:

• Weight-bearing exercise: Your bones become stronger when they bear weight during exercise and when some amount of 'impact' or extra strain is placed on those bones.
• Resistance exercise: Resistance exercises, also called strength training, can have a good effect on the health of your bones and have been shown to reduce the number of falls in older people.

Diagnosing osteoporosis

Osteoporosis is diagnosed by a bone density test (Dual-Energy X-ray Absorptiometry - DEXA study). The bone density test will give you a T-score. The result will be in the range of:

• Normal (higher than -1);
• Osteopenia (low bone density: between -1 and - 2.5); or
• Osteoporosis (-2.5 or lower)

Managing osteoporosis

If you have been diagnosed with osteoporosis, your doctor will probably recommend:

• Important lifestyle changes such as:

Increasing your calcium intake through your daily diet or supplements
Increasing the amount of exercise each week
Quitting smoking
Decreasing your alcohol intake
Increasing your exposure to limited sunlight to correct any vitamin D deficiencies, or with supplementation

• Medication to stop further bone loss and prevent fractures: Osteoporosis medications work by making the bone cells that break down bone ineffective, while leaving the cells that form bone alone. The most common are Fosamax, Evista and HRT. In men with low testosterone levels, then testosterone replacement therapy is applicable.

• Falls prevention measures (as falls can lead to breaks) – balance re-education classes, strengthening classes, hydrotherapy classes.

The concepts presented here are entirely the author's own (unless expressly stated) and do not represent the thoughts or ideas of any other person.