Osteoporosis is vastly under-diagnosed and under-treated. Worldwide, millions of people at high risk of broken bones remain unaware of the underlying silent disease.
Osteoporosis literally means ‘porous bone’. It is a condition where bones become thin and lose their strength as they become less dense, and their quality is reduced. Broken bones due to osteoporosis can be life-changing, with a serious impact on quality of life, mobility, and independence.
Osteoporosis and osteopenia are diagnoses of reduced bone strength. Bone strength can be measured with bone mineral density (BMD) testing such as the gold standard test DEXA scan. BMD measures the level of minerals in your bones, and a lower score means increased risk of fractures. Osteopenia means bone density is lower than normal, but not yet considered at risk like osteoporosis. DEXA scores between -1 and -2.5 are the osteopenic range. Lower than -2.5 is osteoporotic.
Bone density peaks is at 95% for males at 21 and females at 17 years old and peaks in the third decade. Bone density then starts decreasing. Bone cells called osteoblast build bone and osteoclasts break down bone. Like all body tissues we are in a state of ongoing repair and regeneration. Bone tissue is broken down and build up all our lives. When our bone density is increasing to our mid-thirties, osteoblast activity is higher than osteoclast, when it is reducing its reversed.
It is common for people to get osteoporosis and osteoarthritis mixed up. ‘Osteo’ means ‘bone’, ‘arth’ means ‘joint’, ‘itis’ means 'inflammation’. Osteoarthritis is degenerative inflammation of a joint and is an obvious condition with thickened joints and in many cases pain. Osteoporosis is a silent disease till a bone breaks – having osteoporosis doesn’t give you a back or hip ache.
Worldwide, one in three women and one in five men aged 50 years and over will sustain a fragility fracture due to osteoporosis in their remaining lifetimes.
By 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and by 240% in women compared to 1990.
Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporosis fracture every 3 seconds.
Based on the WHO definition of osteoporosis, it is estimated that approximately 500 million men and women worldwide may be affected.
In women, osteoporosis accounts for more days in hospital than breast cancer, heart attack, diabetes, and many other diseases.
In men, fracture risk is up to 27% higher than the risk of prostate cancer.
Spinal fractures can lead to back pain, height loss, deformity, immobility, increased number of bed days, and reduced pulmonary function.
A woman 65 years of age with one vertebral fracture has a one in four chance of another fracture over 5 years.
After a hip fracture, approximately 60% require assistance a year later and 20% will require long-term nursing care.
Mortality rates of up to 20-24% are seen in the first year after a hip fracture.
Over 55% of patients with hip fractures have evidence of a prior vertebral fracture.
A prior fracture is associated with an 86% increased risk of any fracture.
The risk of suffering another fracture is particularly high in the first two years after an initial fracture.
After sustaining a fragility fracture (an osteoporotic bone that breaks with minimal force), around 80% of patients are still not diagnosed and treated for osteoporosis, the underlying disease that caused the fracture.
It is estimated that only one third of vertebral fractures come to clinical attention.
Risk factors for osteoporosis, aside from older age, include height loss, low Body Mass Index (BMI), certain diseases, family history, long-term use of glucocorticoids and other medications.
If you’ve broken any bone (for example, your wrist) after a minor fall from standing height, especially overt the age of 50 this could be a sign of osteoporosis. Be sure to ask your doctor for testing and treatment - one broken bone can be a warning of more to come!
Pharmacological treatments have been shown to reduce the risk of hip fractures by up to 40%, vertebral fractures by 30-70%; and some treatments reduce the risk for non-vertebral fractures by up to 30-40%.
A bone-healthy lifestyle (including good nutrition and a targeted exercise program) is an essential component of osteoporosis management. Bones, like muscles, get stronger when you use them. Exercise helps build bone in children and teens as they grow and helps maintain bone in adults.
At any age, the best types of exercises for bone health are weight-bearing and muscle strengthening. Lift, push, run, jump, and ‘step’ your way up to stronger bones! Overall, most people should aim to exercise for 30 to 40 minutes three to four times each week, with weight-bearing and resistance exercises in the program.
According to the RACGP, leisure walking, swimming, and cycling do not improve bone density. Prescribed regular, varied, high-intensity resistance training and progressive balance training is recommended. High-impact activities should be avoided by individuals at high risk of fracture. Avoid forward flexion and twisting in vertebral osteoporosis.
People with osteoporosis benefit from a targeted exercise plan which also includes exercises to improve balance and posture. Exercise should be tailored to your situation and abilities.
Targeted exercise plays a crucial role in rehabilitation post-fracture, helping to reduce pain, improve physical function, and improve quality of life; Physiotherapists and Osteopaths can give expert advice and develop tailored exercise regimens post-fracture.
Eat well! A bone-healthy diet is a balanced diet with adequate intake of calcium, protein, vitamin D, vitamin K, Vitamin C and magnesium. Nutritional needs change with age. For example, young people who are still growing and women after menopause need higher calcium intake. For most people, a balanced diet provides all the nutrients needed. However, people who cannot get enough calcium from their diets, or vitamin D from exposure to the sun, may need supplements for optimal bone health.
Smoking and excessive alcohol intake are risk factors for osteoporosis. Maintaining a healthy body weight is important - and being underweight with a BMI below 19 is a key risk factor.
Be aware of any potential risk factors – take the IOF Osteoporosis Risk Check
If you have risk factors, talk to your doctor, and ask for testing and treatment if needed.