An Overview of Osteoporosis

Loss of bone density is natural over time, but for the 1 million-plus Australians living with osteoporosis, even a small fall or mechanical injury could mean a trip to hospital.

What is Osteoporosis?

The aptly-named osteoporosis (‘bones with holes’), is a condition causing bones to become more porous due to loss of density (Better Health Channel 2019).

This decreased density means the bones are weaker, thinner and more fragile, which makes them more susceptible to breakage (AIHW 2019). As a result, the potential for injury, even from minor accidents, is increased (Australian Institute of Health and Welfare 2019).

Osteoporosis v Osteopenia

When bones lose minerals (such as calcium) more quickly than they are able to be replenished, the density of those bones decreases (Osteoporosis Australia 2014). This loss of density begins to happen naturally after the age of 35 (Healthdirect 2019).

Loss of bone mineral density can be sorted into three categories depending on how far it has progressed.

These three categories are:

1. Normal;
2. Osteoporosis; and
3. Osteopenia, the severity of which falls in between the above mentioned.

Osteopenia is a condition where there has been some loss of bone density, and bones are therefore weaker, but not frail enough to be considered osteoporosis (AIHW 2019).

In osteopenia there is still some level of risk, but it is not as severe. Furthermore, an individual who has developed osteopenia will not necessarily progress to having osteoporosis, but could be at greater risk of doing so (Healthdirect 2018).

How Common is Osteoporosis?

According to Osteoporosis Australia (2014), 6.3 million Australians are affected by osteopenia, while 1.2 million are affected by osteoporosis.

Because it does not usually present with symptoms, osteoporosis is under-diagnosed and the exact prevalence is difficult to determine (AIHW 2019).

It is generally more common among older populations (Healthdirect 2019).

Signs and Symptoms of Osteoporosis

Osteoporosis is known as a ‘silent disease’ because there are usually no obvious symptoms (Osteoporosis Australia 2014).

Osteoporosis develops slowly over a number of years (Healthdirect 2019). Most people with osteoporosis will not know their diagnosis until a fracture occurs. Due to this, it is recommended that any person over 50 who suffers a broken bone from a minor accident or fall should be tested for osteoporosis (Osteoporosis Australia 2014).

The following signs and symptoms may suggest osteoporosis:

• Back pain;
• Loss of height;
• Stooped posture; and
• A bone that breaks more easily than expected.

(Mayo Clinic 2019)

Osteoporosis Risk Factors

There are certain risk factors that can be used to predict the occurrence of osteoporosis.

Naturally, the presence of osteopenia could suggest progression to osteoporosis in the future.

Other risk factors include:

• Being female, particularly of European or Asian descent.
• Having an early menopause (bone health is related to the amount of estrogen in the body, which decreases after menopause).
• Being of an older age.
• A family history of osteoporosis, or other conditions (e.g. lost height, ‘Dowager’s hump’) that suggest low bone density runs in the family.
• Low calcium or vitamin D levels.
• Certain medical conditions (low hormone levels, malabsorption conditions, thyroid conditions, chronic diseases), or medications (e.g. corticosteroids).
• Certain lifestyle factors (smoking, lack of physical activity, excessive alcohol intake, being overweight or obese).

(Mayo Clinic 2019; Osteoporosis Australia 2014; Healthdirect 2019)

Diagnosing Osteoporosis

A bone density test called the ‘dual-energy x-ray absorptiometry’ (DXA) scan’ can be used to diagnose osteoporosis.

The scan uses radiation to measure bone density in the spine and hip and provides a ‘T-Score’, which categorises the individual’s bone density as either normal, osteopenia or osteoporosis. (Osteoporosis Australia 2014).

Impacts of Osteoporosis

Osteoporosis can occur in any bone, but the hip, spine and wrist are the most commonly affected areas (Osteoporosis Australia 2014).

In some cases of osteoporosis, the bones are so thin that even coughing or bending over is enough to cause a fracture (Mayo Clinic 2019).

The fractures caused by osteoporosis can have a significant impact on the individual’s life, leading to chronic pain, disability or even death in some cases (Osteoporosis Australia 2014).

For this reason, osteoporosis has the potential to be severe or fatal if an accident occurs.

Furthermore, once an individual has experienced an initial fracture due to osteoporosis, they are 2-4 times more likely to experience another fracture in the next 12 months.

This creates a ‘cascade effect’, which means the individual becomes more and more likely to suffer another fracture with each subsequent injury.

Osteoporosis can also cause the vertebrae to weaken and crumple, leading to spinal injuries without an accident having occurred (Mayo Clinic 2019).

Osteoporosis Prevention

Although the genetic risk factors of osteoporosis cannot be changed, it is possible for an individual to reduce the possibility of developing osteoporosis by managing aspects of their lifestyle.

It is important to ensure that bones are thick and healthy from a young age before density begins to decrease.

The following is crucial to ensuring optimal bone health:

• Maintaining a nutritious diet with adequate calcium;
• Getting enough vitamin D;
• Being physically active; and
• Refraining from smoking.

(International Osteoporosis Foundation n.d.)

According to the International Osteoporosis Foundation (n.d.), a ‘10% increase of peak bone mass in children reduces the risk of an osteoporotic fracture during adult life by 50%’.

Osteoporosis Management

There is no cure for osteoporosis, but an individual may be prescribed medication to strengthen their bones and reduce the amount of density lost.

They may also be encouraged to make lifestyle changes. However, the most important way to manage osteoporosis is to focus on fall prevention and put measures into place to reduce the risk of having an accident.

This includes reducing hazards around the home, using walking sticks or frames to assist with steadiness and avoiding certain chores or tasks (Healthdirect 2019).

After the onset of osteoporosis, it is important to stop the cascade effect from occurring.

Additional Resources:

• Osteoporosis Australia, https://www.osteoporosis.org.au
• Identifying Falls Risk, https://www.ausmed.com.au/cpd/courses/identifying-falls-risk
• Osteoarthritis Care and Management, https://www.ausmed.com.au/cpd/articles/osteoarthritis-care-and-management

References

• Better Health Channel 2019, Osteoporosis, Better Health Channel, Melbourne, viewed 27 February 2019, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis
• Australian Institute of Health and Welfare (AIHW) 2019, Osteoporosis, Australian Institute of Health and Welfare, Canberra, viewed 27 February 2019, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoporosis/contents/what-is-osteoporosis
• Osteoporosis Australia 2014, What is it?, Osteoporosis Australia, Sydney, viewed 27 February 2019, https://www.osteoporosis.org.au/what-it
• Healthdirect 2019, Osteoporosis, Healthdirect, Canberra, viewed 27 February 2019, https://www.healthdirect.gov.au/osteoporosis
• Healthdirect 2018, Osteopenia, Healthdirect, Canberra, viewed 27 February 2019, https://www.healthdirect.gov.au/osteopaenia
• Osteoporosis Australia 2014, What You Need to Know About Osteoporosis: Consumer Guide, Osteoporosis Australia, Sydney, viewed 27 February 2019, https://www.osteoporosis.org.au/sites/default/files/files/oa_consumer_ed2_Aug2014.pdf
• Mayo Clinic 2019, Osteoporosis, Mayo Clinic, viewed 27 February 2019, https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968?page=0&citems=10
• International Osteoporosis Foundation n.d., Preventing Osteoporosis, International Osteoporosis Foundation, viewed 27 February 2019, https://www.iofbonehealth.org/preventing-osteoporosis
• Healthdirect 2019, Living with Osteoporosis, Healthdirect, Canberra, viewed 27 February 2019, https://www.healthdirect.gov.au/living-with-osteoporosis