World Osteoporosis Day is on Tuesday 20 October this year. The aims of this day are to raise awareness of how to prevent, diagnose and treat osteoporosis and metabolic bone disease. Osteoporosis is a condition where the bones are weak, brittle and not as dense as normal bone, and are more likely to break. Osteoporosis can cause the bones to become so fragile that a bump, sneeze or minor fall can cause a fracture. These fractures can cause long term disability, reduction in quality of life, unnecessary pain and suffering, and can even be life-threatening.
Bone is a living tissue that is constantly renewed over our lifetime. There is a continuous cycle of new bone being made while old bone is broken down. When we are children and young adults new bone is made faster than old bone is replaced and our bone density is high, increasing until we reach peak bone density in our thirties. After the age of around 35 our bone density begins to decrease and old bone is broken down faster than new bone is made.
One in three women and one in five men over the age of 50 will fracture a bone as a result of osteoporosis. There are usually no symptoms of the disease until a bone is broken and it is often called a ‘silent disease’. Fractures are most common at the wrist, upper arm, pelvis, hip and spine, with the vast majority occurring in people over the age of 65. Loss of height may be one of the only visible signs of osteoporosis. This happens when the vertebra of the spine weaken and compress, causing the spine to curve (called a ‘Dowager’s or widow’s hump). With severe osteoporosis fractures can occur when doing normal things such as lifting, bending or getting out of a chair.
Osteoporosis can be prevented but people need to act early, and take steps throughout their lives to build strong bones and prevent osteoporotic fractures. There are several key points to follow in order to build and retain healthy bones over your lifetime – exercising regularly, eating a bone-healthy diet with adequate calcium, avoiding smoking and excess alcohol, maintaining a healthy weight, finding out about your own risk factors, and getting treated early if you think you may be at risk of osteoporosis.
There are risk factors that contribute to the likelihood of osteoporosis. Being female is one, especially at menopause where oestrogen levels in the body decrease (oestrogen has a protective effect on bone), having a family history of fractures or osteoporosis, increasing age, and immobility. Being below average weight, having an inflammatory condition such as rheumatoid arthritis or inflammatory bowel disease and some medications (prednisone, anti-seizure medicines, some cancer treatments) can all contribute to increased bone loss.
Having a DEXA scan to measure your actual bone mineral density is the most accurate means of diagnosing osteoporosis. Usually the hips and lumbar spine are scanned using very low level radiation to determine this.
The main treatments for osteoporosis are exercise to strengthen bones and supporting muscles, and taking medicines to increase bone density and decrease the risk of fracture. Exercise in the form of weight-bearing aerobic exercise (e.g. running) is very important, however so is resistance exercise (free weights) and posture/balance/strength training such as yoga and tai chi.
Medicines called bisphosphonates (alendronate, risedronate and zoledronic acid) are the mainstay of osteoporosis treatment in New Zealand and decrease the rate of bone loss. Hormone replacement therapy is also used to decrease bone loss and increase bone density. Teriparatide is a synthetic hormone that stimulates bone growth and denosumab inhibits the development of cells that break down bone. Calcium and Vitamin D supplements are often prescribed alongside these osteoporosis treatments .
There are now several online assessment tools available where you can assess your risk of an osteoporotic fracture, one of which is called “Know Your Bones”, developed by Bone Health New Zealand. It’s worth undertaking a quick assessment and getting in touch with your doctor if you think you may be at risk of osteoporosis.