Osteoporosis

What is Osteoporosis?

Osteoporosis is a disease that affects over 1 million Australians. This disease makes the bones brittle leading to a higher risk of fractures than normal bones. When the body loses calcium, faster than it can be replaced, there is loss of bone thickness, ultimately leading to Osteoporosis.

Osteoporosis leads to fractures
As bones become thinner, a minor fall can lead to a fracture. Any bone can be affected by osteoporosis, but the most common sites are the hip, spine and wrist. Fractures of the hip is associated with serious complications, including pain, loss of mobility, loss of independence which may lead to nursing home placement and even death.

Osteoporosis has no symptoms and hence it cant be identified until someone falls and a has a fracture. The risk of future fractures rises with each new fracture. Women with a fracture in the spine are 4 times more likely to have another fracture in the next year.

Risk Factors

Anyone who has a fracture, with a minor trip or fall needs to be investigated. Risk factors for osteoporosis include:

  • Advancing age
  • Previous history of fractures
  • Chronic use of steroids like prednisolone
  • Low body weight/ Low Body mass index (BMI)
  • Parental history of hip fractures
  • Smoking
  • Excess alcohol use
  • Post menopausal women
  • Low calcium and Vitamin D intake
  • Thyroid abnormalities
  • Any disease that affects absorption- coeliac Disease, Inflammatory Bowel Disease
  • Certain medications
  • Chronic diseases like rheumatoid arthritis, chronic liver/kidney disease

Medical professionals use tools to measure your risk for fractures and depending on your score, may recommend further testing with a bone scan called a DEXA scan.
The results of the scan will indicate if you are at risk of fractures.

Treatment

Anyone diagnosed with Osteoporosis are recommended treatment to prevent bone loss and reduce risk of fractures. Treatment includes use of calcium and vitamin D supplements in those who are known to be low in it. In addition, other medications called Bisphosphonates are recommended which slow down the breakdown and removal of bone.
Ex: Alendronate, Risedronate, Pamidronate
Another medication that is being increasingly used to manage osteoporosis is an injection called Denosumab( Prolia). This is an antibody that is directed against a factor that is involved in the formation of cells that breaks down bones. It is used once every six months.
Other agents that can be used are Teriparatide( Parathyroid hormone) and calcitonin but these are not used as commonly as the bisphosphonates or denosumab.

Prevention

Preventative measures against Osteoporosis can be taken at every stage of life

  • Diet-an optimal diet includes consuming an adequate number of proteins and calories as well as calcium and Vitamin D
    1. Calcium intake- an intake of 1000 mg per day is recommended for premenopausal women and men. Sources include, milk and dairy products, green vegetables like Kale and Broccoli. 3-5 serves of calcium rich food is recommended. It is important to note that studies have shown that less than half of all Australian adults get their daily recommended intake of calcium.
      Calcium supplements may be required in those who are unable to obtain the recommended intake in the range of 500-600mg per day.
    2.  

    3. Vitamin D- helps in regulating calcium levels in the blood and also supports growth and maintenance of the skeletonFor most Australians, the main source of vitamin D is exposure to sunlight as Vitamin D is produced when the skin is exposed to Ultraviolet(UVB)light from the sun.
      It is important to balance the need for sun exposure and the risk of sun damage and skin cancers.

      The time for skin exposure and the duration of skin exposure to maintain adequate Vitamin D depends on the season and the state you are in.Vitamin D levels can be easily tested and if found low, supplements are recommended.
      Most vitamin D supplements are available in a form called D3 and are available as capsules, tablets and drops. Only a few dietary sources of Vitamin D are available- salmon, tuna, mackerel, liver, egg yolks etc.
  •  
     
     

  • Exercise– plays a very important role in the improvement of bone mass and Maintainence of bone density. Exercise must be regular and ongoing to have benefits for bones and specific types of exercises are recommended for bone health.
    Goals of exercise change throughout life from building maximum bone strength in childhood and adolescence, to optimising and maintaining muscle and bone strength in young and mid-adulthood, and reducing bone loss in older age.
    For the elderly the focus of exercise is to increase or maintain muscle mass and strength, and address risk factors for falls, particularly any difficultly in balance and walking ability. Specific types of Exercise are important for improving bone health

    1. Weight bearing exercise (exercise done while on your feet so you bear your own weight). For example: brisk walking, jogging, skipping, basketball / netball, tennis, dancing, impact aerobics, stair walking.
    2. Progressive resistance training (becomes more challenging over time). For example: lifting weights – hand / ankle weights or gym equipment.
      The ability of an exercise to build bone (osteogenic capacity) depends on the specific way that stress is applied to the bone during the exercise.

      Exercise must be

      1. Regular- 3 times per week
      2. Must progress over time- amount of weight used, degree of exercise difficulty etc
      3. Varied
      4. Performed in short, intensive bursts
    3. Balance exercises and prevents falls- balance and mobility exercises do not improve bone or muscle strength but can help reduce falls. Exercises that assist with balance include standing on one leg (increasing to standing on one leg with eyes closed), heel-to-toe walking and tai chi.

What is Osteoporosis?

Osteoporosis is a disease that affects over 1 million Australians. This disease makes the bones brittle leading to a higher risk of fractures than normal bones. When the body loses calcium, faster than it can be replaced, there is loss of bone thickness, ultimately leading to Osteoporosis. Osteoporosis leads to fractures As bones become thinner, a minor fall can lead to a fracture. Any bone can be affected by osteoporosis, but the most common sites are the hip, spine and wrist. Fractures of the hip is associated with serious complications, including pain, loss of mobility, loss of independence which may lead to nursing home placement and even death. Osteoporosis has no symptoms and hence it cant be identified until someone falls and a has a fracture. The risk of future fractures rises with each new fracture. Women with a fracture in the spine are 4 times more likely to have another fracture in the next year.

Risk Factors

Anyone who has a fracture, with a minor trip or fall needs to be investigated. Risk factors for osteoporosis include:
  • Advancing age
  • Previous history of fractures
  • Chronic use of steroids like prednisolone
  • Low body weight/ Low Body mass index (BMI)
  • Parental history of hip fractures
  • Smoking
  • Excess alcohol use
  • Post menopausal women
  • Low calcium and Vitamin D intake
  • Thyroid abnormalities
  • Any disease that affects absorption- coeliac Disease, Inflammatory Bowel Disease
  • Certain medications
  • Chronic diseases like rheumatoid arthritis, chronic liver/kidney disease
Medical professionals use tools to measure your risk for fractures and depending on your score, may recommend further testing with a bone scan called a DEXA scan. The results of the scan will indicate if you are at risk of fractures.

Treatment

Anyone diagnosed with Osteoporosis are recommended treatment to prevent bone loss and reduce risk of fractures. Treatment includes use of calcium and vitamin D supplements in those who are known to be low in it. In addition, other medications called Bisphosphonates are recommended which slow down the breakdown and removal of bone. Ex: Alendronate, Risedronate, Pamidronate Another medication that is being increasingly used to manage osteoporosis is an injection called Denosumab( Prolia). This is an antibody that is directed against a factor that is involved in the formation of cells that breaks down bones. It is used once every six months. Other agents that can be used are Teriparatide( Parathyroid hormone) and calcitonin but these are not used as commonly as the bisphosphonates or denosumab.

Prevention

Preventative measures against Osteoporosis can be taken at every stage of life
  • Diet-an optimal diet includes consuming an adequate number of proteins and calories as well as calcium and Vitamin D
    1. Calcium intake- an intake of 1000 mg per day is recommended for premenopausal women and men. Sources include, milk and dairy products, green vegetables like Kale and Broccoli. 3-5 serves of calcium rich food is recommended. It is important to note that studies have shown that less than half of all Australian adults get their daily recommended intake of calcium. Calcium supplements may be required in those who are unable to obtain the recommended intake in the range of 500-600mg per day.
    2.  
    3. Vitamin D- helps in regulating calcium levels in the blood and also supports growth and maintenance of the skeletonFor most Australians, the main source of vitamin D is exposure to sunlight as Vitamin D is produced when the skin is exposed to Ultraviolet(UVB)light from the sun. It is important to balance the need for sun exposure and the risk of sun damage and skin cancers. The time for skin exposure and the duration of skin exposure to maintain adequate Vitamin D depends on the season and the state you are in.Vitamin D levels can be easily tested and if found low, supplements are recommended. Most vitamin D supplements are available in a form called D3 and are available as capsules, tablets and drops. Only a few dietary sources of Vitamin D are available- salmon, tuna, mackerel, liver, egg yolks etc.
  •      
  • Exercise- plays a very important role in the improvement of bone mass and Maintainence of bone density. Exercise must be regular and ongoing to have benefits for bones and specific types of exercises are recommended for bone health. Goals of exercise change throughout life from building maximum bone strength in childhood and adolescence, to optimising and maintaining muscle and bone strength in young and mid-adulthood, and reducing bone loss in older age. For the elderly the focus of exercise is to increase or maintain muscle mass and strength, and address risk factors for falls, particularly any difficultly in balance and walking ability. Specific types of Exercise are important for improving bone health
    1. Weight bearing exercise (exercise done while on your feet so you bear your own weight). For example: brisk walking, jogging, skipping, basketball / netball, tennis, dancing, impact aerobics, stair walking.
    2. Progressive resistance training (becomes more challenging over time). For example: lifting weights – hand / ankle weights or gym equipment. The ability of an exercise to build bone (osteogenic capacity) depends on the specific way that stress is applied to the bone during the exercise. Exercise must be
      1. Regular- 3 times per week
      2. Must progress over time- amount of weight used, degree of exercise difficulty etc
      3. Varied
      4. Performed in short, intensive bursts
    3. Balance exercises and prevents falls- balance and mobility exercises do not improve bone or muscle strength but can help reduce falls. Exercises that assist with balance include standing on one leg (increasing to standing on one leg with eyes closed), heel-to-toe walking and tai chi.