What is osteoporosis?

Osteoporosis is a long-term (chronic) disease which makes your bones less dense and more fragile. If you have osteoporosis, you are more likely to fracture or break a bone if you have a mild injury or minor fall. Osteoporosis can be managed with medicines to strengthen your bones, and through lifestyle changes such as how you exercise and stopping smoking.

What are the symptoms of osteoporosis?

The most common symptom of osteoporosis is breaking or fracturing a bone because of a mild injury, such as falling over. Other symptoms include:

• gradual height loss
• back pain
• tiny cracks in your bones, known as stress fractures, that can feel like joint or muscle pain

What causes osteoporosis?

Osteoporosis is caused by a decrease in bone density, which makes your bones more fragile and easily broken. Everyone’s bones become weaker as they age, but in some people this process happens too quickly. You are more likely to develop osteoporosis if you have risk factors for the disease. Some of the risk factors can be reduced through lifestyle changes or medications but others, such as your age, cannot be changed.

Risk factors that cannot be changed include:

• being over 70 years of age
• being female
• having fallen in the past
• your parents having had hip fractures
• early menopause

Risk factors that can be reduced include:

• not being physically active
• low muscle mass and strength
• low body weight (BMI below 20kg/m2)
• smoking
• high alcohol intake
• not eating enough energy-rich foods or proteins.

If you suffer from certain diseases, you are more likely to develop osteoporosis. These include:

• hypogonadism or early menopause
• diseases that cause bone loss, such as rheumatoid arthritis
• hyperthyroidism or hyperparathyroidism
• chronic liver or kidney disease
• coeliac disease and inflammatory bowel disease
• cushing's syndrome

Some medications can also increase your risk of developing osteoporosis, including:

• steroids — when used for more than 3 months
• anti-androgen therapy — drugs that block testosterone from working and which are sometimes used to treat prostate cancer
• aromatase inhibitors — drugs that block oestrogen from being produced and working and which are sometimes used to treat or prevent ovarian or breast cancer
• thyroid hormone replacement therapy — which can be a risk factor when used for too long
• antidepressant medications — particularly medicines from the SSRI group
• proton pump inhibitors (PPIs) — medicines which make your stomach less acidic
• thiazolidinedione (TZD) — a medicine sometimes used to treat diabetes
• antipsychotic medications — some medicines used in mental illnesses such as schizophrenia
• anti-epileptic medications — some medicines used to control epilepsy

You can find out more about how your risk factors affect your chance of developing osteoporosis by using the Know your Bones self-assessment tool, developed by the Garvan Institute of Medical Research and Healthy Bones Australia.

How is osteoporosis diagnosed?

Osteoporosis is diagnosed based on your medical history, a physical examination by your doctor, and a bone mineral density test. The bone density test uses a special x-ray to look for signs that your bones are becoming weaker, and assigns you a “T-score” based on the results. If your T-score is -2.5 or less, your doctor will diagnose you with osteoporosis. The higher your T-score, the healthier your bones are.

How is osteoporosis treated or managed?

There is no cure for osteoporosis, but the symptoms of the disease can be managed with medicines and lifestyle changes. Depending on your age, sex and medical history, your doctor will recommend different treatments that will be able to help you. Your doctor may complete an osteoporosis risk assessment to help decide which treatment would be best for you.

The aim of treatment is to strengthen your bones so that they are less likely to break, and to prevent falls that could damage your bones. Falls are a major source of injury in older people, and osteoporosis makes it more likely that you will be seriously injured after even a minor fall.

Lifestyle changes

Exercise can strengthen your bones and muscles and decrease your risk of falling. Your doctor or physiotherapist can help you build a safe exercise plan which suits your needs and reduces your risk of fracturing your bones. This may include strength training, like lifting weights, and weight bearing exercises (exercise done while on your feet so you bear your own weight) like brisk walking, jogging, tennis or volleyball. Exercises that help improve your balance are useful to help avoid falling over in the future. Examples of some exercises that can help you improve your balance are:

• Tai Chi
• standing with your feet close together
• standing on one leg
• walking backwards

Maintaining a healthy weight can also help you manage osteoporosis. Stopping smoking and reducing your alcoholic consumption to just 2 standard drinks a day can improve your bone strength.

Reducing your likelihood of falling is also important. Consider how you might arrange your home and workplace so you are less likely to trip — for example by fixing down rugs and keeping the floor clear. Wearing sensible shoes and glasses if you need them can also help to keep you stable as your move around.

Medicines

If you have osteoporosis, you doctor may recommend medicines to strengthen your bones. These medicines can include:

• Bisphosphonates — to slow down the natural bone density loss process, which are either taken as pills or injected once a year.
• Denosumab — an injection given twice a year which can also slow down the development of osteoporosis.
• selective estrogen receptor modulators (SERMs) — these are used to replace oestrogen in post-menopausal women (those who no longer have periods).
• menopause hormonal treatment (MHT) — can be given to women under 60 or those who have stopped getting their period in the past 10 years.
• Teriparatide — this can be helpful if you have tried other medicines but your bones are still vulnerable to breaking or fracturing easily.

Sometimes osteoporosis can be painful. Your doctor or pharmacist will be able to help you choose a pain medicine that is suitable for you.

Can osteoporosis be prevented?

Osteoporosis cannot be entirely prevented, but there are some things you can do to reduce your risk of developing the disease. Men over the age of 50, and post-menopausal women (those who no longer have periods ) should discuss their calcium and vitamin D levels with their doctor to check if they could benefit from more calcium or vitamin D. Your doctor may also suggest:

• stopping smoking: this can decrease your risk of osteoporosis and of lung cancer, starting from the first day you don’t smoke
• maintaining a healthy weight: this can mean losing or gaining weight, depending on your BMI.
• cutting back on alcohol: drinking no more than 2 standard size drinks a day or less will help prevent osteoporosis.
• bone strengthening exercises: weight-bearing exercises, like brisk walking, and muscle-building activities such as strength training can help fragile bones heal themselves and become denser and stronger.
• balance training: if you are at risk of falling, balance training can help you stay stable.

When should I see my doctor?

If you feel concerned that you are at risk of or are experiencing osteoporosis, you should arrange to see your doctor. By treating osteoporosis early, you have the best chance of avoiding broken bones as you get older. Osteoporosis can run in families, so you should mention to your doctor if you have a close family member with the disease, or if you have ever had a bone fracture or break due to a minor injury.

What are the complications of osteoporosis?

Osteoporosis causes your bones to become fragile and more likely to break or fracture from even a minor injury or fall. The hip is one of the bones most likely to be affected and unfortunately, hip fractures or breaks can make it hard to walk. They can also take a long time to heal, even preventing someone from being able to continue living independently at home.

Resources and support

For more information and support, try these resources:

• You can discuss any concerns about osteoporosis and seek expert advice from the Musculoskeletal Australia National Help Line — 1800 263 265
• Learn more about how osteoporosis affects women on the Jean Hailes for Women's Health website or by calling 1800 JEANHAILES (532 642)
• Check your risk factors for developing osteoporosis using the Know your Bones self-assessment tool, developed by the Garvan Institute of Medical Research and Healthy Bones Australia
• Read about living with osteoporosis and discover strategies that can help you manage your symptoms on the Healthy Bones Australia website.