Osteoporosis - prevention and treatment

Osteoporosis occurs when bones lose minerals such as calcium more quickly than the body can replace them. They become less dense, lose strength and break more easily. Osteoporosis literally means ‘porous bones’. Most people don’t realise they have osteoporosis until a fracture happens as there are usually no signs or symptoms. This is why osteoporosis is often called the ‘silent disease’.

Bone density testing

Currently the most reliable way to measure bone density is the dual-energy absorptiometry scan or DXA. A DXA scan is a short, painless scan that usually measures the density of your bones at the hip and spine.

There is a Medicare rebate for a DXA scan if you:

• Have been previously diagnosed with osteoporosis
• Have had one or more fractures due to osteoporosis
• Are 70 years or over
• Have a chronic condition including rheumatoid arthritis, coeliac disease and liver disease.

If you have osteoporosis, lifestyle changes and medical treatment can prevent further bone loss and reduce your risk of bone fractures.

Risk factors for osteoporosis

There are many risk factors for osteoporosis – some of which you cannot change, including being female, being Caucasian or Asian and having a direct relative who has had an osteoporotic fracture.

However there are many risk factors you can address, which can allow you to take control of your bone health and help prevent osteoporosis:

• A well-balanced diet, including adequate intake of calcium
• Appropriate exercise
• Adequate levels of vitamin D
• Lifestyle changes – for example, stopping smoking and minimising alcohol and caffeine intake.

Diet and calcium

Enjoying a healthy balanced diet, with a variety of foods and an adequate intake of calcium, is a vital step to building and maintaining strong healthy bones. Calcium is needed in the blood to perform various functions. If there is not enough calcium in the blood, the body will leach (take) calcium from the bones. Making sure you have enough calcium in your diet is an important way to preserve your bone density.

The average Australian adult is recommended to consume 1,000mg of calcium per day. Postmenopausal women and men aged over 70 years are recommended to have 1,300mg of calcium per day. Children, depending on their age, will need up to 1,300mg of calcium per day.

Dairy foods have the highest levels of calcium, but there are many other sources of calcium including sardines, spinach and almonds. If you are unable to get enough calcium from your diet alone, you might need to talk to your health professional about calcium supplements.

Vitamin D

Vitamin D and calcium promote bone density. Vitamin D is important because it helps your body absorb the calcium in your diet. Your doctor may suggest testing your vitamin D and calcium levels. We obtain most of our vitamin D from the sun, so it is important to expose the hands, face and arms to the sun for 6–8 minutes every day in the warmer months (avoiding the hottest period of the day between 10am and 3pm), and about 30 minutes in the cooler months.

Vitamin D can also be found in small quantities in foods such as:

• fatty fish (salmon, herring, mackerel)
• liver
• eggs
• fortified foods such as low fats milks and margarine.

For most people it is unlikely that adequate quantities of vitamin D will be obtained through diet alone. Talk with your health professional about vitamin D supplements if you are concerned that you are not getting enough vitamin D.

Exercise for strong bones

Weight-bearing exercise encourages bone density. Consult your doctor before starting a new exercise program especially if you have been sedentary, are over 75 years of age or have a medical condition.

General recommendations include:

• Choose weight-bearing activities such as brisk walking, jogging, tennis, netball or dance. Non-weight-bearing exercises, such as swimming and cycling, do not promote bone growth.
• Include some high-impact exercise into your routine, such as jumping and rope skipping. Consult your health professional – high-impact exercise may not be suitable if you have joint problems, another medical condition or are unfit.
• Strength training (or resistance training) is also an important exercise for bone health. It involves resistance being applied to a muscle to develop and maintain muscular strength, muscular endurance and muscle mass. Importantly for osteoporosis prevention and management, strength training can maintain, or even improve, bone mineral density. Be guided by a health or fitness professional who can recommend specific exercises and techniques.
• Activities that promote muscle strength, balance and coordination – such as Tai Chi, Pilates and gentle yoga – are also important as they can help to prevent falls by improving our balance, muscle strength and posture.
• A mixture of weight-bearing and strength training sessions throughout the week is ideal, aiming for 30 to 40 minutes, four to six times a week. Exercise for bone growth needs to be regular and have variety.

Lifestyle changes

Be guided by your doctor, but general recommendations may include:

• Stop smoking – smokers have lower bone density than nonsmokers.
• Get some sun – exposure of some skin to the sun needs to occur on most days of the week to allow enough vitamin D production. This varies considerably depending on the time of year, time of day and your skin colour. In summer, 6–8 minutes a day of sun exposure to the face, arms and hands is usually enough for fair-skinned people. In the winter in the southern states, this should be increased to 30 minutes a day, or 2–3 hours over a week. Remember, it is still important to avoid sun exposure between 10am and 3pm during summer to minimise risk of skin cancer.
• Drink alcohol in moderation – excessive alcohol consumption increases the risk of osteoporosis.
• Limit caffeinated drinks – more than three caffeinated drinks (such as tea, coffee and cola) a day is linked to an increased risk of osteoporosis.

Osteoporosis management

If you have osteoporosis, the strategies listed to prevent osteoporosis will help to manage the condition, but you may also need to consider:

• Safer exercise options
• Falls prevention
• Medications.

Safer exercise options

If you have osteoporosis, the risk of a fracture (break) with high-intensity exercise and poorly performed strength training can outweigh the bone-building benefits of these exercises. The best approach is to have an individually prescribed exercise program put together for you by a physiotherapist or exercise physiologist. The program may include:

• Modified strength-training exercises
• Weight-bearing exercise such as brisk walking
• Gentle exercises that focus on posture and range of movement.

Falls prevention

A third of people aged over 65 fall every year and 10–15 per cent of those falls lead to a fracture. That’s why reducing the risk of falls is important. Be guided by your doctor, but general recommendations include:

• Perform exercises to improve your balance as prescribed by a physiotherapist.
• Wear your prescription eyeglasses as directed by your optician.
• ‘Trip proof’ your home – for example, remove loose rugs, install handrails in the shower and toilet, and make sure all rooms are well lit. An occupational therapist can assist with this.
• Wear sturdy flat-heeled shoes that fit properly.
• Consider wearing a hip protector. This is a shield worn over the hip that is designed to spread the impact of a fall away from the hipbone and into the surrounding fat and muscle. Worn correctly, a hip protector can reduce the risk of hip fracture.

Medication

As well as diet and lifestyle changes, your doctor may recommend medication. The options may include:

• Bisphosphonates – bone cells are created and broken down in a constant cycle. Bisphosphonates encourage bone density by slowing the ‘breakdown’ process. These drugs are commonly used in Australia to treat osteoporosis in men and women. In rare cases, use of bisphosphonates can lead to jawbone problems. Speak to your doctor and dentist about your risk of developing this problem.
• Hormone therapy (HT) – in women, the female sex hormone oestrogen plays an important role in maintaining the strength of bone tissue. Menopause causes a marked drop in oestrogen levels and increases the risk of osteoporosis and osteoporotic fractures. While HT boosts oestrogen levels and prevents osteoporosis after menopause, it has also been associated with an increased rate of heart attack, stroke and breast cancer. Its long-term use is no longer recommended for osteoporosis management.
• Selective oestrogen receptor modulators (SERMs) – sites in the female body called ‘oestrogen receptors’ respond to the hormone oestrogen. SERMs mimic the action of oestrogen and therefore reduce bone loss. SERMs have been shown to reduce the risk of spinal fractures, but they may increase the risk of clots and stroke.
• Strontium ranelate – similar to bisphosphonates, strontium ranelate slows down the ‘breakdown’ process of bones and additionally increases the ‘build-up’ process.
• Testosterone therapy – men with symptoms of testosterone deficiency and low testosterone levels can improve their bone density with testosterone replacement. It is treated by giving doses of testosterone to bring the blood levels back up to normal either by injections, implants, skin patches, oral capsules, gels and creams.
• Parathyroid hormone – the parathyroid glands make the parathyroid hormone (PTH). This chemical regulates the amounts of calcium, phosphorus and magnesium in the bones and blood. Parathyroid hormone therapy stimulates new bone formation and can increase bone density and strength. This medication is used for people with severe osteoporosis when other types of medication are considered either unsuitable or ineffective.

Treatment

There is no standard treatment given to all patients with osteoporosis. Treatment is tailored for the specific needs of the individual. Generally speaking, the patient’s overall risk of fracture helps to determine the best course of treatment.

Where to get help

• Your doctor
• Arthritis Victoria incorporating Osteoporosis Victoria Tel. (03) 8531 8000 or 1800 242 141
• Osteoporosis Australia Tel. (02) 9518 8140
• The Jean Hailes Foundation Tel. (03) 9562 7555
• Australasian Menopause Society Tel. (07) 4642 1603

Things to remember

• Diet, vitamin D and exercise can help to prevent osteoporosis.
• If you have osteoporosis, medical treatment can prevent further bone loss and reduce your risk of bone fractures.
• Treatment options for osteoporosis include dietary changes, supplements, exercise, lifestyle changes, falls prevention and medications.

You might also be interested in:

• Bones.
  
• Osteoporosis.
  

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Arthritis Victoria

Fact sheet currently being reviewed.
Last reviewed: January 2011

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Osteoporosis occurs when bones lose minerals such as calcium more quickly than the body can replace them. They become less dense, lose strength and break more easily. Calcium, exercise and vitamin D can help to prevent osteoporosis. If you have osteoporosis, medical treatment and lifestyle changes can prevent further bone loss.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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