Osteoporosis - prevention and treatment

Osteoporosis occurs when bones become less dense, lose strength and break more easily due to calcium loss. It literally means ‘bones with holes’. Diet, exercise and limiting alcohol and caffeine can help to prevent and manage osteoporosis.

Osteoporosis is diagnosed by a special x-ray that measures bone density, known as a DXA (dual-energy x-ray absorptiometry) scan. If you have osteoporosis, lifestyle changes and medical treatment can prevent further bone loss and reduce your risk of bone fractures.

Prevention
There are various factors that will help prevent osteoporosis including:

• A well balanced diet, including adequate intake of calcium and vitamin D
• Appropriate exercise
• Lifestyle changes.

• 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.
• Do strength training with your arms and legs by lifting weights. Be guided by a health or fitness professional who can recommend specific exercises and techniques.
• 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.

• Stop smoking – smokers have lower bone density than non-smokers.
• 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, a few 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 2–3 hours over a week. Remember, it is still important to avoid sun exposure between 10am and 2pm during summer (11am and 3pm during daylight saving) 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.

• Safer exercise options
• Falls prevention
• Medications.

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

• 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.

• 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. This drug is only approved for use by postmenopausal women.
• Testosterone therapy – about one in six men with osteoporosis has hypogonadism, which is an abnormally low level of the male sex hormone testosterone. Testosterone therapy is used to treat the symptoms of hypogonadism. Medical trials are limited, but it seems that testosterone therapy can modestly increase bone density in some cases. However, no studies have been done to find out if long-term use of testosterone therapy can reduce the risk of fractures in men with osteoporosis.
• 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 can reduce the risk of fractures. The doctor may choose this medication if other types of medication are not suitable.
• Calcitriol – this is a form of vitamin D. Initial studies suggest that calcitriol can boost calcium levels and reduce the risk of vertebral fractures. However, one study found that calcitriol was not helpful in treating osteoporosis in men. More research is needed.

• Your doctor
• The Jean Hailes Foundation Tel. (03) 9562 6771
• Australasian Menopause Society Tel. (07) 4642 1603
• Women’s Health Victoria Tel. (03) 9662 3755
• Arthritis Victoria incorporating Osteoporosis Victoria Tel. (03) 8531 8000 or 1800 242 141
• Osteoporosis Australia Tel. (02) 9518 8140

• Diet, exercise and limiting alcohol and caffeine 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.

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