OSTEOPOROSIS

What is osteoporosis

Osteoporosis is a condition where the bones are thin.  The bones are at risk of fracture or breaking as the hard, dense material that forms bone becomes porous.

Over 1 million Australians have osteoporosis.

What is the anatomy of osteoporosis

Osteoporosis can affect any bone in your body such as the hip, pelvis, spine and wrist.

Who is at risk of osteoporosis

Risk factors for osteoporosis include:

  • Older age

  • Menopausal women due to loss of estrogen

  • Men with low testosterone

  • Family history of osteoporosis

  • Low body mass index (BMI)

  • History of eating disorders

  • Smoking

  • Excessive use of alcohol

  • Sedentary lifestyle

Patients who have suffered an initial fracture are subsequently at a far higher risk of additional fractures.

What is my risk of a fracture?

You can work out your risk of a fracture by using the Garvan fracture calculator available at:  

https://www.garvan.org.au/promotions/bone-fracture-risk/calculator/

What are the causes of osteoporosis

Bones are constantly gaining and losing cells.  Osteoporosis occurs where this process becomes unbalanced and a patient starts to lose more bone mass than is replaced.

Osteoporosis can be caused by:

  • Thyroid conditions such as hyperthyroidoidism

  • Calcium disorders such as hyperparathyroidoidism

  • Other metabolic and hormonal conditions such as Cushings (high cortisol level)

  • Kidney failure can disrupt bone metabolism

  • Chronic liver disease

  • Rheumatoid arthritis

  • Conditions leading to malabsorption e.g. coeliac disease, inflammatory bowel disease

  • Long-term use of steroid medication for asthma, rheumatoid arthritis and inflammatory conditions

  • Some medicines for breast cancer, prostate cancer, epilepsy and some antidepressants

What is the difference between osteoporosis, osteopenia and osteomalacia

  • Osteopenia and osteoporosis are both terms used to describe low bone density or thin bones.

  • Osteoporosis is more severe thinning of the bones than osteopenia.  

  • Osteomalacia is marked thinning of the bones.  It is most often due to vitamin d deficiency.

 

What are the symptoms of osteoporosis

Most commonly people with osteoporosis may have no symptoms at all.  People can have thin bones and not know it until they have a fractures.

Bone are more fragile in osteoporosis.  Fracture can occur following a fall or a minor movement such as stepping off a curb.  

Other symptoms of osteoporosis can include:

  • Loss of height: Compression fractures in the spine can cause a loss of height.

  • Back or neck pain caused by compression fractures of the spine.  

  • Kyphosis or stooped posture from compression fracture causing curving of the upper back

How is osteoporosis diagnosed

When investigating if a patient may have osteoporosis your doctor may use a combination of history, examination, pathology tests and xrays.  

Osteoporosis may be diagnosed based upon either low bone density and/or a history of a minimal trauma fractures.

Clinical Examination

At an appointment with your endocrinologist they may:

  • Take a complete medical history

  • Perform a physical examination

  • Discuss various risk factors of osteoporosis

  • Look for symptoms of osteoporosis or related conditions

For patients who have risk factors for osteoporosis or have had a previous minimal trauma fracture other tests or investigations may be required to:

  1. Determine how thin the bones are

  2. Look for causes of thin bones or fracture

Pathology

  • Blood tests can be used to:

    • Look for causes of the osteoporosis

    • Measure hormone levels such as thyroid hormone, parathyroid hormone and oestrogen or testosterone

    • Check vitamin d levels

    • Measure important electrolytes like calcium and phosphate

    • Measure bone turn over

  • Urine test can determine the rate at which an individual is losing bone calcium.

Radiology

Various radiology examinations can include:

  • X-Rays of the hip, vertebrae or other areas check for fractures.

  • Sometimes scans of the parathyroid gland in the neck may be required for patients who have high calcium and high parathyroid hormone levels.   

  • DEXA X-ray or dual energy x-ray absorptiometry scan provides a bone-mineral density reading, indicating the degree of bone loss at different locations such as the hip, spine or arm.

How is osteoporosis treated

Your endocrinologist can review the options in the treatment of osteoporosis and develop a care plan.

Typically the best response to this bone-thinning condition is a multifaceted approach to treatment to build bone density and replace lost calcium in bones. This regimen can include:

  • Medication Therapy

  • Supplementing normal vitamin D intake along with additional calcium

  • Diet changes

  • Exercise to force or stimulate bone growth and

  • Measures aimed at decreasing the patient’s risk of falls

Osteoporosis Medication

In order to prevent or treat bone cell loss the following medication can be prescribed:

Bisphosphonates

  • Work by slowing down the amount of bone breakdown

  • Can be given as a tablet or intravenously.  

Denosumab

  • Work by slowing down the amount of bone breakdown

  • Is given as a injection subcutaneously under the skin

Teriparatide

  • Work by building up the bone

  • Daily injection for 18 months to stimulates bone growth

Selective estrogen-receptor modulators

  • Stimulates estrogen receptors in bone to improve the strength of the bone

Hormone Replacement Therapy

  • Is used in people with low gonadal hormones levels to restore the normal levels.  Can given either oestrogen in women or testosterone in men to restore normal levels

What if osteoporosis is not treated

Untreated osteoporosis can lead to brittle bones, bone fractures and breakages.  

Serious complications of broken bones include being not able to walk, pain or death.  

What lifestyle factors can help prevent osteoporosis

Patients with confirmed osteoporosis should be re-evaluated by their doctor regularly.

If you have had a fracture or have had an earlier diagnosis of osteoporosis the following preventative approaches are recommended:

Exercise

  • Weight bearing exercises like walking help build bone

  • Balance exercises help build muscle, prevent muscle wasting and reduce chances of falls

  • Resistance training (lifting weights) to move more freely and rebuild bone strength

  • A physiotherapist or exercise physiologist can help find the right exercises for you

Diet

  • Adequate dietary calcium with 3-5 serves of calcium rich foods

  • If you do not get enough calcium in your diet you may also need to take calcium supplements

  • Avoid excessive alcohol intake

Vitamin D

  • Vitamin D is needed to absorb calcium and ensure that your bones remain strong

  • For people who do not have enough vitamin D sometimes they may need to take a supplement to aim for a normal level