OSTEOPEROSIS:

are you at risk?

Osteoporosis affects more than one million Australians and is most common in adults over 50, with women four times more likely to suffer from the condition than men.

And yet you may only find out you suffer from osteoporosis when your GP arranges a bone density scan. Suddenly you could find yourself having to make decisions about treatment for a problem when you have no symptoms at all.

Alternatively, you may discover you have osteoporosis after a minor bump, stumble or fall, and suddenly you are in severe pain with a fractured bone in your wrist, your spine, a hip or a rib.

Osteoporosis can take a toll beyond the pain of a fracture, too. And being in chronic pain, unable to get around or losing your independence, can be just as traumatic as the injury itself.

What is osteoporosis?

Osteoporosis (“porous bones”) causes bones to become thin, weak and fragile. As our bones lose density, they lose strength. Right throughout life each bone is in a constant state of change, being broken down and re-formed. Nutrients including protein, calcium, magnesium, phosphorus, vitamin D, potassium, manganese, copper, boron, iron, zinc, vitamin A, vitamin K, vitamin C, the B-group vitamins and fluoride are essential to healthy bone formation.

When you are young more bone is laid down than removed. But in older age, more bone breaks down than is replaced. Menopause is a particularly critical time – women can lose up to a 10th of their bone mass in the first five years after menopause.

It’s important to note that there may be no symptoms, but it doesn’t mean you are not suffering from the condition. The most common symptoms are:

• A bone fracture from a minor injury. Literally any bone can break but the most common fractures are in the hip, wrist and spine.

• Loss of height.

• A “hump” at the top of your back and a stooped posture caused by compression of the vertebral bones.

The only way to find out for sure if you have osteoporosis is to have a bone density test, or bone densitometry. A doctor might run urine and blood tests if there is a suspicion that there is some underlying medical condition contributing to the bone loss (such as hyperparathyroidism or having vitamin D deficiency).

What causes osteoporosis?

Many factors can contribute to the development of osteoporosis. By far the major risk factors relate to your genetic predisposition, processes of ageing and hormone deficiency. However, some risk factors can be modified by paying attention to lifestyle such as smoking; drinking too much alcohol; consuming too much

caffeine; a lack of weight-bearing exercise, or excessive exercise; eating disorders, excessive or restrictive dieting and very low body weight; not having enough calcium and other nutrients in your diet; and inadequate vitamin D.

Other factors can include early menopause or low hormone levels prior to menopause; overactive thyroid; untreated coeliac disease; over six months’ use of corticosteroid medication for asthma, arthritis or autoimmune diseases; and some medications such as proton pump inhibitors used to treat gastro-oesophageal reflux.

What are my treatment options?

The earlier osteoporosis is diagnosed, the better chance there is of reducing the risk of fractures. Lifestyle measures are essential, and there are treatments available which will either prevent the progression of bone loss, or in some cases strengthen bone by improving bone density, such as: • Hormone replacement therapy if you are close to menopause. • Raloxifene is an oral medication for post-menopausal women which mimics the beneficial effect of oestrogen on bone density. • Bisphosphonates such as alendronate can be taken daily, weekly or monthly. These can cause side effects including nausea, constipation or diarrhoea, muscle pain and acid reflux. These medications must be limited to less than five years.

• Denosumab (Prolia) is given as an injection once every six months. • Teriparatide (Forteo) stimulates bone-forming cells, improving bone strength and structure. It is only prescribed for people with severe osteoporosis, when other osteoporosis medicines have not worked. For further information, contact your local doctor or Osteoporosis Australia at www.osteoporosis.org.au