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Osteoporosis means porous bone
Osteoporotic bones break more easily than normal bones
Calcium, vitamin D and exercise play important roles in the health of our bones
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Bone is living tissue
Our bones are living tissue that is constantly growing, rebuilding, replacing and repairing.
From birth to about 25 years of age, we build more bone than we lose. Our bones are not only getting bigger as we grow during this time, but they are developing their density. This determines how strong they are.
From about 25 to 50 years of age our bones break down and rebuild at about the same rate. They are in a state of balance. This is when we have achieved our ‘peak bone mass’. Our bones are at their strongest.
After about 50 years of age, we start to break down more bone than we rebuild. While this means that we will all experience some bone loss – it doesn’t mean that everyone will develop osteoporosis.
Women commonly experience a period of rapid bone loss after the onset of menopause. After this time there is a steady but less rapid loss of bone.
It is important during all of these stages that we do everything we can to improve our bone health.
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Normal bone and osteoporotic bone
If we look closely at our bones, we can see that the inside is a honeycomb-like structure.
In normal bone, the holes in the honeycomb are small and densely packed. This provides them with the strength they need to provide our body with structure and to protect our insides, while at the same time being light enough for us to move around.
When a person develops osteoporosis, the holes in this structure become larger and this density is lost. This means the bone becomes more fragile. They have lost their strength.
Osteoporotic bones fracture more easily than normal bone. Even a minor bump or fall can cause a serious fracture.
Osteoporosis is often called a silent disease, as there are usually no signs or symptoms until someone has a fracture.
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If you are concerned that you may have osteoporosis, or may be at risk of developing it, you should see your doctor.
Your doctor will assess your risk factors for developing osteoporosis, and will look at your medical history – including your family history.
Family history is important because having a parent or sibling with osteoporosis puts you at greater risk of developing osteoporosis.
After assessing your risk factors, your doctor will then decide whether you need to have a bone scan. This scan will measure the density of your bones. The best scan for assessing your bone density is a DEXA scan
The DEXA machine is a flat bed with an arm that travels over the body. You are not enclosed.
Osteoporosis is diagnosed based on the measurements of bone mineral density. Knowing your bone mineral density helps your doctor know if you are at risk of a fracture.
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Bone health: calcium, vitamin D and exercise
Our bones act as a calcium bank. Most of the body‘s calcium is stored here. If you don’t have enough calcium in your diet, your body will take calcium from your bones. If calcium is constantly taken from your bones, they will become weaker over time.
For adults the amount of calcium required each day is between 1000 – 1300mg – the exact amount depends on your age.
Calcium can be found in lots of foods – including dairy food, oranges, sardines and salmon, almonds, tofu, baked beans, green leafy vegetables.
Some people are not able to get enough calcium through their diet alone. Check with your health professional such as a GP or dietitian whether a calcium supplement may be necessary for you.
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Vitamin D is produced when the skin is exposed to the sun. It is essential for strong bones because:
it helps increase our absorption of calcium
it helps regulate the amount of calcium in our blood
it helps strengthen our skeleton
it can assist with muscle function and reduce the risk of falls.
In Australia, the main source of vitamin D is sunlight.
It’s important to expose your hands, face and arms to the sun every day. The amount of time you need to do this depends on where you live, the time of the year and the complexion of your skin. Osteoporosis Australia has developed a chart to help you work this out. You can access it here.
Vitamin D can also be found in small quantities in foods such as: fatty fish (salmon, herring, mackerel), liver, eggs and fortified foods such as low fat milks and margarine. For most people it is unlikely that adequate quantities of vitamin D will be obtained through diet alone.
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Apart from having a calcium rich diet, and making sure you get enough vitamin D, regular physical activity and exercise is important for maintaining healthy bones.
Exercise must be regular and ongoing to have a proper benefit.
Exercise is important in making bones as strong as possible and reducing the risk of fractures later in life. Doing a variety of different exercises including weight bearing exercises is best as it exercises the bone in different ways.
In children exercise helps growing bones become as strong as possible to help minimise bone loss as we grow older.
maintains bone health in adulthood
helps to prevent or slow bone loss after menopause in women
helps to improve balance and co-ordination to reduce the risks of falls.
If you’re unsure about what exercise is right for you then seek advise from a health professional such as a physiotherapist or exercise physiologist.
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Falls and fractures
Osteoporosis has no obvious symptoms, and does not cause pain. However osteoporosis causes bone to become more likely to break. This is what leads to pain, disability and in some cases, loss of independence.
Fractures due to osteoporosis can occur in any bone, however the most commonly fractured are: spine, hip and wrist.
Falls are a common cause of fracture. As people age their chance of falling increases. For people with osteoporosis even a minor fall can cause a fracture.
Falls are most commonly caused by:
poor muscle strength
problems with balance (due to weak muscles, low blood pressure, inner ear problems, medicines, poor nutrition)
home hazards which lead to tripping – eg rugs, pets, extension cords.
There are things that you and your healthcare team can do to reduce your risk of falling. Talk with your doctor for information and advice.
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Tips for bone health
There are many things you can do to reduce your risk of developing osteoporosis. If you have osteoporosis there are also things you can do to improve your bone health, and hopefully prevent your osteoporosis progressing.
Things you can do:
know your risk - talk to your doctor about osteoporosis. Are you at risk of developing osteoporosis? If you have osteoporosis, is it being managed as well as possible?
learn about your condition - this helps you take control. Talk with your healthcare team and ask questions. Call our Help Line for more information
ensure your diet has enough calcium - a dietitian can help you ensure you are getting calcium through a variety of different foods
safe sun exposure to obtain vitamin D
keep moving and exercise regularly—talk with a physiotherapist or exercise physiologist about an exercise program tailored specifically for you
falls prevention - if you have either fallen before or you feel unsteady and are concerned you may fall, talk with your doctor
stop smoking - as well as the many other health issues related to smoking, it’s also linked to reduced bone density
consume in moderation - alcohol, caffeine and salt as they can all affect our bone density. Alcohol also increases the risk of falling, and the chance of fracturing a bone
have a support team - this may be your family, friends or a peer support group. They can all help you deal with the physical and emotional challenges of living with osteoporosis.
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Osteoporosis can be effectively managed. The best approach is a team which includes you and your health professionals and those closest to you.
Your GP is an important partner in the management of your condition. They can help you manage day-to-day, as well as helping you access other health services.
You may from time-to-time need to see a specialist such as a rheumatologist or an endocrinologist if you are experiencing complications relating to your condition.
The type of medication chosen by your doctor depends on factors such as your age, general health and fracture risk.
Osteoporosis medicines work by:
slowing down bone loss - antiresorptives
increasing the amount of bone that is made -anabolic medicines.
Antiresorptives - these are the most commonly prescribed medicines for treating osteoporosis. Antiresorptives include the group known as bisphosphonates, as well as denosumab and raloxifene.
Anabolic medicine - teriparatide is used to treat people with severe osteoporosis.
Strontium ranelate - is another medicine used for osteoporosis. It has been shown to work by slowing down bone loss and increasing bone formation.
Hormone replacement therapy (HRT) - may be an option for some postmenopausal women. Your doctor will carefully consider the risks and benefits and duration of treatment on an individual basis for HRT.
Supplements - your doctor may prescribe calcium or vitamin D supplements if you are not getting enough through diet or exposure to sunlight.
The Australian Rheumatology Association has developed information sheets on several medications used to treat osteoporosis. You can access them here.
You can also find patient information on the National Prescribing Service website www.nps.org.au or by calling Medicines Line on 1300 MEDICINE (1300 633 424) 9am to 5pm weekdays.
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Where to get help
Your rheumatologist or endocrinologist
MOVE muscle, bone & joint health
Help Line Tel. 1800 263 265
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Need information regarding your condition and commonly prescribed treatments? Or assistance navigating the health, disability and social services system? Do you want to speak to someone who has a chronic musculoskeletal condition, and can understand what you are going through? Contact our Help Line on 1800 263 265.
Interested in finding out about our upcoming webinars and seminars and other events. Click here to learn more.
Download a PDF of this information.
Lance, 62, lives in Melbourne’s outer south eastern suburbs. As a former truck driver and motor mechanic, racing and restoring classic motorbikes and hot-rod cars was his passion – until he discovered that he has osteoporosis.
Lance describes what happened.