Osteoporosis and osteopenia (a milder form of osteoporosis) are conditions that affect the strength of your bones, which increases susceptibility to bone fracture. Although the conditions are more common in older people and females, males and younger people may also develop osteoporosis or osteopenia. There is a lot you can do to optimise your bone health and minimise fracture risk.
--How do I know if I have osteoporosis?
Osteopenia is considered a precursor to osteoporosis. A loss of bone strength occurs when the density of bone material decreases and when the internal architecture of the bone changes. These changes occur with ageing; changes in hormone levels (particularly after menopause); the use of some medications; genetics; with other health conditions, like rheumatoid arthritis; and with lifestyle habits that are unhelpful for bone health (e.g., poor nutrition, inadequate physical activity, smoking).
Two-thirds of Australians aged over 50 years have osteoporosis or osteopenia. The vast majority have osteopenia (78 per cent) and as a result, more than half of all fractures occur in people with osteopenia, rather than osteoporosis. From age 50, about one in three women and one in five men will sustain a fracture due to osteoporosis or osteopenia. Fractures occur most commonly at the hip, spine, wrist, arm and pelvis. Currently, a fracture due to osteoporosis in Australia occurs every 3.4 minutes and is expected to rise to one every 2.9 minutes by 2022.
Osteoporosis and osteopenia are considered a ‘silent disease’ until a fracture occurs or your posture changes. Therefore, many people do not know they have the condition, so assessing risk factors is very important. Your physiotherapist can help with risk factor-assessment. Risk factors for osteoporosis and osteopenia include a history of a low trauma fracture, family history of poor bone health, early menopause (before age 45), certain medications and health conditions, low body weight, low calcium and vitamin D, and unhelpful lifestyle habits (smoking, excessive alcohol, low physical activity). Use the Know Your Bones online tool (knowyourbones.org.au) to assess your bone health risk factors.
Osteoporosis and osteopenia can be formally diagnosed with a bone mineral density test. This can be arranged by your GP and may be important for men and women aged 50 years and over with risk factors.
--Is it true that only women get osteoporosis?
No. While osteoporosis is more common in women, men can also develop osteoporosis. In fact, the risk of re-fracture after an initial fracture is greater in men than women. Low testosterone in men is a risk factor for osteoporosis.
--What can I do to prevent osteoporosis?
Poor bone health can be prevented by optimising nutrition, particularly calcium and vitamin D, avoiding smoking and excessive alcohol and maintaining a healthy body weight. It is important to engage in regular weight-bearing exercise. It is recommended that Australians consume 3–5 serves of calcium-rich foods per day and ensure an adequate amount of exposure to sunshine for vitamin D production. Further detail about sun exposure guidelines can be found here.
--What are the risks to my health if I have osteoporosis?
The main health risk from osteoporosis is bone fracture. Fractures can lead to persistent muscle and joint pain, postural changes, reduced balance and confidence leading to increased risk of falling, breathing problems, loss of independence and increased risk of death. Once an initial osteoporotic fracture is sustained, the risk of more fractures increases.
--How can physiotherapy help with osteoporosis?
Prevention. Your physiotherapist can advise you about ways to optimise your bone health. Specifically, they can guide you in a bone health plan, which may include appropriate physical activity, nutritional information and guidance about smoking and alcohol intake. Physiotherapists can also talk to you about any risk factors you might have for poor bone health and refer you for further assessment and management, if appropriate. Other members of your healthcare team may include your GP, rheumatologist or endocrinologist.
Management of osteoporosis and osteopenia. Physiotherapy forms an important component of the management of osteoporosis and osteopenia. Strategies may include: a physical activity or exercise program that safely loads the bones to help keep them strong; exercises to optimise your posture or address postural changes; balance training to minimise your risk of falls; other strategies to manage pain associated with fractures; education about bone health and self-management strategies, and assisting in rehabilitation after a fracture is sustained.
--How effective is physiotherapy for treating osteoporosis?
The effectiveness of exercise for management of bone health and prevention of falls has been demonstrated in many studies. A comprehensive, physiotherapy program for people who have sustained spinal fractures due to osteoporosis has also been shown to be effective in a preliminary study. Recommendations have also recently been developed to guide appropriate exercise-based care for people with osteoporotic fractures.
--What can I do at home?
There is a lot you can do at home to manage your osteoporosis or osteopenia, including exercise and optimising nutrition. Appropriately prescribed, high-impact, weight-bearing exercise performed about three times per week is recommended for improving your bone health. If you have sustained a fracture due to osteoporosis it is advisable to seek guidance from your physiotherapist about the mode and intensity of exercise that is right for you. Many physiotherapy practices and community health centres operate group exercise sessions specifically for people trying to prevent or manage osteoporosis. For more information about osteoporosis, refer to the Osteoporosis Australia website.
