Osteoporosis, which literally means 'porous bone', is a disease in which the density and quality of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased. This loss of bone occurs silently and progressively: there's often no symptoms until the first fracture occurs.
Bone is in a continuous state of remodelling throughout life, where old bone and damaged bone is removed (bone resorption) and replaced by new bone. As we age, this rebuilding process can become unbalanced, leaving bones thinner and more fragile.
This is osteoporosis – and when someone has osteoporosis, even a slight bump or fall can lead to a a fragility fracture. A fragility fracture is one that involves a fall from a standing height or less, or an event that wouldn't break a healthy bone.
Although osteoporosis usually occurs in older people, it can also be seen in children and young adults.
- Diagnosis & Treatment
Adverse lifestyle habits such as smoking, excessive drinking or unhealthy diet may influence peak bone mass, causing lower bone density in later years. As the bone mineral amount falls, the fragility of the bones progressively increases and so does the risk of fractures. Most osteoporotic fractures occur before age 75.
Women are three to four times more likely than men to have osteoporosis. The possibility of sustaining a fracture, for both women and men, increases exponentially with age. This is not only due to the progressive decrease in bone mass and bone quality, but also to the increased rate of falls among the elderly – and the elderly represent the fastest growing segment of the population.
As well as a previous fracture, risk factors include:
- a family history of osteoporosis or fractures
- low vitamin D levels
- inadequate intake of calcium
- low body weight
- physical inactivity
- history of falls
- and smoking or excess alcohol consumption.
Other risk factors include rheumatoid arthritis, menopause and hormone imbalances (including those caused by cancer treatment), organ transplantation, diabetes mellitus, hyperthyroidism, gastrointestinal disease, chronic liver or kidney disease, chronic obstructive pulmonary disease, epilepsy, systemic lupus erythematosus and HIV.
Secondary causes of osteoporosis
The most common secondary cause is the long-term use of anti-inflammatory steroid tablets, such as cortisone or prednisone (used to treat respiratory disease like asthma), musculoskeletal conditions (rheumatoid arthritis), inflammatory bowel disease and skin disease (severe eczema, psoriasis).
One in five patients treated with anti-inflammatory steroid tablets has an osteoporotic fracture within the first 12 months of treatment. This increases to 50% after 5–10 years.
Increased fracture risk
Approximately 50% of people with one osteoporotic fracture will have another – and each new fracture increases the risk. Aside from the pain and disability caused by fractures, some 20% of people who have a hip fracture will die within six months.
Osteoporosis can lead to reduced mobility, poorer health generally and reduced quality of life. Fractures due to osteoporosis, including at the hip and pelvis, spine, ribs, wrist and upper arm, and ankle and foot, can result in chronic pain, disability, loss of independence and even premature death, especially from hip and spine fractures.
Garvan has developed the Know Your Bones fracture risk calculator to help assess your risk. Depending on the level of risk, after consultation, your doctor may prescribe a bone density test and possibly bone-protecting medication.
Osteoporosis shows no symptoms until a fracture occurs, but there are well-known factors that signal a person is at risk of developing osteoporosis. Although bone conditions can impact anyone at any age, women are three to four times more likely than men to have osteoporosis.
The possibility of sustaining a fracture, for women and for men, increases exponentially with age. This is not only due to the progressive decrease in bone mass and bone quality, but also to the increased rate of falls among the elderly – and the elderly represent the fastest growing segment of the population.
Use our Know Your Bones fracture risk calculator to assess your risk of fracture.
Osteoporotic fractures are generally diagnosed by x-rays, but osteoporosis itself is generally diagnosed by a painless bone mineral density (DXA) scan at the spine and hip.
Management strategies incorporate bone-strengthening lifestyle choices, as well as the use of medications, such as bisphosphonates or denosumab, that help maintain or improve bone density and reduce the risk of all types of fragility fractures.
Depending on your doctor, other treatments include calcium and/or Vitamin D supplements, hormone therapy (mainly for postmenopausal women, selective oestrogen receptor modulators (SERMs) that increase bone density while decreasing fractures of the spine, and strontium ranelate that also reduces fracture risk.
Prevention and healthy lifestyle
Fragility fractures are most common in people over the age of 50, however they are not an inevitable part of growing old. A healthy lifestyle and bone-protecting medication – prescribed when a person has been diagnosed with osteoporosis – can halve a person’s risk of suffering a fragility fracture.
Healthy behaviours early in life and through adulthood, such as diet with adequate protein, calcium, optimal vitamin D, and regular progressive weight-bearing exercise, can also help improve bone health in later life.
Use our Know Your Bones fracture risk calculator to assess your fracture risk. Depending on the level of risk, after consultation, your doctor may prescribe a bone density test and possibly bone-protecting medication.