OSTEOPOROSIS AND FRACTURES

Osteoporosis is a condition in which bones become weak and brittle,  making them more likely to fracture. It mainly affects people over the age of 50 when bones loose minerals such as calcium faster than the body can replace them resulting in reduced bone thickness (also known as bone density). 2/3 of Australian’s over 50 have poor bone health.

THE SILENT DISEASE

It is often called the ‘’silent disease’’ as it usually has no signs or symptoms until a fracture occurs. These fractures  can occur from a minor injury or fall and are called ‘’minimal trauma fractures’’. The most common fracture sites are the spine, hip and wrist.  It is not just a Women’s disease as 1 in 3 women and 1 in 5 men will have an osteoporotic fracture in their lifetime.  Osteoporotic fractures can be devastating leading to disability, loss of independence, depression and chronic pain. This is especially the case for hip fractures with 50% of elderly people needing long term nursing care and up to 15% dying within 4 months of the fracture.  The cost of osteoporotic fractures is greater than that of heart attacks, stroke and breast cancer.

THE CASCADE EFFECT

Approximately 50% of those that have a fracture due to osteoporosis will have another fracture. The risk of future fractures rises with each new fracture and is known as the ’cascade effect’’. To reduce the cascade effect and prevent further fractures it is essential that osteoporosis is diagnosed and treated.

RISK FACTORS  FOR DEVELOPING OSTEOPOROSIS  

  • History of a Minimal Trauma Fracture
  • Family history of osteoporosis
  • Advancing age
  • Low Bone Mineral Density (as detected on a Bone Density scan)
  • Smoking
  • Excessive alcohol intake
  • Low body weight
  • Physical inactivity
  • Low Calcium intake
  • Low Vitamin D levels.
  • Recurrent falls
  • Certain medical conditions such as coeliac disease, an overactive thyroid, chronic liver or kidney disease, prolonged steroid use, treatment for breast and prostate cancer, early menopause and low testosterone levels.

SCREENING FOR OSTEOPOROSIS  

If you have strong risk factors for osteoporosis, are over the age of 70 or have had a minimal trauma fracture, your doctor may order a Bone Density Scan (DEXA scan). This scan is like an X-ray which measures the thickness of the bones in the spine and hip. The test gives a result call a T-score which compares your bone density to that of young healthy adults. If your T-score is -2.5 or lower, this indicates you have Osteoporosis and your fracture risk is high. If it is between -1 to -2.5, this indicates ‘’osteopenia’ which means you have mild thinning of the bone and are at risk of developing osteoporosis. Normal bone density is greater than -1. Your doctor will use your T-score to help decide your management plan.  These scans may be repeated every 2 years depending on your risk level.

TREATMENT

There are a number of lifestyle changes that can reduce your risk of fractures such as eating well and exercising regularly.

Calcium and Vitamin D are essential for keeping our bones strong. Calcium is a major building block of bone and the recommended daily intake is 1000 –  1300mg for women and men over the age of 50.  Consider supplements if the recommended calcium intake of 1300mg cannot be achieved alone through diet.  Vitamin D helps us absorb calcium and has a positive effect on muscle function. The easiest way to get Vitamin D is a little bit of sunshine every day. Of course we need to be ‘’sun smart’ but  5 – 10 minutes mid-morning or in the late afternoon with your arms or legs exposed can help boost your levels (more time may be required for dark-skinned people).  If blood Vitamin D levels are less than 50nmol/l  or less than than 75nmol/l in those with osteoporosis, a Vitamin D supplement may be required

Regular exercise is important to increase our bone strength and also prevents our risk of falls by improving our coordination and balance. A ‘’bone friendly’’ exercise program is one that is varied and includes weight bearing, muscle strengthening and high intensity training.

Avoid negative lifestyle factors such as smoking  and reduce alcohol intake to less than 2 standard drinks a day.

Try to prevent falls from occurring in the first place. Half of all falls occur around the home and approximately 1/3 of people over 65 fall each year. Strategies to prevent falls include muscle strengthening and balance exercises such as tai chi, and removing any trip hazards such as loose rugs. A medical review to ensure you are not on medication that could be causing poor balance  or light headedness is important and make sure your eye checks are up to date.

Medication

You may be commenced on medication if you are diagnosed with osteoporosis or are at high risk of fractures. Theses medicines work by preventing further bone loss and making the bones stronger over time. There are a number of different type of medications for osteoporosis and your doctor will choose one best suited for you. Osteoporosis medicines can reduce the risk of spinal fractures by 30 to 70% and hip fractures by 30 to 50%.

 

Fractures due to osteoporosis can have a devastating effect on our lifestyle and independence. Therefore it is essential that osteoporosis is diagnosed and treated early to stop the ‘’cascade effect’’ and prevent further fractures.

Discuss with your doctor if you;

  • have any risk factors for developing osteoporosis
  • have had a ‘minimal trauma fracture’
  • are aged over 70
  • have had a loss of height of more than 3 cm, developed a curve or hump in the spine or develop sudden severe back pain

About the author

1
Dr Georgia Page MBBS, FRACGP , BSci (biomedical)
Dr Georgia Page graduated from the University of Sydney in 2002 and has been working on the Central Coast since 2002. She has many interests, in particular Women's health, paediatrics, preventative health and men's health. She is a medical educator for GP Synergy, regularly lecturing and supervising the GPs of tomorrow and is also an examiner for the RACGP (Royal Australian College of General Practitioners).

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