Osteoporosis is a disease which occurs when bone becomes weak and brittle as a result of bone density loss. Bone density is an important factor when it comes to bone health and strength, and when this is significantly reduced it places the bone at risk of being fractured with relatively little force.
Osteopenia is a condition similar to osteoporosis, where the bone density is significantly reduced, however not to the point where the bone is at risk of being easily fractured. Osteopenia is the precursor to osteoporosis and is therefore as important to treat to stop the disease progression towards osteoporosis.
Osteoporosis is caused by rapid reabsorption of bone tissue, which is much faster than the rate the bone tissue is being replaced. This causes the bony matrix to become porous and brittle.
- Family history of osteoporosis
- Calcium and Vitamin D deficiencies
- Medical conditions such as coeliac disease, diabetes, low hormone levels, menopause, anorexia/bulimia nervosa, overactive thyroid or parathyroid, rheumatoid arthritis, chronic liver or kidney disease
- Certain medications such as immunosuppressants for breast or prostate cancer, epilepsy, depression or HIV medications or corticosteroids
- Poor diet
- Sedentary Lifestyle
Osteoporosis is known as the “silent disease” as the symptoms indicating a bone is osteoporotic are subtle unless the symptoms involves a fracture, by which stage the disease is quite advanced. Symptoms relating to an osteoporotic fracture include constant severe pain, waking night pain, limb deformity and loss of function and bony tenderness on palpation on the fracture sight. Other symptoms of osteoporosis can involve stooped posture or loss of height due to the vertebrae collapsing.
Osteoporosis and osteopenia is diagnosed with a bone density scan (different to a bone scan), known by the medical name of a DEXA scan. This scan measures the bone mineral density at different sites within your bone, commonly assessing your hip, spine and forearms. The test itself takes about 10 to 15 minutes while you lie flat on a padded table, fully clothed. The arm of the machine passes over you scanning the aforementioned area’s, with the results interpreted and returned to your referring doctor.
Gold standard treatment for osteoporosis should involve input from medical practitioners, physiotherapists and dieticians to assist with reversing or stopping the disease progress and for ongoing falls prevention and management.
Osteoporosis requires prescribed treatment to protect bone health. Your medication will be prescribed by a GP or specialist. In Australia there are a range of treatment options available. You and your doctor will determine the best treatment for you, taking into consideration other medical conditions and medications. Your doctor can also advise if your medication is subsidised by the Pharmaceutical Benefits Scheme (PBS).
If a fracture is involved, surgery or casting may be required to fixate the fracture sight.
Physiotherapy plays an important role in terms of improving bone density and fracture prevention. Resistance based exercise including weight bearing and impact activities have the strongest evidence supporting good bone health. Unfortunately walking, cycling and swimming activities have little evidence in improving bone mineral density, however they do help with improving cardiovascular endurance.
It is equally important to incorporate balance exercises safely as falls are a common mechanism of causing an osteoporotic fracture.
It’s important to discuss with your physiotherapist regarding a prescribed exercise regime that allows appropriate bone loading and balance exercises without risking further injury due to overload or falling.
Diet also plays a role with overall bone health. Eating foods that are rich in calcium, vitamin D and other nutrients assist with improving bone mineral density and overall nutritional health. Consulting with a dietician can help identify if you getting the recommended amount of nutrients from your diet, or if you need to compliment your diet by taking multivitamins or supplements.