According to health economists the cost of osteoporosis in dollars to you, your family and the community totals over $1 billion annually in Australia. The cost in personal terms is also appalling.

The personal costs

Hip fractures are probably the most serious consequence of osteoporosis. It's estimated that approximately 1.6 million hip fractures occur each year worldwide.

Fifty per cent of these patients may no longer be independent. That is, they will have to go into some form of care arrangement, such as a hostel or nursing home. Moreover, the elderly in the developed world are becoming more numerous and living longer due to better nutrition and healthcare, so the incidence of hip fractures will also increase.

Thirty per cent of hip fractures occur in men, and one in 20 men aged 50 or over will develop an osteoporotic hip fracture.

Then there's the 'dowager's hump', a collapse of the upper spine causing the upper body to bend forward resulting in pain and distress due to change in body shape. Breathing and eating become difficult because of the stress on the stomach area.

What is this devastating disease?

Simply put, osteoporosis literally means 'porous bones'. The bones in our skeleton are made of a thick outer shell and a strong inner mesh filled with collagen (protein), calcium salts and other minerals. The inside looks like honeycomb, with blood vessels and bone marrow in the spaces between bone. Osteoporosis occurs when the holes between bone increase in size, making it fragile and liable to break easily. Osteoporosis usually affects the whole skeleton but it most commonly causes breaks to bone in the wrist, spine and hip.

Who’s at risk?

Doctors cannot be sure who will develop fractures. Osteoporosis is a subtle and silent attacker of both men and women as unfortunately the diagnosis is usually made after the fracture has occurred.

The incidence of osteoporosis increases with age and also in sufferers of chronic diseases of the liver, kidneys, gastrointestinal tract and some hormonal conditions. It is also associated with lack of exercise, excessive exercise, eating disorders and steroid treatments. We are all potentially at risk of osteoporosis because of the bone loss that occurs as we get older, particularly as we are living longer as a population.

What are the risk factors?

In addition to the factors mentioned above, the following factors affect men and women.

Women

• A lack of oestrogen, caused by early menopause (before the age of 45)
• Early hysterectomy (before the age of 45), if both ovaries are removed (oophorectomy)
• Missing periods for six months or more (excluding pregnancy) as a result of over-exercising or over-dieting

Men

• Low levels of the male hormone, testosterone (hypogonadism)

Men & women

• Long-term use of corticosteroid tablets (for conditions such as asthma)
• Maternal history of a hip fracture
• Malabsorption, inflammatory bowel disease (Crohn's disease or ulcerative colitis) and gastric surgery
• Long-term immobility
• Heavy drinking
• Smoking
• Low body weight

If you have broken a bone after a minor bump or fall, this may be a sign that you already have osteoporosis. Other warning signs include height loss and kyphosis (curvature of the spine). If you have a poor diet that is low in calcium and you do little weight-bearing exercise you are also at risk of having osteoporosis.

The good news is that osteoporosis can be treated in most cases and there are ways to help to prevent it and keep bones healthy.

How do you know if you have osteoporosis?

Medical opinion seems to state that you don't know until a fracture occurs.

A bone density scan, called a Dual Energy X-ray Absorptiometry (DEXA) scan, will show whether you have osteoporosis. This test is currently the most accurate and reliable means of assessing the strength of your bones and your risk of fracture. It's a simple, painless procedure that uses very low doses of radiation.

You will be asked to lie down on the machine for ten to fifteen minutes while an x-ray arm passes over you to take an image of your spine and hip. Some centres have forearm machines, which measure the density of the wrist.

A bone density scan can diagnose osteoporosis, assess risk of fracture and monitor effects of treatment. The results will show how your bone density compares to the average bone density of both a young adult of the same sex and someone the same age (and sex) as you. The results can be given as a percentage of the normal value, or as standard deviation, which means the number of units above or below the average for the population. If your bone density is between the normal range and the range defined as osteoporosis this is called osteopenia, which means you have low bone density.

Bone density scans are recommended only for people who are at high risk of osteoporosis.

Discuss your medical history with your doctor, who can decide whether to refer you to a hospital for a scan. Your doctor may use the results to decide on the treatment for you, or you may be asked to see a specialist consultant.

Preventing fractures

What is important with this disease is to prevent the fractures, and it's best to develop a healthy lifestyle. Prevention has to start early in life, but the same basic principles of good eating and regular exercise, not smoking and safe drinking apply to the prevention of diabetes, strokes, cancer and heart disease.

What can you do?

According to many medical practitioners it's the old rule - exercise and eat well. To help prevent fractures that are the result of osteoporosis it's necessary to:

• Maximise peak bone density in childhood and adolescence.
• Maintain bone density throughout adult life.
• Start and maintain a diet with adequate calcium and discourage fad and crash dieting.
• Encourage regular weight-bearing exercise in children and teenagers.
• Encourage good nutrition at all ages with adequate vitamin D supplements, particularly among the elderly.

Healthy bones need a well-balanced diet, incorporating minerals and vitamins from different food groups, including bread and cereals; fruit and vegetables; milk and dairy products; meat, fish, eggs, nuts and seeds.

You especially need to ensure that your diet is rich in calcium. Calcium is the most abundant mineral found in our bones and helps to give them strength and rigidity. Men and women need different amounts of calcium at different stages of life, so check your needs in the table below.

Good sources of calcium are dairy products such as milk, cheese and yoghurt. If you don't like or can't eat dairy products, you should be able to get enough calcium from non-dairy foods such as bread, green leafy vegetables, dried apricots, tofu and baked beans.

Exercise

Bones, like muscles and other parts of the body, suffer if they are not used. They need regular weight bearing exercise that exerts a loading impact and stretches and contracts the muscles, strengthening the bone.

Good bone-building exercise includes jogging, skipping, aerobics, tennis and weight-training. Even a brisk walk can be of some benefit to your bones. Swimming and cycling are excellent for overall fitness but do not directly benefit bones as you are not supporting your own weight.

Try to exercise at least three times a week for a minimum of 20 minutes but most importantly choose exercise that you enjoy and stick to a regular routine. If you haven't exercised for a while, start gently and check with a doctor if you have a health problem and are worried about exercising.

Living with osteoporosis

Once a diagnosis is made, lifestyle changes can be implemented according to the severity of the disease to make day-to-day living easier and safer. Start a long-term treatment regime to maintain bone density and slow down the progression of the disease.

• Consume plenty of calcium and have regular gentle exercise.
• Prevent falls by removing loose rugs and other objects on the floor.
• Install rails in toilet, bath, shower and stairways.
• Don't be proud - use a stick to maintain balance.
• Relieve pain with heat application.
• Improve posture, balance and muscle tone with gentle exercise.
• Women should speak to their doctor about Hormone Replacement Therapy.
• Maintain contact with supportive family and friends.

It is also important to develop a relationship with your GP. Osteoporosis can be treated at all ages. It's never too late.

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Osteoporosis Australia

1800 242 141
www.osteoporosis.org.au

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